Intra-articular Steroid alone vs Hydrodilatation with intra-articular Steroid in Frozen Shoulder - A Randomised Control Trial.

Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groups-one group received intra-articular steroid with hydrodilatation (HDS) and other group received intra-articular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.

Real-time assessment of the Ganga river during pandemic COVID-19 and predictive data modeling by machine learning.

In this study, four water quality parameters were reviewed at 14 stations of river Ganga in pre-, during and post-lockdown and these parameters were modeled by using different machine learning algorithms. Various mathematical models were used for the computation of water quality parameters in pre-, during and post- lockdown period by using Central Pollution Control Board real-time data. Lockdown resulted in the reduction of Biochemical Oxygen Demand ranging from 55 to 92% with increased concentration of dissolved oxygen at few stations. pH was in range of 6.5-8.5 of during lockdown. Total coliform count declined during lockdown period at some stations. The modeling of oxygen saturation deficit showed supremacy of Thomas Mueller model (R2 = 0.75) during lockdown over Streeter Phelps (R2 = 0.57). Polynomial regression and Newton's Divided Difference model predicted possible values of water quality parameters till 30th June, 2020 and 07th August, 2020, respectively. It was found that predicted and real values were close to each other. Genetic algorithm was used to optimize hyperparameters of algorithms like Support Vector Regression and Radical Basis Function Neural Network, which were then employed for prediction of all examined water quality metrics. Computed values from ANN model were found close to the experimental ones (R2 = 1). Support Vector Regression-Genetic Algorithm Hybrid proved to be very effective for accurate prediction of pH, Biochemical Oxygen Demand, Dissolved Oxygen and Total coliform count during lockdown. Supplementary Information: The online version contains supplementary material available at 10.1007/s13762-022-04423-1.

Intra-articular Steroid alone vs Hydrodilatation with intraarticular Steroid in Frozen Shoulder - A Randomised Control Trial

@#Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groupsone group received intra-articular steroid with hydrodilatation (HDS) and other group received intraarticular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.

Selection of ACC deaminase positive, thermohalotolerant and drought tolerance enhancing plant growth-promoting bacteria from rhizospheres of Cyamopsis tetragonoloba grown in arid regions.

Plant growth-promoting bacteria (PGPB) expressing 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase activity are widely acknowledged to have a role in mitigation of abiotic stress caused by extreme environmental conditions. Consequently, several studies have focused on the isolation of ACC deaminase positive PGPBs. However, the application of such strains in drought-prone arid regions has remained grossly under-exploited. In order to be used in arid agroecosystems, PGPBs need to have the dual capability: to express ACC deaminase and to have the ability to tolerate increased temperature and salt concentration. Conspicuously, to date, very few studies have reported about isolation and characterization of PGPBs with this kind of dual capability. Here we report the isolation of bacterial strains from rhizosphere(s) of Cyamopsis tetragonoloba, a commercial crop from arid regions of Rajasthan, India, and their characterization for ACC deaminase activity and thermohalotolerance. Isolates found positive for desired traits were subsequently assessed for plant growth promotion under simulated drought conditions. Our finding showed that although the bacterial diversity within the rhizosphere of C. tetragonoloba grown in the arid region is quite poor, multiple isolates are ACC deaminase positive. Four isolates were found to be ACC deaminase positive, thermohalotolerant, and successfully enhanced drought tolerance. These isolates were identified as strains belonging to genera Pseudomonas, Enterobacter, and Stenotrophomonas based on 16S rRNA sequence homology.

Surgical data science - from concepts toward clinical translation.

Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.

Signatures for chronic obstructive pulmonary disease (COPD) and asthma: a comparative genetic analysis.

Background: Chronic obstructive pulmonary disease (COPD) and asthma are obstructive lung diseases which progress in severity with time. Environmental causes and genetic makeup of individuals play important roles in disease manifestation. The aim of present study was to search for diagnostic/prognostic biomarkers to differentiate COPD and asthma.Materials and methods: Seven ADAM33 and two AQP5 single-nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction-restriction fragment length polymorphism method. The association of genotypes, haplotypes and allelic combination of variants in different genes was analyzed in 194 COPD, 150 asthma patients and 220 controls.Results: The genotype frequencies of SNPs V4(C/G), T1(T/C), S2(G/C) of ADAM33 and AQP5 A/G (rs3736309) were associated with COPD and asthma (P=0.038 to P<0.001), while S1(A/G) and F+1(C/T) were associated with asthma (both P<0.001) and V1(G/T) with 20 COPD (P<0.001). The allele frequencies of V4(C/G) (both P<0.001), V1(G/T) (both P<0.05), S2(G/C) (both P<0.01) and S1(A/G) (both P<0.05) were associated with COPD and asthma, while F+1(C/T) was associated only with asthma (P=0.005). Haplotypes of ADAM33 'GGTGGGT' (P=0.027), 'CGTCGGC' (P<0.001) and AQP5 'GA' and 'AG' (both P<0.001) were significant only in COPD.Conclusion: ADAM33 F+1(C/T) variant and allele combination 'GGTGGGTGA' may be specific markers for asthma, while AQP5 'AG' appeared as a haplotype associated only with COPD. These specific genetic biomarkers may be exploited to predict individual predisposition to COPD and asthma.

A novel fibrinolytic enzyme from marine Pseudomonas aeruginosa KU1 and its rapid in vivo thrombolysis with little haemolysis.

A direct acting, extracellular, fibrinolytic enzyme, ~50 KDa from marine Pseudomonas aeruginosa KU1 (PEKU1), was purified. It was found to be a metalloprotease. 60% of the total activity of the purified PEKU1 was retained at 70 °C and the enzyme was practically denatured at 80 °C, 2 h. Metal ions, such as Na+, K+ and Co2+, were found to enhance slightly the fibrinolytic activity, while Fe2+, Mn2+ and Zn2+ were found to be inhibiting. The enzyme showed only less than 5% haemolysis, suggesting its thrombolytic administration safe. Tryptic digestion revealed its similarity to serralysin like alkaline protease of P. aeruginosa. In silico studies showed its binding of protease substrates and fibrin D-dimer in its active site. High affinity binding of bradykinin to the active site of PEKU1, confirmed by in vitro cleaving, suggested its future use as an analgesic. The purified enzyme with Na+, K+ and Co2+, and without Fe2+, Mn2+ and Zn2+ showed thrombolysis in vivo in carrageenan induced murine tail thrombolytic model. The enzyme PEKU1, a novel protease from marine isolate Pseudomonas aeruginosa KU1 has great potential to be developed as a therapeutic agent to combat cardiovascular diseases, as well as analgesic and anti-inflammatory drug in appropriate sites.

Fibrinolytic Enzymes for Thrombolytic Therapy.

Cardiovascular diseases are a group of disorders consisting importantly of coronary heart disease, peripheral arterial disease, cerebrovascular disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism. Severe cardiovascular disease conditions lead to acute myocardial infarction and stroke. One of the reasons for this is formation of blood clots inside the vessel. Anticoagulants and antiplatelet drugs are used for managing cardiovascular diseases for a long time. However, they were unable to dissolve an existing thrombus. Fibrinolytic enzymes have become more substantial for treating cardiovascular diseases since they could lyse the fibrin clot within the blood vessel. Inability of plasma fibrinolytic system demands better thrombolytic drugs. Major thrombolytic enzymes belonging to plasminogen activators and plasmin like enzymes. Currently used fibrinolytic enzymes and their limitations are revisited in the present chapter. Reported enzymes from various sources with potential to be used as cardiovascular therapeutic is also discussed here.

Fatigue Life Enhancement of Titanium Alloy by the Development of Nano/Micron Surface Layer Using Laser Peening.

Ti-15V-3Cr-3Al-3Sn (Ti-15-3) is a metastable beta alloy which is considered to be a potential alternative for Ti-6Al-4V alpha+beta alloy for aerospace applications, especially for sheet products. This paper describes the work carried out to enhance the fatigue life of Ti-15-3 in an economical way by means of laser peening without coating (LPwC) using Nd:YAG laser operating at a power density of 5 GW cm-2. In order to have a sufficient bulk hardness and high compressive stresses on the surface, as-received beta solution treated (ST) Ti-15-3 was subjected to aging (520 °C/10 h/Air-cooled) and then to LPwC. Laser peening induced a notable increase in Ra (arithmetic mean roughness), which was measured using MAHR GD-120 profilometer. The Electron Back Scatter Diffraction (EBSD) analysis of the aged sample (STA) revealed a significant increase in the alpha precipitation (20 vol%), and this led to a substantial increase in the hardness (~40%) and UTS (~50%). In addition to this, peening of aged (STA+LPwC) sample resulted in a considerable increase (~12%) in near-surface microhardness and compressive residual stress (maximum stress of -195 MPa at a depth of 150 µm). This increase in compressive stress and microhardness led to an enhancement in the fatigue life of the STA+LPwC sample by 210% when compared to STA sample. In spite of high surface roughness induced by the LPwC, fractography studies revealed that crack initiation was independent of surface roughness.

Neuroleptic malignant syndrome in cycloserine-induced psychosis.

A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months. Patient's antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness.

Canine filarial infections in a human Brugia malayi endemic area of India.

A very high prevalence of microfilaremia of 42.68 per cent out of 164 canine blood samples examined was observed in Cherthala (of Alappuzha district of Kerala state), a known human Brugia malayi endemic area of south India. The species of canine microfilariae were identified as Dirofilaria repens, Brugia malayi, and Acanthocheilonema reconditum. D. repens was the most commonly detected species followed by B. pahangi. D. immitis was not detected in any of the samples examined. Based on molecular techniques, microfilariae with histochemical staining pattern of "local staining at anal pore and diffuse staining at central body" was identified as D. repens in addition to those showing acid phosphatase activity only at the anal pore. Even though B. malayi like acid phosphatase activity was observed in few dogs examined, they were identified as genetically closer to B. pahangi. Hence, the possibility of dogs acting as reservoirs of human B. malayi in this area was ruled out.

A somaclonal variant of rose-scented geranium (Pelargonium spp.) with moderately high content of isomenthone in its essential oil.

Rose-scented geranium (Pelargonium spp.), which is highly valued for its essential oil, is exclusively propagated vegetatively. Hence no genetic improvement work is possible through conventional breeding. Somaclonal variation was generated with and without in vitro mutagenesis using N-nitroso-N-methyl urea (NMU) in an Indian cultivar 'Bourbon', and a clone 'Narmada'. A somaclonal variant (N75) with a moderately high content of isomenthone in its essential oil was isolated from somaclones generated after treatment of internodal explants of clone, 'Narmada' with 0.25 mM NMU for 1 h. The contents of isomenthone in its essential oil were 26% and 35%, respectively, in SC2/VM2 and SC3/VM3 generations (second and third vegetative generations, respectively, after in vitro mutagen treatment) as compared with 0.7% and 0.3%, respectively, in the parental clone, 'Narmada'. The contents of alcohols and their esters (linalool, citronellol, geraniol, citronellyl formate and geranyl formate) in the essential oil of N75 in SC2/VM2 and SC3/VM3 generations were 49% and 35%, respectively, as compared with 69% and 63%, respectively, in the parental clone, 'Narmada'. This is the first report on a chemovariant of rose-scented geranium with a moderately high content of isomenthone. All earlier reported isomenthone-rich variants of rose-scented geranium had quite high contents of isomenthone (64-71%) in their essential oils. The probable modes of origin of this somaclonal variant, its parental clone 'Narmada' (with very low content of isomenthone) and four earlier reported isomenthone-rich variants of Indian cultivars of geranium are discussed.

Chitinase production in solid-state fermentation from Oerskovia xanthineolytica NCIM 2839 and its application in fungal protoplasts formation.

The present study reports the economic production of thermostable chitinase production from Oerskovia xanthineolytica NCIM 2839 by solid-state fermentation (SSF) technique and its application in fungal protoplasts formation. The Oerskovia xanthineolytica NCIM 2839 was found to produce thermostable chitinase 148 U g(-1) of solid substrate in SSF using wheat bran with colloidal chitin as base. Protoplasts of A. niger were formed by using crude chitinase produced in SSF and formed protoplasts were confirmed by using scanning electron microscopy. This is the simple and economical method for protoplast formation which makes it possible applications in strain improvement of various fungi by protoplasts fusion in Biotechnological industries.

Network meta-analysis-highly attractive but more methodological research is needed.

Network meta-analysis, in the context of a systematic review, is a meta-analysis in which multiple treatments (that is, three or more) are being compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator. To ensure validity of findings from network meta-analyses, the systematic review must be designed rigorously and conducted carefully. Aspects of designing and conducting a systematic review for network meta-analysis include defining the review question, specifying eligibility criteria, searching for and selecting studies, assessing risk of bias and quality of evidence, conducting a network meta-analysis, interpreting and reporting findings. This commentary summarizes the methodologic challenges and research opportunities for network meta-analysis relevant to each aspect of the systematic review process based on discussions at a network meta-analysis methodology meeting we hosted in May 2010 at the Johns Hopkins Bloomberg School of Public Health. Since this commentary reflects the discussion at that meeting, it is not intended to provide an overview of the field.

Variability in visual segmentation of digitized prostate tissue microarray cores.

OBJECTIVE: To examine bias associated with human-interactive semi-automated systems key components with machine vision used in quantitative histometry. STUDY DESIGN: A standard image set of 20 images was created using 5 nuclei sampled from hematoxylin-eosin-stained sections of benign tissue within a prostate tissue microarray that were rotated through the cardinal directions. Four trained technicians performed segmentation of these images at the start, then at the end, of 3 daily sessions, creating a total analytic set of 480 observations. Measurements of nuclear area (NA), nuclear roundness factor (NRF), and mean optical density (MOD) were compared by segmenter, time, and rotational orientation. RESULTS: NA varied significantly among sessions (p < 0.0009) and session variance differed within segmenter (p < 0.0001). NRF was significant among segmenters (p < 0.001) and sessions (p < 0.0001), and in session (p < 0.0001) and intra-session differences (p = 0.026). Differences in MOD varied among sessions (p < 0.0001) and within sessions (p < 0.049). CONCLUSION: Imaging systems remain vulnerable to statistical inter-segmenter variation, in spite of extensive efforts to eliminate variation among individual segmenters. As statistical significance often guides decision-making in morphometric analysis, statistically significant effects potentially produce bias. Current practices and quality assurance methods require review to eliminate individual operator effects in semiautomated machine systems.

Manual and automated systems in the analysis of images from prostate tissue microarray cores.

OBJECTIVE: To compare manual and automated image analysis systems in morphologic analysis of nuclei from benign prostate, high-grade prostatic intraepithelial neoplasia (HGPIN) and prostate cancer (CaP). Morphologic features derived using automated image analysis systems may be more objective and reproducible than manual systems, which require humans to segment nuclei from histologic images. STUDY DESIGN: Images of hematoxylin-eosin-stained sections of prostate tissue microarray were analyzed independently using the automated and manual systems. Mean optical density (MOD), nuclear area (NA), and nuclear roundness factor (NRF) were the morphologic features studied. The ability to differentiate between tissue types using morphologic features derived from an automated and a manual system was compared. RESULTS: Nuclei from 17 benign prostate hyperplasia (BPH), 4 HGPIN, and 8 aggressive CaP were analyzed. The manual system distinguished better between BPH and HGPIN (p < 0.0001), whereas the automated system distinguished better between BPH and CaP (p = 0.01) in multivariate models. The manual system distinguished better BPH and HGPIN using NA (p < 0.0001) and MOD (p < 0.0001), whereas the automated system distinguished better BPH and CaP using MOD (p < 0.0001) and NRF (p = 0.004). CONCLUSION: The minimal human effort required for automated image analysis makes it superior to the manual system.

Comparison of ACINUS, caspase-3, and TUNEL as apoptotic markers in determination of tumor growth rates of clinically localized prostate cancer using image analysis.

BACKGROUND: The balance between apoptotic and proliferative processes determines the enlargement of a tumor. Accurate measurement of apoptotic and proliferative rates from diagnostic prostate biopsies would allow calculation of tumor growth rates in a population-based prostate cancer (CaP) study. Automated image analysis may be used if proliferation and apoptotic biomarkers provide clearly resolved immunostained images. METHODS: Clinical CaP aggressiveness was assigned as low, intermediate or high using clinical criteria for 46 research subjects with newly diagnosed CaP. Diagnostic biopsy sections from the research subjects were dual-labeled for proliferation biomarker, Ki-67 and apoptotic biomarker, apoptotic chromatin condensation inducer in the nucleus (ACINUS). Apoptotic biomarkers, caspase-3 and terminal deoxyribonucleotidyltransferase mediated dUTP-biotin nick end labeling (TUNEL) were labeled separately. Images from immunostained sections were analyzed using automated image analysis and tumor growth rates computed. Association between clinical CaP aggressiveness and tumor growth rates was explored. RESULTS: Sixteen subjects had high, 17 had intermediate, and 13 had low clinical CaP aggressiveness. Positive immunostaining was localized to the nucleus for Ki-67, ACINUS, and TUNEL. A statistically significant linear trend across clinical CaP aggressiveness categories was found when tumor growth rates were calculated using ACINUS (P = 0.046). Logistic regression and ROC plots generated showed ACINUS (AUC = 0.677, P = 0.048) and caspase-3 (AUC = 0.694, P = 0.038) to be better predictors than TUNEL (AUC = 0.669, P = 0.110). CONCLUSIONS: ACINUS met the criteria for automated image analysis and for calculation of apoptotic rate. Tumor growth rates determined using automated image analysis should be evaluated for clinical prediction of CaP aggressiveness, treatment response, recurrence, and mortality.

Thioredoxin Reductase 1 Expression and Castration-recurrent Growth of Prostate Cancer.

INTRODUCTION: Many genes are differentially expressed between androgen-dependent and androgen-independent prostate cancer (CaP). Differential expression analysis and subtractive hybridization previously identified nine genes expressed in intact mice bearing CWR22 tumors and castrated mice bearing recurrent CWR22 tumors but not in regressed tumors. The objectives of this study were to develop an immunostaining method to dual-label foci of proliferating tumor cells [the origin of castration-recurrent CaP (CR-CaP)], to determine which of the nine candidate proteins were differentially expressed in proliferating versus nonproliferating cells at the onset of growth after castration, and to test preclinical findings using clinical specimens of androgen-stimulated benign prostate (AS-BP) and CaP (AS-CaP) and CR-CaP. METHODS: Paraffin-embedded, bromodeoxyuridine-injected CWR22 tumors were hydrated, antigen-retrieved using high heat and high pressure, labeled for each of the nine antigens of interest, visualized using peroxidase, and counterstained with hematoxylin. Mean optical density was calculated for proliferating and nonproliferating areas using automated (nuclear staining) or manual (cytoplasmic staining) image analysis. Prostate tissue microarray sections were immunostained and visually scored. RESULTS: Immunohistochemistry revealed higher nuclear expression of thioredoxin reductase 1 (TrxR1) in proliferating cells than nonproliferating cells (P < .005). There were no statistical differences between cell types in the expression of other proteins. TrxR1 expression was higher (P < .01) in CR-CaP compared with AS-BP or AS-CaP. CONCLUSIONS: Increased TrxR1 expression in CR-CaP was consistent with increased TrxR1 and BrdU expression at the onset of growth in the CWR22 model. Thioredoxin reductase 1 should be targeted in an attempt to delay or prevent CaP recurrence after castration.

Evaluation of heart rate variability indices using a real-time handheld remote ECG monitor.

Studies on retrospective electrocardiogram (ECG) recordings of patients during cardiac arrest have shown significant changes in heart rate variability (HRV) indices prior to the onset of cardiac arrhythmia. The early detection of these changes in HRV indices increases the chances for a successful medical intervention by increasing the response time window. A portable, handheld remote ECG monitor designed in this research detects the QRS complex and calculates short-term HRV indices in real-time. The QRS detection of the ECG recordings of subjects from the MIT-Arrhythmia database yielded a mean sensitivity of 99.34% and a specificity of 99.31%. ECG recordings from normal subjects and subjects with congestive heart failure were used to identify the differences in HRV indices. An increase in heart rate, high-frequency spectral power (HFP), total spectral power, the ratio of HFP to low-frequency spectral power (LFP), and a decrease in root mean square sum of RR differences were observed. No difference was found on comparison of the standard deviation of normal to normal interval between adjacent R-waves, LFP, and very-low-frequency spectral power. Based on these, additional analytical calculations could be made to provide early warnings of impending cardiac conditions.