Cardiac Computed Tomographic Angiography Evaluation of Right Ventricle-Pulmonary Artery Conduits with Surgical Correlation.

Right ventricle-pulmonary artery (RV-PA) conduits are used in the treatment of certain congenital heart disease (CHD). RV-PA conduit complications might develop over time and require intervention. To evaluate how well cardiac computed tomographic angiography (CCTA) performs compared to transthoracic echocardiography (TTE) in evaluating RV-PA conduit complications by using surgical findings as the reference standard. A retrospective chart review of all patients over a 5-year period who underwent CCTA for RV-PA conduit evaluation was performed. Patient demographics and clinical data were recorded. Preoperative CCTA and TTE findings were compared to the operative findings for concordance or discordance. Forty-one patients were included, 51% females. The complications were conduit stenosis (28.68%), infection (7.17%) and aneurysm/pseudoaneurysm (6.15%). TTE and CCTA were consistently able to visualize focal conduit stenosis (96%). The greatest discrepancy between TTE and CCTA was in evaluating for aneurysm/pseudoaneurysm, where TTE detected only 2/6 (33%) compared to CCTA which detected 6/6 (100%) of the cases. However, TTE was slightly better at detecting conduit infection (3/7, 43%) compared to CCTA (2/7, 29%). Note that 5 out of 7 patients with endocarditis had bovine jugular graft. CCTA and TTE provide similar diagnostic accuracy evaluating certain types of RV-PA conduit complications. However, certain complications were only visualized on CCTA or TTE making both modalities complementary to each other during diagnostic evaluation.

Food-grade xylitol production from corncob biomass with acute oral toxicity studies.

Xylitol, a sugar substitute, is widely used in various food formulations and finds a steady global market. In this study, xylitol crystals were produced from corncob by fermentation (as an alternative to the chemical catalytic process) by a GRAS yeast Pichia caribbica MTCC 5703 and characterized in detail for their purity and presence of any possible contaminant that may adversely affect mammalian cell growth and proliferation. The acute and chronic oral toxicity trials demonstrated no gross pathological changes with average weekly weight gain in female Wistar rats at high xylitol loading (LD50 > 10,000 mg/kg body weight). The clinical chemistry analysis supported the evidence of no dose-dependent effect by analyzing blood biochemical parameters. The finding suggests the possible application of the crystals (> 98% purity) as a food-grade ingredient for commercial manufacture pending human trials.

Role of gated cardiac computed tomographic angiography in the evaluation of postsurgical complications after stage I Norwood procedure and its implications on management: a comparative study with two-dimensional echocardiography.

BACKGROUND: The Norwood procedure is the first part of a three-stage surgical palliation for patients with functionally single ventricle anatomy. Complications after the stage I operation are not uncommon. Transthoracic echocardiography (TTE) is traditionally the mainstay for evaluation. OBJECTIVE: The purpose of our study is to compare gated cardiac computed tomographic angiography (CCTA) with TTE when evaluating for postoperative complications after stage I Norwood procedure and to describe management implications. MATERIALS AND METHODS: A retrospective chart review of all patients over a 4-year period who underwent nonelective urgent CCTA for suspected complications related to stage I Norwood procedure was performed. Elective CCTA studies before stage II palliation were excluded. Patient demographics, CCTA and TTE findings, as well as interventions performed, were recorded. RESULTS: Thirty-four patients were included. The mean age at CCTA was 63 days (range: 4-210 days). All patients had a recent TTE with a mean time interval between TTE and CCTA of 2 days. CCTA detected 56 abnormalities in 30 patients, with 23 directly related to postsurgical complications, including shunt-related complications (10/23, 43%), Damus-Kaye-Stansel anastomotic narrowing (2/23, 9%) and neo-aortic arch/branch vessel abnormalities (11/23, 48%). These complications were managed as follows: surgery (9, 39%), catheter-based intervention (7, 30%), medical (4, 17%) and no change in management (3, 13%). TTE did not detect 8/23 (35%) findings found on CCTA, of which 75% were either managed with surgery (4/8, 50%) or catheter-based intervention (2/8, 25%). CONCLUSION: CCTA plays an important role in detecting surgical complications after stage I Norwood procedure and demonstrates additional findings that have direct management implications.

Value of emergent pediatric cardiac computed tomographic angiography service: initial experience at a large children's hospital.

BACKGROUND: Demand for pediatric cardiac computed tomography (CT) angiography is increasing due to recent advances that reduce the need for sedation and radiation exposure while enhancing diagnostic accuracy. This has resulted in the increasing use of cardiac CT angiography emergently during weekends and after hours. The unexpected demand for these services can be challenging, as most hospitals are not staffed to provide 24/7 pediatric cardiovascular imaging. OBJECTIVE: To describe a large single-center experience of providing emergent cardiac CT angiography services in children. MATERIALS AND METHODS: We identified all patients who underwent after--hours weekday and weekend emergent cardiac CT angiography between January 2017 and August 2018. Cardiac CT angiography in the settings of congenital heart disease and coronary imaging were included. Data collected included day and time of cardiac CT angiography, patient age, referral unit, indication, surgical history, need for sedation, need for surgery, intervention and/or change in medical management based on the cardiac CT angiography. RESULTS: Forty-seven studies were identified, 26 (55%) of which were performed on a weekend or holiday and 21 (45%) after 5 p.m. on a weekday. Based on cardiac CT angiography findings, 20 (43%) patients underwent either surgery or an interventional procedure, and 9 (19%) had a change in medical management. The time between cardiac CT angiography and the related surgery/intervention ranged from 0 to 29 days with a median of 3.5 days. CONCLUSION: Emergent pediatric cardiac CT angiography is a valuable service. Larger multi-institutional studies with standardized referral and utilization patterns are needed to determine if outcomes are affected by this service, which in turn will influence hospital staffing patterns for emergent imaging.

Utility of immediate postoperative hip MRI in developmental hip dysplasia: closed vs. open reduction.

BACKGROUND: Magnetic resonance imaging (MRI) of the hips is being increasingly used to confirm hip reduction after surgery and spica cast placement for developmental dysplasia of the hip (DDH). OBJECTIVE: To review a single institutional experience with post-spica MRI in children undergoing closed or open hip reduction and describe the utility of MRI in directing the need for re-intervention. MATERIALS AND METHODS: Seventy-four patients (52 female, 22 male) who underwent post-spica hip MRI over a 6-year period were retrospectively reviewed. One hundred and seven hips were included. Data reviewed included age at intervention, gender, type of intervention performed, MRI findings, the need for re-intervention and the interval between interventions. Gender was compared between the closed and open reduction groups via the Fisher exact test. Age at the first procedure was compared via the Wilcoxon rank test. Rates of re-intervention after closed and open reduction were calculated and the reasons for re-intervention were reviewed. RESULTS: The mean age at the time of the first intervention was 16.4 months (range: 4 to 63 months). Mean age for the closed reduction group was 10.5 months (range: 4-24 months) and for the open reduction group was 23.7 months (range: 5-63 months), which was significant (P-value <0.0001). Of the 52 hips that underwent closed reduction, 16 (31%) needed re-intervention. Of the 55 hips that underwent open reduction, MRI was useful in deciding re-intervention in only 1 (2%). This patient had prior multiple failed closed and open reductions at an outside institute. CONCLUSION: Post intervention hip spica MRI is useful in determining the need for re-intervention after closed hip reduction, but its role after open reduction is questionable.

Subtilase from Beauveria sp.: conformational and functional investigation of unusual stability.

Retention of total activity of the subtilisin-like serine protease from Beauveria sp. MTCC 5184 (Bprot) in the vicinity of (1) 3 M GdnHCl for 12 h, (2) 50% methanol and dimethyl sulfoxide each for 24 h, and (3) proteolytic enzymes (trypsin, chymotrypsin, and proteinase K) for 48 h led to expect the enzyme to be a kinetically stable protein. Also, the structure of the protein was stable at pH 2.0. Biophysical characterization and conformational transitions were monitored using steady-state and time-resolved fluorescence, FTIR, and CD spectroscopy. Single tryptophan in the protein exists as two conformers, in hydrophobic and polar environment. The secondary structure of Bprot was stable in 3 M GdnHCl as seen in far-UV CD spectra. The active fraction of Bprot obtained from size-exclusion chromatography in the presence of GdnHCl (1.0-3.0 M) eluted at reduced retention time. The peak area of inactive or denatured protein with the same retention time as that of native protein increased with increasing concentration of denaturant (1.0-4.0 M GdnHCl). However, the kinetics of GdnHCl-induced unfolding as studied from intrinsic fluorescence revealed k unf of native protein to be 5.407 × 10(-5) s(-1) and a half-life of 3.56 h. The enzyme is thermodynamically stable in spite of being resistant to the denaturant, which could be due to the effect of GdnHCl imparting rigidity to the active fraction and simultaneously unfolding the partially unfolded protein that exists in equilibrium with the folded active protein. Thermal and pH denaturation of Bprot exhibited interesting structural transitions.

Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions.

The popliteus is a relatively small but unique muscle of the knee. It is a component of the posterolateral corner of the knee and acts as a major stabilizer of the posterolateral knee. It is important to be aware of the normal magnetic resonance (MR) imaging appearance of the popliteus musculotendinous complex and its relation to other structures of the posterolateral corner for accurate diagnosis. It is also important to be aware of the pitfalls in imaging of the popliteus. Dysfunction of the popliteus is often underappreciated and is usually secondary to direct or indirect trauma. Injuries of the popliteus can be classified as first-, second-, or third-degree strains. Injuries of the popliteus are often associated with other posterolateral corner injuries. Pathologic conditions of the popliteus may be a clue to other injuries in the knee. The site and pattern of popliteus tear can be helpful to the orthopedic surgeon in deciding whether repair is warranted and determining the approach to surgery and has prognostic implications. Undiagnosed popliteus injuries can lead to poor functional results after knee reconstructive surgery. Inflammatory pathologic conditions of the popliteus may cause knee pain and can be diagnosed with MR imaging. The popliteus is an important component of the posterolateral corner that needs closer attention for optimal diagnosis and patient care.

Detection of anomalous aortic origin of a coronary artery (AAOCA) by echocardiogram: When does computed tomographic angiography add value?

BACKGROUND AND OBJECTIVE: There is limited literature comparing TTE and CCTA in children with suspected AAOCA. To determine the distribution of various coronary anomalies comparing TTE and CCTA data, and define the added value advanced imaging brings in clinical decision-making. MATERIALS AND METHODS: Retrospective review of data was obtained in patients aged 0-18 years who underwent TTE and CCTA for suspected AAOCA. Patient demographics, CCTA and TTE findings, and interventions performed were recorded. RESULTS: 100 consecutive patients were included (60% male), mean age 11 years (7 days-18 years old). In 93 patients, CCTA detected 94 anomalous coronaries. Definitive coronary abnormality was reported on TTE in 77 patients; 76 of which were confirmed by CCTA, 1 patient was found to have a normal variant. Suspected anomalous origin was reported in 16 patients on TTE, 13 of which were abnormal on CCTA. The coronary origin was not seen on TTE in 6 patients; of these, 3 had AAOCA on CCTA and 3 had hypoplastic RCA with left dominant system. Only 1 patient who had a normal TTE was found to have AAOCA on CCTA. CCTA was better than TTE in defining ostial characteristics and the course of the anomalous coronary artery, and detecting myocardial bridge. CONCLUSIONS: CCTA adds value in diagnosing AAOCA when the coronary origins are not well assessed or suspected anomalous origin is suggested on TTE. In addition, when a confident definitive diagnosis of AAOCA is reported on TTE, CCTA demonstrates better performance in determining additional features of AAOCA.

Application of structured triacylglycerols in food products for value addition.

The present study aims to evaluate the suitability of structured triacylglycerol (ST) consisting of medium chain triacylglycerol (MCT) as low calorie and instant energy source in combination with essential fatty acids for formulations in different food products to add value to existing products. The study investigates the effect of presence of ST on the physicochemical and sensory properties of various food products such as mayonnaise enriched with ST synthesized from medium chain fatty acid (MCFA) and rice bran oil, cookies enriched with ST synthesized from MCFA and oleic acid rich moringa oil, energy bar with ST synthesized from MCFA and omega 3 enriched fish oil, as well as yogurt drink with ST synthesized from MCFA and omega 6 enriched flaxseed oil. The obtained results established the suitability of incorporation of ST in food products and comparison with standard market products revealed the validity of the products to sustain the demand with value addition. The oxidative stability studies of all the products in the presence of natural antioxidants from moringa leaves and pomegranate peel using the peroxide value test and rancimat analysis demonstrated similar stability to the standard marketed product. Application of plant wastes and residues in the form of leaves or peels as the likely sources for isolating bioactive compounds demonstrates potential of the sustainable approach also giving benefit of increasing the stability of the product. The study also points towards possible replacement option for synthetic carcinogenic antioxidants with natural antioxidants obtained from moringa leaves and pomegranate peel. The present work clearly demonstrates the effective use of structured triacylglycerols synthesized using green methodologies for creating unique health enriched food products with all worthy and green components.

Ultrasound pretreatment as a novel approach for intensification of lipase catalyzed esterification of tricaprylin.

The current work deals with ultrasound assisted intensification of synthesis of tricaprylin based on the enzyme catalyzed reaction of caprylic acid and glycerol with novel approach of using ultrasound in only the initial stages of the reaction. Two types of immobilized lipases as Lipozyme RM (Rhizomucor miehei) and Novozym 435 (Candida antarctica) have been used in the work. The effect of ultrasonic conditions such as treatment time and power as well as the reaction conditions such as substrate molar ratio, reaction time and enzyme loading on the yield of tricaprylin has been investigated. It was established that the optimum pretreatment conditions were irradiation time as 30min with ultrasonic frequency of 20kHz, supplied power of 240W, 70% duty cycle (7s on 3s off cycle) whereas the optimum reaction conditions were 4:1 molar ratio of caprylic acid to glycerol, enzyme loading as 3% and operating temperature of 50°C. It was also established that reuse of enzymes for 10 cycles was possible without any significant effect on the activity of lipase. It was also conclusively established that compared to the conventional approach of synthesis, ultrasound pretreatment based approach greatly influenced the rate of reaction and maximum tricaprylin yield of 94.8% was achieved in 7h of reaction time under the optimum conditions.

Chromium removal and reduction in COD of tannery effluents.

Tannery effluents are highly polluting and contain chromium and high COD and BOD. Alkalotolerant/alkalophilic actinomycetes NCIM 5080 and NCIM 5109 have been shown earlier to tolerate and accumulate chromium during growth also produce alkaline protease in presence of chromium ions. These properties of the isolates are suitable for treatment of tannery effluents which are alkaline and contain chromium and proteinaceous matter. Both the actinomycetes are able to grow in undiluted tannery effluents and remove chromium almost completely and reduce the COD by 70-80% during growth as well as by pregrown biomass.