Psoas Muscle Area as a Predictor of Transcatheter Aortic Valve Implantation Outcomes.

BACKGROUND: Frailty is a well-recognised predictor of outcomes after transcatheter aortic valve implantation (TAVI). Psoas muscle area (PMA) is a surrogate marker for sarcopaenia and is a validated assessment tool for frailty. The objective of this study was to examine frailty as a predictor of outcomes in TAVI patients and assess the prognostic usefulness of adding PMA to established frailty assessments. METHODS: Frailty assessments were performed on 220 consecutive patients undergoing TAVI. These assessments used four markers (serum albumin, handgrip strength, gait speed, and a cognitive assessment), which were combined to form a composite frailty score. Preprocedural computed tomography scans were used to calculate cross-sectional PMA for each patient. The primary outcomes were all-cause mortality at 1-year and post-procedure length of hospital stay. RESULTS: Frailty status, as defined by the composite frailty score, was independently predictive of length of hospital stay (p=0.001), but not predictive of 1-year mortality (p=0.161). Albumin (p=0.036) and 5-metre walk test (p=0.003) were independently predictive of 1-year mortality. The PMA, when adjusted for gender, and normalised according to body surface area, was not predictive of 1-year mortality. Normalised PMA was associated with increased post-procedure length of stay within the female population (p=0.031). CONCLUSIONS: A low PMA is associated with increased length of hospital stay in female TAVI patients but does not provide additional predictive value over traditional frailty scores. The PMA was not shown to correlate with TAVI-related complications or 1-year mortality.

Fat augments leptin-induced uterine contractions by decreasing JAK2 and BKCa channel expressions in late pregnant rats.

Altered lipid metabolism in obesity causes pregnancy complications in humans and animals. Leptin levels increase in pregnancy, as well as obesity. However, the effect of obesity on uterine leptin receptors and its distal signaling is not clear. The present study aimed to understand the effect of increased fat on leptin signaling in rat uterus. Wistar female rats were fed with an HF diet (40% Fat, 17% Sucrose, 1.25% Cholesterol, 0.75% Cholic acid) for 6 weeks before the mating and during pregnancy. HF diet significantly increased the fat depots, liver weight, serum, and tissue cholesterol levels. It produced fatty degeneration in the liver and caused infiltration of inflammatory cells, cystic endometrial glands, and sub endometrial fibrosis of the uterus. In isometric tension experiments, leptin caused a significant increase in uterine contractions in high fat-fed animals compared to control animals. Analysis of receptor expressions revealed no significant difference between the groups. However, a significant decrease in the JAK2 and BKCaα mRNA expression was observed in the uterus of high fat-fed rats. No change in the BKCaß, eNOS, iNOS, MLCP, and MLCK mRNA expressions was noticed in the HF group compared to the control. The findings of the present study suggest that the contractile response to leptin in the uterus of high fat-fed rats may be attributed to reduced signaling through JAK2 and, lowered expressions of BKCa channel α subunits.

Persistence and diffusion behaviour of chlorpyrifos in five different species of vegetables: A comparative analysis.

Understanding of pesticide persistence and diffusion on the fresh vegetables are extremely important in food safety and decontamination process. In this study, we examine the persistence and diffusion behaviour of chlorpyrifos pesticide in five different species of vegetables. The chlorpyrifos pesticide was spiked on the vegetable surfaces and the extracted samples from peel and tissues were subjected to Gas Chromatography equipped with a Flame Photometric Detector (GC-FPD). Further, the chlorpyrifos diffusion behaviour was compared with the osmotic potential, shear strength, cuticular chemical profile and microstructure of peel surface of vegetables. The persistence analysis results revealed that chlorpyrifos level was decreased in peel surface and diffusion rate was increased in inner tissue with respect to durations. Within 72 h exposure, chlorpyrifos reached 0.7 cm depth into the inner tissue of vegetables. Significant level of chlorpyrifos diffusion with P ≤ 0.05 was observed in beetroot (2.47%), khon khol (1.46%) and brinjal (0.92%) compared to cucumber and potato. Remarkably, there was no direct linkage between the chlorpyrifos diffusion rate, osmotic potential and toughness of vegetables. In addition, the Gas Chromatography Mass Spectroscopy (GC-MS) and Scanning Electron Microscopy (SEM) analyses revealed that epicuticular surface microstructure and chemical profiles were not correlated with the chlorpyrifos diffusion in all the tested vegetables. The study results concludes that chlorpyrifos diffusion is vegetable species specific and it is highly variable between the species.

Transcatheter aortic valve implantation: a new standard of care.

Aortic stenosis is the most common valvular lesion requiring intervention and with an ageing population, its burden is likely to increase. Increasing comorbidity and a desire for less invasive treatment strategies has facilitated the expansion of percutaneous aortic valve therapies. Robust clinical trial data are now available to support the role of transcatheter aortic valve implantation (TAVI) in patients of prohibitive, high and now intermediate surgical risk. The introduction of a Medicare Benefits Schedule reimbursement is likely to see TAVI use grow exponentially in Australia over the next 5 years. Clinical trials evaluating low risk patients may be the final frontier to see TAVI become the standard of care for most patients with severe aortic stenosis.

Oral impacts on daily performance: Validity, reliability and prevalence estimates among Indian adolescents.

BACKGROUND: Dental diseases negatively influence people's oral health-related quality of life and thus their perceived need for dental care. OBJECTIVES: To test the validity and reliability of an Indian version of Oral Impacts on Daily Performance (OIDP) index for college students and to identify age and sex-specific OIDP prevalence estimates. METHODS: Cross-sectional descriptive survey was conducted among 800 professional and non-professional bachelor degree college students of Udaipur, India aged between 17 and 24 years. Oral health-related quality of life among the college students was assessed through OIDP, tested for validity and reliability and then prevalence rates were estimated. Chi square test was employed for statistical analysis. Cronbach's alpha was found to be 0.82. RESULTS: Sixty percent subjects reported at least one oral impact in last 6 months with overall mean OIDP score of 2.49±3.92. The most commonly affected performances were cleaning teeth (24%) and eating (12%). A significant association in oral impacts on daily performances among college students was observed with age (P=.001) but not with gender (P=.053). CONCLUSIONS: The validity and reliability of OIDP and also the prevalence of oral health-related impacts were found to be high. OIDP index showed acceptable psychometric properties in the context of an oral health survey among Indian college students.

Vascular endothelial growth factor polymorphisms and a synchronized examination of plasma and tissue expression in epithelial ovarian cancers.

In this study, we have analyzed six genetic polymorphisms of the VEGF-A gene and correlated the genetic data with plasma and tissue expression of VEGF-A in epithelial ovarian carcinomas. A total of 130 cases including 95 malignant carcinomas, 17 low malignant potential and 18 benign tumours were studied. rs699947, rs833061, rs1570360, rs2010963, rs1413711 and rs3025039 were studied by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Plasma levels of VEGF-A were estimated by enzyme-linked immunosorbent assay (ELISA) and tissue expression of VEGF-A by immunohistochemistry (IHC). Four polymorphisms of the above excluding rs699947 and rs3025039 showed significant association with malignancy, and we observed the presence of positive correlation between haplotype CCGGCC and increased expression of VEGF-A in both plasma and tissues which also correlated with poor prognosis and recurrence suggesting a probable increase in resistance to treatment in such carriers. Highly upregulated tissue expression of VEGF-A was seen in all epithelial ovarian carcinomas with intensity of expression increasing from benign to malignant cases. ELISA data from our study showed an increase in circulating levels of VEGF-A in malignancies. VEGF-A plasma levels can be employed as a biomarker for high-grade malignancy in epithelial ovarian cancers alongside tissue expression and CA-125 levels. This study is unique due to the fact that a simultaneous analysis of plasma and tissue expression has been demonstrated and is a first such study in epithelial ovarian cancers and representing the Indian population (South-east Asian) synchronized with genetic polymorphism data as well.

Design and development of annatto (Bixa orellana L.) seed separator machine.

A small, continuous power operated machine with a capacity of 132 kg/h was designed, fabricated and evaluated its performance for separation of annatto (Bixa orellana L.) seeds from freshly harvested pods. Physical and engineering parameters of annatto pods and seeds were evaluated to design a machine. The densities of pod, seed, and husk are 134.7 to 186.0 kg/m(3), 1206 to 1253.9 kg/m(3), 317 to 381.4 kg/m(3) respectively. The moisture content of seeds were in the range 18.83 - 20.1 % (db) and pod 8 to 10 % (db). Bixin content of seed was in the range 1.34 to 1.765 %. The friction angle for pod, seed, and husk lies between angle 30.15° to 35.76°. Breaking force was 98 N at a span of 14.5 mm. The machine consisted of concentric cylinders and beaters with different pitch of 40, 45 and 50 mm and a length of shaft is 800 mm. The actual machine output was observed to be 132.5 kg/h. Maximum bixin content was found to be retained at 300 rpm.

Acute renal failure in the ICU setting: A prospective observational study.

BACKGROUND: Acute renal failure (ARF) is a common entity in the intensive care unit (ICU) setting. There is scanty data regarding acute kidney injury (AKI) in ICUs from our country and no data from the service setting. METHODS: All patients admitted to the ICU of a tertiary care teaching hospital for six months were included in the study. They were divided into two groups: surg gr (admitted in surgical ICU) and med gr (admitted in medical ICU). During the stay in ICU, patients were observed for the development of AKI depending on the creatinine values and hourly urine output. Staging was done based upon the Risk Injury Failure Loss and End stage kidney (RIFLE) criteria. Relevant data associated with development of AKI was collected for correlation. RESULTS: 17.15% patients developed AKI after admission to the ICU 40% patients admitted with sepsis developed AKI. An increased susceptibility to develop AKI was found on day 4 of admission in both the groups. Of the patients who developed AKI, the surg gr of patients had a higher sequential organ failure assessment (SOFA) score both on day of admission (7.85 vs 5.65) and on the day of development of AKI (9.47 vs 6.18) as compared to the medical group. CONCLUSION: The incidence of ARF in our study was 17.2% with the patients of polytrauma/MODS being of major concern. The initial 3-4 days are the most critical and susceptible patients must be intensive monitored during this time for prevention of ARF. Medical ICU patients develop ARF at a low SOFA score in comparison to surgical ICU patients and thus need greater attention.

Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events.

BACKGROUND: Patients with heart failure (HF) have abnormal endothelial function. Although use of a continuous flow left ventricular assist device (CF-LVAD) results in significant hemodynamic improvement, the effects on systemic endothelial function are unclear. METHODS AND RESULTS: Eighteen HF patients with CF-LVAD implantation were included in this prospective observational study. We measured reactive hyperemia index (RHI) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function. Patients were followed clinically for the occurrence of adverse cardiovascular events, a composite of death, thrombosis, bleeding, HF, renal failure, and arrhythmia. Preoperative RHI was 1.77±0.39. Early in the postoperative period (7-14 days after operation) RHI significantly decreased to 1.19±0.31 (P<0.001, compared with preoperative RHI). At first and second follow-up (4-6 weeks and 3-7 months after operation) RHI remained lower at 1.48±0.50 (P=0.030) and 1.26±0.37 (P=0.002), respectively, compared with preoperative RHI. The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events after CF-LVAD (age-adjusted risk ratio for 0.25 decrease in RHI, 1.35; 95% confidence interval: 1.13-1.62, P=0.001). CONCLUSIONS: Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD, and this decline was associated with adverse cardiovascular events. These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients.

Control of hospital acquired infections in the ICU: A service perspective.

BACKGROUND: The service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. METHODS: Following an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. RESULTS: The total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. CONCLUSION: Our study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.

BRCA1 promoter hypermethylation and protein expression in ovarian carcinoma--an Indian study.

Mounting evidences suggest that aberrant methylation of CpG islands is a major pathway leading to the inactivation of tumour suppressor genes and the development of cancer. The aim of the current study was to examine the prevalence of the promoter hypermethylation and protein expression of the BRCA1 gene in epithelial ovarian carcinoma (EOC) to understand the role of epigenetic silencing in ovarian carcinogenesis. We studied the promoter methylation of the BRCA1 gene by methylation-specific PCR in a cohort of 88 patients with EOC, 14 low malignant potential (LMP) tumours and 20 patients with benign tumours of the ovary. The expression of the BRCA1 protein by immunohistochemical analysis was carried out in a subset of 64 EOCs, 10 LMP tumours, 10 benign tumours and 5 normal ovarian tissues. The frequencies of methylation in EOCs and LMP tumours were 51.2 and 57%, respectively, significantly higher (p = 0.000 and p = 0.001) in comparison to benign tumours and normal ovarian tissue where no methylation was seen. Expression of BRCA1 was significantly lower in EOCs (p = 0.003). Lack of protein expression correlated with tumour grade and type. The methylation status correlated well with downregulation of BRCA1 expression. Our results clearly demonstrate that hypermethylation of BRCA1 promoter is a frequent event in ovarian cancer. These data support the hypothesis that BRCA1 promoter methylation plays an important role in the functional inactivation of BRCA1. Follow-up clinical data will reveal the impact of BRCA1 methylation on survival.

Relationship between promoter methylation & tissue expression of MGMT gene in ovarian cancer.

BACKGROUND & OBJECTIVES: Epigenetic alterations, in addition to multiple gene abnormalities, are involved in the genesis and progression of human cancers. Aberrant methylation of CpG islands within promoter regions is associated with transcriptional inactivation of various tumour suppressor genes. O 6-methyguanine-DNA methyltransferase (MGMT) is a DNA repair gene that removes mutagenic and cytotoxic adducts from the O 6 -position of guanine induced by alkylating agents. MGMT promoter hypermethylation and reduced expression has been found in some primary human carcinomas. We studied DNA methylation of CpG islands of the MGMT gene and its relation with MGMT protein expression in human epithelial ovarian carcinoma. METHODS: A total of 88 epithelial ovarian cancer (EOC) tissue samples, 14 low malignant potential (LMP) tumours and 20 benign ovarian tissue samples were analysed for MGMT promoter methylation by nested methylation-specific polymerase chain reaction (MSP) after bisulphite modification of DNA. A subset of 64 EOC samples, 10 LMP and benign tumours and five normal ovarian tissue samples were analysed for protein expression by immunohistochemistry. RESULTS: The methylation frequencies of the MGMT gene promoter were found to be 29.5, 28.6 and 20 per cent for EOC samples, LMP tumours and benign cases, respectively. Positive protein expression was observed in 93.8 per cent of EOC and 100 per cent in LMP, benign tumours and normal ovarian tissue samples. Promoter hypermethylation with loss of protein expression was seen only in one case of EOC. INTERPRETATION & CONCLUSIONS: Our results suggest that MGMT promoter hypermethylation does not always reflect gene expression.

Prevalence of +405G>C,-1154G>A Vascular Endothelial Growth Factor Polymorphism in Breast Cancer.

Vascular endothelial growth factor (VEGF) plays an important role in the development of Breast Cancer. The aim of this study was to investigate the association of polymorphisms in the VEGF gene on prognosis of Breast Cancer patients. This study comprised 200 patients with histologically confirmed cases of Breast cancer and 200 controls. Genotyping of the VEGF gene polymorphisms at +405G>C,-1154G>A, were performed by PCR-RFLP analysis. Preoperative plasma VEGF levels were determined by ELISA. Amongst both cases and controls, the genotypic distribution of the individual SNPs were all in Hardy-Weinberg equilibrium. Mean VEGF level was significantly elevated in cases compared to controls (t = 8.248; P < 0.001). No significant association was found between +405G>C,-1154G>A VEGF polymorphism and Breast Cancer. Logistic regression analysis revealed that 405GG & 1154GG were associated with higher levels of VEGF.

Isolated megalourethra: A rare case report and review of literature.

Megalourethra is a rare congenital disorder of anterior urethra and erectile tissue of penis. It mainly appears in two types-a milder scaphoid type and severe fusiform type. Fusiform type is commonly associated with congenital anomalies of various systems of the body. Isolated megalourethra without other congenital anomalies is extremely rare. We report one such case which was detected postnatally and successfully treated by reduction urethroplasty.

Hybrid manifold smoothing and label propagation technique for Kannada handwritten character recognition.

Handwritten character recognition is one of the classical problems in the field of image classification. Supervised learning techniques using deep learning models are highly effective in their application to handwritten character recognition. However, they require a large dataset of labeled samples to achieve good accuracies. Recent supervised learning techniques for Kannada handwritten character recognition have state of the art accuracy and perform well over a large range of input variations. In this work, a framework is proposed for the Kannada language that incorporates techniques from semi-supervised learning. The framework uses features extracted from a convolutional neural network backbone and uses regularization to improve the trained features and label propagation to classify previously unseen characters. The episodic learning framework is used to validate the framework. Twenty-four classes are used for pre-training, 12 classes are used for testing and 11 classes are used for validation. Fine-tuning is tested using one example per unseen class and five examples per unseen class. Through experimentation the components of the network are implemented in Python using the Pytorch library. It is shown that the accuracy obtained 99.13% make this framework competitive with the currently available supervised learning counterparts, despite the large reduction in the number of labeled samples available for the novel classes.

Study of graphene p-n junctions formed by the electrostatic modification of the SiO2 substrate.

We study the transport properties of mm-scale CVD graphene p-n junctions, which are formed in a single gated graphene field effect transistor configuration. Here, an electrical-stressing-voltage technique served to modify the electrostatic potential in the SiO2/Si substrate and create the p-n junction. We examine the transport characteristics about the Dirac points that are localized in the perturbed and unperturbed regions in the graphene channel and note the quantitative differences in the Hall effect between the perturbed and unperturbed regions. The results also show that the longitudinal resistance is highly sensitive to the external magnetic field when the Hall bar device operates as a p-n junction.

Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice.

Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.

Distinctive clinical characteristics according to age and gender in apical ballooning syndrome (takotsubo/stress cardiomyopathy): an analysis focusing on men and young women.

BACKGROUND: Apical ballooning syndrome (ABS) predominantly affects postmenopausal women. There is a paucity of data regarding ABS in men and young women. The aim of this study was to compare the clinical characteristics and outcomes of men and young women (<50 y) to older women (≥50 y). METHODS & RESULTS: We retrospectively reviewed the records of 224 patients and divided them into men (n = 12), young women (n = 12), and older women (n = 200). Older women were further subdivided into those who were and were not on hormone replacement therapy (HRT) at the time of presentation. Men were more likely to present after a physical trigger (100% vs 46%; P = .009), have lower ejection fractions (30.1 ± 8.0% vs 40 ± 13.9%; P = .04), and have greater need for mechanical ventilation (67% vs 17%; P < .0001) compared with older women. Younger women were more likely to have a history of psychiatric disorders (75% vs 24%; P = .0001) at presentation and a higher rate of recurrence (16% vs 3%; P = .017) compared with older women. Of the older women, 15 developed ABS while on chronic HRT. Those without HRT were more likely to require mechanical hemodynamic (7.7% and 0%; P = .002) and ventilatory (18.1% and 0%; P = .017) support compared with older women who were on HRT. CONCLUSIONS: Men appeared to develop ABS as a consequence of a physical trigger, whereas young women had a higher rate of psychiatric comorbidities and a greater propensity for recurrence. Treatment with HRT in older women does not preclude the development of ABS.

Altered expression of ß-catenin, E-cadherin, and E-cadherin promoter methylation in epithelial ovarian carcinoma.

The aim of the study was to evaluate the immunoexpression of E-cadherin, ß-catenin, and Ki-67, as well as the promoter methylation of E-cadherin gene in epithelial ovarian cancer (EOC), as well as to find a possible relationship between the immunoexpression and hypermethylation. Promoter methylation was studied using methylation-specific PCR in 86 malignant cases, 14 low malignant potential (LMP) tumors and 19 benign cystadenomas. Immunohistochemical expression was carried out in 64 malignant cases, 8 LMP tumors, and 11 benign cystadenomas. Immunoexpression of E-cadherin was reduced in EOC, while 100 % expression was seen in LMP tumors and benign cystadenomas. An interesting observation was the nuclear expression of E-cadherin in a high percentage of cancers, which showed a positive correlation with Ki-67. Β-Catenin expression showed heterogeneous localization with increased nuclear localization, which was significantly higher in cases that did not express E-cadherin. Promoter methylation of E-cadherin was 36, 14, and 11 % in EOC, LMP tumors, and benign cystadenomas, respectively. Our results suggest that reduced expression of E-cadherin is associated with promoter methylation of E-cadherin gene, in addition to providing evidence for the aberrant nuclear localization of E-cadherin in EOC.