Traumatic hemorrhage and chain of survival.

Trauma is the number one cause of death among Americans between the ages of 1 and 46 years, costing more than $670 billion a year. Following death related to central nervous system injury, hemorrhage accounts for the majority of remaining traumatic fatalities. Among those with severe trauma that reach the hospital alive, many may survive if the hemorrhage and traumatic injuries are diagnosed and adequately treated in a timely fashion. This article aims to review the recent advances in pathophysiology management following a traumatic hemorrhage as well as the role of diagnostic imaging in identifying the source of hemorrhage. The principles of damage control resuscitation and damage control surgery are also discussed. The chain of survival for severe hemorrhage begins with primary prevention; however, once trauma has occurred, prehospital interventions and hospital care with early injury recognition, resuscitation, definitive hemostasis, and achieving endpoints of resuscitation become paramount. An algorithm is proposed for achieving these goals in a timely fashion as the median time from onset of hemorrhagic shock and death is 2 h.

NuSegDA: Domain adaptation for nuclei segmentation.

The accurate segmentation of nuclei is crucial for cancer diagnosis and further clinical treatments. To successfully train a nuclei segmentation network in a fully-supervised manner for a particular type of organ or cancer, we need the dataset with ground-truth annotations. However, such well-annotated nuclei segmentation datasets are highly rare, and manually labeling an unannotated dataset is an expensive, time-consuming, and tedious process. Consequently, we require to discover a way for training the nuclei segmentation network with unlabeled dataset. In this paper, we propose a model named NuSegUDA for nuclei segmentation on the unlabeled dataset (target domain). It is achieved by applying Unsupervised Domain Adaptation (UDA) technique with the help of another labeled dataset (source domain) that may come from different type of organ, cancer, or source. We apply UDA technique at both of feature space and output space. We additionally utilize a reconstruction network and incorporate adversarial learning into it so that the source-domain images can be accurately translated to the target-domain for further training of the segmentation network. We validate our proposed NuSegUDA on two public nuclei segmentation datasets, and obtain significant improvement as compared with the baseline methods. Extensive experiments also verify the contribution of newly proposed image reconstruction adversarial loss, and target-translated source supervised loss to the performance boost of NuSegUDA. Finally, considering the scenario when we have a small number of annotations available from the target domain, we extend our work and propose NuSegSSDA, a Semi-Supervised Domain Adaptation (SSDA) based approach.

Electrical experimental data collection of polycrystalline and monocrystalline photovoltaic modules in an indoor environment using artificial sun simulator.

In the twenty-first century, energy sustainability and reliability are one of the major challenges in the world and prime factors of the national development plan. Recently, Solar PV is gaining popularity and making a significant effect as an alternative to fossil fuels due to reduction of cost and enhanced efficiency. However, the production performance of Solar PV over the period gets significantly impacted owing to a variety of problems such as dust, aging due to shading and soiling over the cell, hot spot, discoloration and corrosion for excessive atmospheric temperature, inadequate solar light, cell damage, and so on. In this research, a low-cost halogen-based artificial sun simulator is developed and deployed to examine the electrical properties of Solar PV in indoor conditions. Two monocrystalline and three polycrystalline PV panels under Standard Test Conditions, as well as a prototype 5 × 8 PV array, using this artificial light source, were evaluated rigorously for experimental purposes. With the help of a microcontroller-based I-V tracer and an actual data storage system, Open Circuit Voltage (Voc), Short Circuit Current (Isc), Maximum Power Voltage (Vmp), Maximum Power Current (Imp), and Maximum Power (Pmax) at three irradiance levels were measured and recorded. Utilizing Microsoft Excel software, the data logger's recorded data were analyzed and I-V and P-V curves were plotted. These data are extremely valuable for obtaining a good understanding of the validity of the Sun Simulator and the rate of deterioration of solar PV performance depending on irradiance. These data will aid the research community in future research regarding PV array performance monitoring, corresponding solution modeling, and developing cost-effective installation of large-scale PV arrays.

Antibacterial and antioxidant potential of the phenolic extract and its fractions isolated from Allium ascalonicum (onion) peel.

Aqueous methanolic (20:80) crude extract of the outer peel of Allium ascalonicum (onions) was fractionated into anthocyanin (II), acidic (i.e., phenolic acids, Ia), neutral A (i.e., flavanols, Ib) and neutral B (i.e., flavonols, Ic) phenols using C-18 and hydrophilic-lipophilic balanced (HLB) Co-polymer cartridges. The fractions were analysed for total phenolic, total flavonoids, antibacterial activity, antioxidant potential and lipoxygenase (LOX) inhibition. The recovery of total phenols and bio functional activity in all fractions were found to be more in HLB. All fractions showed antimicrobial activity against tested strains with phenolic acids (Ia) being most active and flavanol (Ib) least active, while the highest free radical scavenging, reducing power and LOX inhibition was exhibited by flavonol (Ic) and least by flavanols (Ib). HPLC analysis revealed the presence of vanillic acid and quercetin in non-anthocyanin I and cyanidin in anthocyanin II.

Effect of Hepatocellular Carcinoma Surveillance Programmes on Overall Survival in a Mixed Cirrhotic UK Population: A Prospective, Longitudinal Cohort Study.

INTRODUCTION: Surveillance for hepatocellular carcinoma (HCC) is recommended by national and international guidelines. However, there are no trial data on whether surveillance improves clinical outcomes in a UK cirrhosis population of mixed aetiology. Our aim was to determine the impact of, and adherence to, surveillance on overall survival. METHODS: We prospectively collected data on consecutive patients diagnosed with HCC between January 2009 and December 2015 at two large UK centres. We assessed outcomes depending on whether they had been entered into an HCC surveillance programme, and if they had adhered to that. RESULTS: Out of 985 patients diagnosed with HCC in this study, 40.0% had been enrolled in a surveillance programme. Of these, 76.6% were adherent with surveillance and 24.4% were not. Adherence to surveillance was significantly associated with improved overall survival, even when accounting for lead-time bias using different approaches (HR for 270 days lead-time adjustment 0.64, 0.53 to 0.76, p < 0.001). CONCLUSIONS: When adjusted for lead-time bias, HCC surveillance is associated with improved overall survival; however, the beneficial effect of surveillance on survival was lower than reported in studies that did not account fully for lead-time bias.

The conundrum of contrast-induced acute kidney injury.

More than sixty years have elapsed since contrast induced nephropathy (CIN) was first described in the medical literature. This term has since been extensively explored, with a variety of studies conducted to investigate its incidence and various mechanisms examined to explain its pathophysiology. However, the topic of CIN remains one of controversy with a widely variable and often questionable incidence derived from various studies. The past two decades have seen a surge in reports questioning the existing of CIN altogether and if more harm is actually being caused to patients out of fear of this potential complication. We have attempted to review relevant studies regarding CIN and highlight the key points of its surmised understanding. The review has a higher focus on more recent literature and updates, in order to determine if an accurate estimate can be made on the incidence of CIN. While there was certainly no lack of material available, practically all the studies reviewed were limited by one or more significant drawbacks that limited the reliability of their conclusions regarding CIN. Based on the information reviewed, the strengths and the flaws encountered in other studies can be used to design a randomized control trial that may help in concluding the longstanding debate on this topic. However due to time, financial, and perhaps even ethical constraints such a trial will be difficult to arrange, and so a definitive answer on CI-AKI, and whether it really exist, may continue to elude clinicians.

Amelioration in gliadin antigenicity and maintenance of viscoelastic properties of wheat (Triticum aestivum L.) cultivars with mixed probiotic fermentation.

Sourdough fermentation of twenty wheat cultivars was carried out using mixed probiotic culture (Lactobacillus acidophilus UNI, Lactobacillus brevis LR/5 and Lactobacillus plantarum ATCC 8014). The gliadin antigenicity was expressed in terms of its content in twenty different wheat cultivars. The gliadin proteins were characterized by SDS-PAGE and structural changes analyzed on FTIR spectrophotometer. Moreover, changes in the viscoelastic character of fermented and non-fermented dough were studied by rheometry. The results showed a remarkable reduction in antigenicity by 60% (average) in all wheat cultivars on sourdough fermentation. This reduction may be due to the synergistic effect of protease secretion by mixed lactobacilli, responsible for gliadin degradation. These changes in gliadins by mixed culture proteolysis were confirmed on SDS-PAGE on observing new gliadin-derived low molecular weight peptides. The results were further validated by FTIR spectroscopy where structural changes of gliadins were analyzed in the fermented dough. The rheological data indicated a higher storage modulus (G') compared to loss modulus (G″) in both control and fermented flour of all wheat cultivars, however, with a lower efficacy in sourdoughs. The present study thus establishes that mixed culture sourdough fermentation decreases the antigenic potential of gliadins without any change in the rheology and thereby maintaining the baking or viscoelastic properties of the wheat flour.

Imatinib and liver toxicity.

Imatinib is a specific tyrosine kinase inhibitor which has been approved for the treatment of Philadelphia chromosome-positive chronic myeloid leukaemia and c-KIT (CD117)-positive gastrointestinal stromal tumours. It has been associated with hepatotoxicity ranging from abnormal liver function tests to acute liver failure along with chronic hepatitis B reactivation. We report the case of a patient who was started on adjuvant treatment with imatinib following resection of a primary gastrointestinal stromal cell tumour of jejunum and developed severe hepatotoxicity. There was no history of risk factors for liver disease, and a search for the underlying causes of hepatotoxicity was unremarkable. Imatinib was stopped and she was treated with steroids which resulted in dramatic improvement of liver function tests. Liver biopsy in this case was not performed because liver function tests improved following discontinuation of imatinib and treatment with steroids. Repeat imaging did not reveal any evidence of tumour recurrence.

Innovative edible packaging from mango kernel starch for the shelf life extension of red chili powder.

In this study mango kernel starch (MKS) based heat sealable pouches were developed for packing of red chili powder. The films were prepared by casting technique using glycerol, sorbitol and 1:1 mixture of glycerol and sorbitol and were sealed. All films showed better heat sealing capacity but glycerol films plasticized exhibited higher seal strength than their counterparts. The red chili powder was packed in the MKS film pouches while commercially available polyethylene (PE) film was used as control. The pungency and color of red chili powder was monitored during six months storage at 40°C. The capsaicinoid content was extracted from the red chili with acetonitrile and evaluated quantitatively using spectrophotometric method. The extractable color was measured by ASTA method using acetone. The results showed significant differences in color and pungency of chili packed in MKS and PE pouches. The highest reduction in capsaicinoid content (pungency) of chili powder was observed in PE pouch (25.9%) while lowest was observed in MKS pouch containing sorbitol (15.7%). Similarly color loss was also highest in chili packed in PE pouch while lowest in MKS-sorbitol pouch.

Heat stress and antioxidant enzyme activity in bubaline (Bubalus bubalis) oocytes during in vitro maturation.

In vitro environments like heat stress usually increase the production of reactive oxygen species in bubaline oocytes which have been implicated as one of the major causes for reduced developmental competence. Oocytes during meiotic maturation are sensitive to oxidative stress, and heat stress accelerates cellular metabolism, resulting in the higher production of free radicals. Therefore, the aim of present work was to assess the impact of heat stress during meiotic maturation on bubaline cumulus-oocyte complexes (COC), denuded oocytes (DO), and cumulus cell mass in terms of their oxidative status. Accordingly, for control group, COC were matured at 38.5 °C for complete 24 h of meiotic maturation and heat stress of 40.5 and 41.5 °C was applied to COC during the first 12 h of maturation and then moved to 38.5 °C for rest of the 12 h. In another group, COC after maturation were denuded from the surrounding cumulus cells by manual pipetting. Results indicated that the production of reactive oxygen species (ROS), lipid peroxides, and nitric oxide (NO) was significantly (P < 0.05) higher in the oocytes subjected to heat stress (40.5 and 41.5 °C) during meiotic maturation compared to the oocytes matured under standard in vitro culture conditions (38.5 °C). Also, the antioxidant enzymatic activities of superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase were significantly (P < 0.05) increased in all the treatment groups compared to the control group. Therefore, the present study clearly establishes that heat stress ensues oxidative stress in bubaline oocytes which triggers the induction of antioxidant enzymatic defense system for scavenging the ROS.

Release of ß-casomorphin-7/5 during simulated gastrointestinal digestion of milk ß-casein variants from Indian crossbred cattle (Karan Fries).

Crossbred Karan Fries (KF) cows, among the best yielders of milk in India are carriers of A1 and A2 alleles. These genetic variants have been established as the source of ß-casomorphins (BCMs) bioactive peptides that are implicated with various physiological and health issues. Therefore, the present study was aimed to investigate the release of BCM-7/5 from ß-casein variants of KF by simulated gastrointestinal digestion (SGID) performed with proteolytic enzymes, in vitro. ß-Casein variants (A1A1, A1A2 and A2A2) were isolated from milk samples of genotyped Karan Fries animals and subjected to hydrolysis by SGID using proteolytic enzymes (pepsin, trypsin, chymotrypsin and pancreatin), in vitro. Detection of BCMs were carried out in two peptide fractions (A and B) of RP-HPLC collected at retention time (RT) 24 and 28min respectively corresponding to standard BCM-5 and BCM-7 by MS-MS and competitive ELISA. One of the RP-HPLC fractions (B) showed the presence of 14 amino acid peptide (VYPFPGPIHNSLPQ) having encrypted internal BCMs sequence while no such peptide or precursor was observed in fraction A by MS-MS analysis. Further hydrolysis of fraction B of A1A1 and A1A2 variants of ß-casein with elastase and leucine aminopeptidase revealed the release of BCM-7 by competitive ELISA. The yield of BCM-7 (0.20±0.02mg/g ß-casein) from A1A1 variant was observed to be almost 3.2 times more than A1A2 variant of ß-casein. However, release of BCM-7/5 could not be detected from A2A2 variant of ß-casein. The biological activity of released peptides on rat ileum by isolated organ bath from A1A1 (IC50=0.534-0.595µM) and A1A2 (IC50=0.410-0.420µM) hydrolysates further confirmed the presence of opioid peptide BCM-7.

Comparative evaluation of cow ß-casein variants (A1/A2) consumption on Th2-mediated inflammatory response in mouse gut.

PURPOSE: Recently, apprehension has been raised regarding "A1/A2 hypothesis" suggesting relationship between consumption of A1 "like" variants of cow ß-casein and various physiological disorders. The information available is based on either the human epidemiological data of milk consumption or in vitro trials on cell lines with ß-casomorphin peptides. The direct scientific evidence establishing the link between consumption of A1/A2 "like" milk and health is scanty. Thus, under present investigation, in vivo trials in mice were undertaken to study the effect of feeding three genetic variants (A1A1, A1A2 and A2A2) of cow ß-casein milk on gastrointestinal immune system as it is the first and foremost site of immunological interactions. METHODS: Animals were divided into four groups for feeding with basal diet (control) and ß-casein isolated from milk of genotyped (A1A1, A1A2 and A2A2) dairy animals, respectively. Gut immune response was analyzed by spectrophotometric assessment of MPO activity, quantitative sandwich ELISA of inflammatory cytokines (MCP-1 and IL-4), antibodies (total IgE, IgG, sIgA, IgG1 and IgG2a) and qRT-PCR of mRNA expression for toll-like receptors (TLR-2 and TLR-4). Histological enumeration of goblet cells, total leukocytes and IgA(+) cells was also carried out. RESULTS: It was observed that consumption of A1 "like" variants (A1A1 and A1A2) significantly increased (p < 0.01) the levels of MPO, MCP-1, IL-4, total IgE, IgG, IgG1, IgG2a and leukocyte infiltration in intestine. TLR-2 and TLR-4 mRNA expression was also up-regulated (p < 0.01) on administration of A1 "like" variants. However, no changes in sIgA, IgA(+) and goblet cell numbers were recorded on consumption of any of the ß-casein variants. CONCLUSION: It is reasonable to conclude that consumption of A1 "like" variants of ß-casein induced inflammatory response in gut by activating Th2 pathway as compared to A2A2 variants. The present study thus supports the purported deleterious impacts of consumption of A1 "like" variants of ß-casein and suggests possible aggravation of inflammatory response for etiology of various health disorders.

Age-associated aberrations in mouse cellular and humoral immune responses.

BACKGROUND AND AIMS: Several contradictions and inconsistent reports regarding nature of dysfunction of immune system with age are known. The lack of multipoint age comparisons in immune functions contributes to the observed ambiguity in understanding immunosenescence. Thus, the present study aimed at a concurrent analysis of different immune cells in an attempt to delineate the nature of dysregulation with progressive aging in mice. METHODS: 4, 8, 12 and 16 months old mice were analyzed for various immune parameters involving neutrophils, peripheral blood lymphocytes, peritoneal macrophages, splenocytes, inflamm-aging markers in plasma and humoral immune response in intestine. RESULTS: Neutrophils registered a remarkable decrease in activities of respiratory burst enzymes and phagocytosis, while macrophages recorded a decrease in TLR-2 and TLR-4 expression. MCP-1 and CRP levels increased in plasma, whereas stimulation index and CD28 expression decreased in lymphocytes. Interleukins analysis (IFN-γ, IL-4, IL-10) showed a remarkable shift towards Th2 response which further resulted in increased IgG1/IgG2a ratio and IgE levels in intestine. CONCLUSION: A decline in cell-mediated immune response, chronic inflammation and aggravation of humoral immunity was evident which conclusively suggests a skewed Th2 pathway during aging.

Subwavelength-size solid immersion lens.

We report on the fabrication and characterization of nanoscale solid immersion lenses (nano-SILs) with sizes down to a subwavelength range. Submicrometer-scale cylinders fabricated by electron-beam lithography are thermally reflowed to form a spherical shape. Subsequent soft lithography leads to nano-SILs on transparent substrates for optical characterization. The optical characterization is performed using a high-resolution interference microscope with illumination at 642 nm wavelength. The focal spots produced by the nano-SILs show both spot-size reduction and enhanced optical intensity, which are consistent with the immersion effect.

Efficacy of adjunctive high frequency repetitive transcranial magnetic stimulation of left prefrontal cortex in depression: a randomized sham controlled study.

OBJECTIVE: To examine the efficacy of adjunctive left prefrontal high-frequency rTMS treatment in depression patients as compared to sham stimulation. METHOD: 45 right handed moderate to severe depression patients according to ICD-10 DCR criteria were randomized to receive daily sessions of active or sham rTMS (10Hz, 90% of resting MT, 20 trains, 6s duration, 1200 pulses/day) over the right dorsolateral prefrontal cortex for 10 days. Depression and psychosis was rated using Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D) and Brief Psychiatric Rating Scale (BPRS) respectively before and after rTMS. RESULT: For SIGH-D scores, repeated measures ANOVA showed a significant effect of treatment over time as shown by interaction effect (Pillai's Trace F [1/38] = 56.75, p<.001, η(2) = .60). For BPRS, repeated measures ANOVA showed a significant interaction effect of treatment over time (Pillai's Trace F [1/38] = 39.87, p<.001, η(2) = .51). In psychotic depression patients, repeated measures ANOVA showed a significant effect of treatment over time for SIGH-D scores (Pillai's Trace F [1/25] = 43.04, p<.001, η(2) = .63) and BPRS scores (Pillai's Trace F [1/25] = 42.17, p<.001, η(2) = .63). CONCLUSION: High-frequency left prefrontal rTMS was well tolerated and found to be effective as add-on to standard pharmacotherapy in nonpsychotic as well as psychotic depression.

Non-conventional transmission of hepatitis C: a true possibility ignored.

OBJECTIVE: The exact mode of hepatitis C virus (HCV) transfer remains elusive in a vast majority of cases. We examined the possibility of non-conventional transmission of HCV by person-to-person contact. METHOD: A questionnaire based, prospective study was conducted at Pakistan Institute of Medical Sciences (PIMS) from July-October, 2006. Patients with compensated chronic hepatitis B (CHB) &/or C (CHC) were registered for 6 month interferon (IFN) therapy. All candidates furnished information about age, gender and mode of transmission. The unanswered queries were interpreted as "missing data". After omission of cases with hepatitis B virus (HBV) infection alone, the remaining persons included in the present study were placed in: Group-A: Multifactorial transfer involving conventional (blood borne) and non-conventional modes; Group-B: Unifactorial transfer by non-conventional routes only; Group-C: No identifiable risk factor. Unlike conventional routes, the non-conventional modes represented likelihood of CHB &/or CHC by exposure to household contacts, to persons with hepatic cirrhosis and during traveling. RESULTS: Initially, 879 patients (mean age: 35.52 +/- 9.1 years) were registered. After exclusion of 25 subjects with HBV infection only, the remaining 854 were included. Of 854 cases, 830 (97.18%) were infected with HCV and 24 (2.81%) had co-infection with HBV & HCV. According to the mode(s) of transmission, Group-A: 515 (60.30%); Group-B: 136 (15.92%) and Group-C: 203 (23.77%) cases were identified. Dental treatment: 278 (32.55%) was the commonest conventional risk factor in Group-A. The non-conventional transfer of HCV in Group-A was mainly suggested by household contact: 222 (25.99%). Groups-A and -B combined, the sum of any non-conventional risk factor was comparable with and even higher than the leading haematogenous routes in Group-A. Groups-B and -C combined, HCV infection in 339 patients (39.69%) was apparently acquired by non-conventional modes, most probably by person-to-person interaction. CONCLUSION: Non-conventional transmission of HCV is a genuine possibility which is currently underestimated.

Aripiprazole-induced hiccups: a case report.

Hiccups can arise from idiopathic, psychogenic and organic causes. The use of therapeutic drugs forms one of the important causes of hiccups. Although the exact pathophysiological processes involved have not yet been established, the neurotransmitters dopamine, serotonin and gamma amino butyric aid (GABA) have been documented to play a significant role in the generation of hiccups. We report a patient of organic bipolar affective disorder who developed hiccups with the atypical antipsychotic aripiprazole. The possible underlying neurotransmitter mechanisms, predisposing factors and clinical implications of this rare adverse event are discussed.

alpha/beta-Arteether-induced mania in a predisposed adolescent.

Artemisinin, by the name of Qinghaosu, has been used in China for the treatment of fever over the years. Recently, a number of artemisinin derivatives such as artesunate, artemether, dihydroartemisinin, and arteether have been developed and have found widespread clinical use because of their efficacy against resistant forms of all plasmodial species and a favorable side-effect profile. However, concerns have been expressed about the neurotoxic effects of artemisinin derivatives based on some animal and human studies. We present a case of alpha/beta-arteether-induced mania in an adolescent having a family history of chloroquine-induced psychosis to discuss the hereditary predispositions, possible mechanisms, management, and clinical implications of this rare adverse event.