Terbutaline for acute tocolysis prior to emergency caesarean delivery for suspected foetal compromise.

INTRODUCTION: Terbutaline has been used as a foetal resuscitation measure to improve the intrapartum foetal heart rate abnormalities and neonatal outcome for suspected foetal compromise. Unfortunately, till date, the available data are limited to draw any recommendation. MATERIAL AND METHODS: This was a double-blind, placebocontrolled trial conducted among women planned for emergent caesarean delivery for suspected foetal compromise where 100 were randomised to receive subcutaneous terbutaline or placebo. The primary outcomes were the neonatal acid-base status, while the 5- minute Apgar score, admission to the intensive care unit and the maternal outcomes were recorded as secondary outcomes. RESULTS: Data from a total of 96 women were analysed and showed a lower incidence of neonatal acidemia (4.4% vs 10.4%) and fewer neonates born with umbilical artery pH of less than 7.20 (12.5% vs 27.1%) and 7.10 (4.2% vs 6.2%) after terbutaline injection. However, the difference in the incidence of neonatal acidaemia, mean cord pH and base excess, Apgar score or admission to the intensive care unit did not differ significantly. No difference was seen in the maternal mean arterial pressure, estimated blood loss or haematocrit after the surgery between the study groups. The only significant maternal effect was tachycardia which was more common after terbutaline injection (54.2% vs 25.0 %, p=0.003). CONCLUSION: The study shows that acute tocolysis with subcutaneous terbutaline prior to caesarean delivery has the potential to improve the neonatal outcome in suspected intrauterine foetal compromise and should be further investigated.

Relationship Between Added Sugar Intake and Sleep Quality Among University Students: A Cross-sectional Study.

Eating foods high in added sugar has recently increased among people of all ages. This is expected to negatively affect health and life quality. This study was conducted to investigate the relationship between added sugar intake and sleep quality among university students. A total of 100 randomly selected female students (19-25 years old) from Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, participated in the study after applying exclusion criteria. Sample size was calculated with expected correlation of -0.4 between sugar intake and sleep quality, a power of 90%, and a type 1 error of 5%. Participants completed the Food Frequency Questionnaire (FFQ), sleep quality questionnaire, and 24-hour dietary recall. Data were analyzed using IBM SPSS Statistics 25, and the χ2 test was used for measuring the association between added sugar intake and sleep quality, where P <.05 was considered statistically significant. Results showed that only 17% of participants had good sleep. Data of the 24-hour dietary recall showed a significant association (P = .014) between consumption of added sugars and sleep quality. This is the first study to directly report on the effect of higher intake of added sugars on sleep quality. The study concluded that poor sleep quality was significantly related to higher added sugar intake.

BCOR Internal Tandem Duplication Associated Uterine Sarcoma: Expanding the Clinicopathologic Spectrum.

The diagnosis of high-grade endometrial stromal sarcoma has become more refined following molecular characterization of these tumors. Recently BCOR internal tandem duplications (ITD) have been identified in a small number of high-grade endometrial stromal sarcoma. Here we present an additional case of this rare entity in a young woman in her late teens. She presented with menorrhagia and underwent resection of 2 uterine lesions. The tumor was a spindle cell neoplasm composed of long fascicles with low to moderate cellularity, mild to moderate cytologic atypia, and up to 2 mitotic figures per 10 high power fields. Necrosis was not identified. Immunohistochemical stains showed the tumor to be positive for cyclin D1 in >50% of tumor cells, focally positive for CD10, and negative for SMA, desmin, h-caldesmon, and ALK1. BCOR ITD was confirmed by polymerase chain reaction with subsequent Sanger sequencing. Clues to the diagnosis of BCOR ITD uterine sarcoma include young patient age, uniform nuclear features, and diffuse positivity for cyclin D1. These features should prompt further molecular interrogation for definitive diagnosis, which is important for prognostication.

Advances in solid-state fermentation for bioconversion of agricultural wastes to value-added products: Opportunities and challenges.

The increase in solid waste has become a common problem and causes environmental pollution worldwide. A green approach to valorise solid waste for sustainable development is required. Agricultural residues are considered suitable for conversion into profitable products through solid-state fermentation (SSF). Agricultural wastes have high organic content that is used as potential substrates to produce value-added products through SSF. The importance of process variables used in solid-phase fermentation is described. The applications of SSF developed products in the food industry as flavouring agents, acidifiers, preservatives and flavour enhancers. SSF produces secondary metabolites and essential enzymes. Wastes from agricultural residues are used as bioremediation agents, biofuels and biocontrol agents through microbial processing. In this review paper, the value addition of agricultural wastes by SSF through green processing is discussed with the current knowledge on the scenarios, sustainability opportunities and future directions of a circular economy for solid waste utilisation.

PLAG1-rearrangment in a uterine leiomyosarcoma with myxoid stroma and heterologous differentiation.

A variety of molecular alterations have been reported in uterine leiomyosarcomas, but most are considered nondiagnostic. There are, however, rare exceptions including PLAG1 rearrangement which has recently been identified in a subset of myxoid leiomyosarcomas. A 41-year-old woman presented with symptoms of a fibroid. She underwent a myomectomy which revealed a high-grade uterine sarcoma with areas of myxoid stroma and heterologous elements. The tumor expressed desmin, smooth muscle actin, H-caldesmon, and estrogen and progesterone receptors. RNA sequencing revealed a novel TRIM13-PLAG1 fusion gene which was subsequently independently confirmed by fluorescence in situ hybridization. On further evaluation the patient was found to have multiple pulmonary metastases and died due to disease progression shortly after diagnosis. This report describes a novel fusion partner of PLAG1 in a uterine leiomyosarcoma with myxoid leiomyosarcoma and heterologous elements, thereby broadening the spectrum of morphologic and genetic findings within this rare group of neoplasms.

Glycerol waste to value added products and its potential applications.

The rapid industrial and economic development runs on fossil fuel and other energy sources. Limited oil reserves, environmental issues, and high transportation costs lead towards carbon unbiased renewable and sustainable fuel. Compared to other carbon-based fuels, biodiesel is attracted worldwide as a biofuel for the reduction of global dependence on fossil fuels and the greenhouse effect. During biodiesel production, approximately 10% of glycerol is formed in the transesterification process in a biodiesel plant. The ditching of crude glycerol is important as it contains salt, free fatty acids, and methanol that cause contamination of soil and creates environmental challenges for researchers. However, the excessive cost of crude glycerol refining and market capacity encourage the biodiesel industries for developing a new idea for utilising and produced extra sources of income and treat biodiesel waste. This review focuses on the significance of crude glycerol in the value-added utilisation and conversion to bioethanol by a fermentation process and describes the opportunities of glycerol in various applications.

High methoxyl pectin extracts from Hylocereus polyrhizus's peels: Extraction kinetics and thermodynamic studies.

The effect of physicochemical treatment on pectin yield, degree of esterification, along with the kinetics and thermodynamics characteristics was investigated in the present study. Several extraction parameters were observed to have impacted the yield and degree of esterification significantly, and the best extraction condition was as follows: agitation rate of 250 rpm, temperature of 70 °C, extraction time of 120 min, pH 2, and liquid to solid ratio of 10 v/w which has resulted in 28.20% of pectin yield, with DE (degree of esterification) of 57.00%. A theoretical model which describes the extractability, dissolution and degradation rate of pectin to predict the maximal yield at the maximal time was established to study the extraction kinetics of pectin from HPP. The kinetic analysis from Panchev's model shows the extraction rate was found highest at LSR 10 with ymax 30.85%. The calculated activation energy for pectin dissolution and degradation was found to be 4.532 kJ/mol and 28.054 kJ/mol, respectively. The thermodynamic study has suggested that the process was endothermic, spontaneous and reversible. These results suggest that the physical and chemical treatment applied could be an efficient technique for the extraction of pectin from Hylocereus polyrhizus peels.

Hylocereus polyrhizus peel's high-methoxyl pectin: A potential source of hypolipidemic agent.

In the present study, high-methoxyl pectin (HMP) was extracted from Hylocereus polyrhizus peel's using physico-chemical process. In addition, the hypolipidemic activity of HMP was investigated at different concentration and time corresponding to its adsorption ability. FTIR and contact angle analysis were used to determine the sorbent characterization. A high degree of esterification (63.8%) and the contact angle (95.5°) confirmed hydrophobic nature and resulting bad wetting of the HMP extract, respectively. The methoxyl content in the pectin acted as an affinity-precursor of the pectin towards cholesterol due to its increased hydrophobicity. The maximum equilibrium uptake capacity of cholesterol of 370.5mg/g (0.96mmol/g) was observed by HMP. The experimental data showed good fitting for Freundlich isotherm equation and followed pseudo-first-order kinetic model with a correlation coefficient (R2) of 0.89-0.97 due to physisorption mechanism. Intra-particle model confirmed that the cholesterol sorption rate by HMP was significantly influenced by external mass transfer (surface diffusion) and intra-particle diffusion (diffusion control). It was also revealed that the HMP extracted from Hylocereus polyrhizus peels possess a high affinity towards cholesterol, making it an ideal hypolipidemic agent.

A Case of Postpartum Anogenital Mammary-Like Gland Tumor with Focal Lactational Features: A Nomenclature Issue.

Mammary-like glands (MLG) are considered to be a normal constituent of the anogenital region and can give rise to tumors with variable morphology that may be difficult to classify. We present a case of an anogenital mammary-like gland tumor in a breastfeeding woman showing morphological variation with lactational change, an unusual finding. We discuss the differing terminology used to report these tumors and the variation in assignment of their origin to MLG or ectopic breast tissue.

Neoadjuvant therapy in gynaecological malignancies: What pathologists need to know.

In recent times, there has been a growing tendency to treat advanced gynaecological malignancies with neoadjuvant chemotherapy (NACT), with the goal of reducing tumour volume and enhancing operability resulting in optimal cytoreduction. This approach is used in particular for patients with advanced high-grade serous carcinoma of the ovary, fallopian tube or peritoneum. Pathology plays a crucial role in the management of these patients, both before and after NACT. Prior to initiation of NACT, a biopsy should be performed, usually of the omental cake, to confirm that a malignancy is present, to identify the site of origin of the tumour and to type and grade the tumour. Histopathologists must be aware of the resultant morphological effects of NACT when examining specimens following interval cytoreduction surgery. Tumour typing and grading, and even the identification of residual neoplasia, are particular challenges. Immunohistochemistry, when used judiciously, can be a useful adjunct in certain scenarios. A pathological assessment of the response to chemotherapy, and the pathological stage should be provided in the pathology report, as these may inform prognosis and subsequent management. We present a comprehensive overview of the relevant clinical and pathological aspects pertaining to NACT for gynaecological malignancies for the practicing surgical pathologist.

Production of High Commercial Value Xylooligosaccharides from Meranti Wood Sawdust Using Immobilised Xylanase.

The present study explores the utilisation of a new raw material from lignocellulose biomass, Meranti wood sawdust (MWS) for high commercial value xylooligosaccharides (XOS) production using immobilised xylanase. The xylanase was immobilised by a combination of entrapment and covalent binding techniques. The hemicellulosic xylan from MWS was extracted using a standard chlorite delignification method. The production of total and derivatives of XOS from the degradation of the hemicellulosic xylan of MWS were compared to the production from the commercial xylan from Beechwood. The utilisation of the extracted xylan from MWS yielded 0.36 mg/mL of total XOS after 60 h of hydrolysis. During the hydrolysis reaction, the immobilised xylanase released a lower degree of polymerisation (DP) of XOS, mainly X2 and X3, which were the major products of xylan degradation by xylanase enzymes. The production of XOS with a lower DP from MWS demonstrated the biotechnological potential of the MWS in the future. The XOS production retained about 70% of its initial XOS production during the second cycle. This is also the first report on the utilisation of MWS wastes in enzymatic hydrolysis using immobilised xylanase for XOS production.

Enzymatic Production of Bioxylitol from Sawdust Hydrolysate: Screening of Process Parameters.

Xylose-rich sawdust hydrolysate can be an economic substrate for the enzymatic production of xylitol, a specialty product. It is important to identify the process factors influencing xylitol production. This research aimed to screen the parameters significantly affecting bioxylitol synthesis from wood sawdust by xylose reductase (XR). Enzymatic bioxylitol production was conducted to estimate the effect of different variables reaction time (2-18 h), temperature (20-70 °C), pH (4.0-9.0), NADPH (1.17-5.32 g/L), and enzyme concentration (2-6 %) on the yield of xylitol. Fractional factorial design was followed to identify the key process factors. The screening design identified that time, temperature, and pH are the most significant factors influencing bioxylitol production among the variables with the values of 12 h, 35 °C, and 7.0, respectively. These conditions led to a xylitol yield of 71 % (w/w). This is the first report on the statistical screening of process variables influencing enzyme-based bioxylitol production from lignocellulosic biomass.

Inhibition by toxic compounds in the hemicellulosic hydrolysates on the activity of xylose reductase from Candida tropicalis.

Xylose reductase (XR) is an oxidoreductase having potential applications in the production of various specialty products, mainly xylitol. It is important to screen for compounds that can decrease XR activity and consequently can decrease xylitol production. We have identified the byproducts in the hemicellulosic hydrolysate that inhibit XR from Candida tropicalis and measured their effects. XR inhibitory activities of byproducts, glucose, acetic acid, arabinose, lignin-degradation products (LDPs), furfural and hydroxymethylfurfural (HMF), were evaluated by measuring the MIC and IC50 values. XR activity was 11.2 U/ml. Acetic acid, LDPs, furfural and HMF significantly inhibited XR with IC50 values of 11, 6.4, 2.3 and 0.4 g/l, respectively. This is the first report on the inhibitory activities of several byproducts for XR.

Biochemical properties of xylose reductase prepared from adapted strain of Candida tropicalis.

Xylose reductase (XR) is an intracellular enzyme, which catalyzes xylose to xylitol conversion in the microbes. It has potential biotechnological applications in the manufacture of various commercially important specialty bioproducts including xylitol. This study aimed to prepare XR from adapted strain of Candida tropicalis and to characterize it. The XR was isolated from adapted C. tropicalis, cultivated on Meranti wood sawdust hemicellulosic hydrolysate (MWSHH)-based medium, via ultrasonication, and was characterized based on enzyme activity, stability, and kinetic parameters. It was specific to NADPH with an activity of 11.16 U/mL. The enzyme was stable at pH 5-7 and temperature of 25-40 °C for 24 h and retained above 95 % of its original activity after 4 months of storage at -80 °C. The K m of XR for xylose and NADPH were 81.78 mM and 7.29 µM while the V max for them were 178.57 and 12.5 µM/min, respectively. The high V max and low K m values of XR for xylose reflect a highly productive reaction among XR and xylose. MWSHH can be a promising xylose source for XR preparation from yeast.

Production of xylose from Meranti wood sawdust by dilute acid hydrolysis.

Xylitol production by bioconversion of xylose can be economically interesting if the raw material can be recovered from a cheap lignocellulosic biomass (LCB). Meranti wood sawdust (MWS) is a renewable and low-cost LCB that can be used as a promising and economic source of xylose, a starting raw material for the manufacture of several specialty chemicals, especially xylitol. This study aimed to optimize the hydrolysis process of MWS and to determine the influence of temperature, H2SO4 concentration, and residence time on xylose release and on by-product formation (glucose, arabinose, acetic acid, furfural, hydroxymethylfurfural (HMF), and lignin degradation products (LDPs)). Batch hydrolysis was conducted under various operating conditions, and response surface methodology was adopted to achieve the highest xylose yield. Xylose production was highly affected by temperature, acid concentration, and residence time. The optimum temperature, acid concentration, and time were determined to be 124 °C, 3.26 %, and 80 min, respectively. Under these optimum conditions, xylose yield and selectivity were attained at 90.6 % and 4.05 g/g, respectively.

Differentiating between endocervical glandular neoplasia and high grade squamous intraepithelial lesions in endocervical crypts: cytological features in ThinPrep and SurePath cervical cytology samples.

A recent audit at our institution revealed a higher number of cases diagnosed as endocervical glandular neoplasia on ThinPrep (TP) cervical cytology samples (9 cases) as opposed to SurePath (SP) (1 case), which on histology showed only high-grade cervical intraepithelial neoplasia (CIN) with endocervical crypt involvement (CI). We attempted to ascertain the reasons for this finding by reviewing the available slides of these cases, as well as slides of cases diagnosed as glandular neoplasia on cytology and histology; cases diagnosed as high-grade squamous intraepithelial lesions (HSIL) on cytology which had CIN with CI on histology and cases with mixed glandular and squamous abnormalities diagnosed both cytologically and histologically. Single neoplastic glandular cells and short pseudostratified strips were more prevalent in SP than TP with the cell clusters in glandular neoplasia 3-4 cells thick, in contrast to the dense crowded centre of cell groups in HSIL with CI. The cells at the periphery of groups can be misleading. Cases with HSIL and glandular neoplasia have a combination of the features of each entity in isolation. The diagnosis of glandular neoplasia remains challenging and conversion from conventional to liquid based cervical cytology requires a period of learning and adaptation, which can be facilitated by local audit and review of the cytology slides in cases with a cytology-histology mismatch.