[Risk factors of perivalvular leakage after transcatheter aortic valve replacement with Venus-A valve].

Objective: To investigate the risk factors of moderate or severe perivalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) with Veneus-A valve. Methods: This study was a single-center case-control study. The clinical data of patients with severe aortic stenosis, who underwent TAVR in the Department of Cardiology of Second Affiliated Hospital of Army Medical University from October 2017 to January 2021, were analyzed. According to the circumferential extent of prosthetic valve paravalvular regurgitation measured by transthoracic echocardiography before discharge (patients who died in hospital were referred to transesophageal echocardiography results after valve implanted), the patients were divided into moderate or severe PVL group and mild or non-PVL group. The clinical features, CT scan and analysis results of aortic root were compared between the two groups. Multivariate logistic regression analysis was used to identify the independent risk factors of postoperative moderate or severe PVL, and receiver operating characteristic (ROC) curve was used to explore the predictive value of related factors. Results: Eighty-two patients (mean age: (70.9±6.5) years, 46 males) were included in the analysis, there were 16 patients in the moderate or severe PVL group and 66 patients in the mild or non-PVL group. The proportion of male gender, depth of valve implantation, size of valve annulus and left ventricular outflow tract (LVOT), and coverage index of LVOT were significantly higher in moderate or severe PVL group than those in mild or non-PVL group (Pall<0.05). As there was a strong collinearity among the valve annular short diameter, LVOT short diameter and LVOT coverage index (partial correlation coefficient R 0.251-0.779, P<0.05), these parameters were not entered in regression model. Multivariate logistic regression analysis showed that valve implantation depth(OR=1.239,95%CI 1.036-1.442,P=0.023), aortic angulation(OR=1.128, 95%CI 1.044-1.312,P=0.038)and LVOT tract coverage index (OR=1.123, 95%CI1.003-1.315, P=0.032) were independent risk factors for moderate or severe PVL after TAVR. The ROC curve showed that the valve implantation depth could predict the occurrence of moderate or severe PVL after TAVR (area under ROC curve (AUC)=0.697, 95%CI 0.554-0.851, P=0.039). Conclusion: Among patients with severe aortic stenosis who undergo TAVR with Venus-A valve, the implantation depth, aortic angulation and LVOT coverage index are independent risk factors of moderate/severe PVL after TAVR, among which valve implantation depth could be used to predict the occurrence of moderate/severe PVL after TAVR.

THE EFFECT OF A SINGLE DOSE OF MAGNESIUM SULPHATE AS AN ADJUVANT TO EPIDURAL BUPIVACAINE FOR INFRAUMBILICAL SURGERIES: A PROSPECTIVE DOUBLE-BLIND, RANDOMIZED CONTROL TRIAL.

CONTEXT: Epidural anesthesia provides the advantage of segmental blockade and many adjuvants have been added to shorten the onset of action, improve the quality of analgesia and prolong the duration of analgesia. Magnesium sulphate(MgSO4) by virtue of its anti-iociceptive property has been administered by various routes. AIM: To assess the effect of MgSO4 on the duration of onset of action of injection bupivacaine for epidural anesthesia in infraumbilical surgeries. MATERIALS AND METHODS: A prospective, double-blind, randomized control study was conducted in 40 patients. Group M received 15 ml of bupivacaine 0.5% + 1 ml of 50 mg MgSO4 and Group C received 15 ml of bupivacaine 0.5% + 1 ml of normal saline via epidural route. Onset time of the sensory and motor blockade were the primary outcomes studied. Highest level of sensory block, time for two segment regression, hemodynamic parameters, side effects were the secondary parameters. RESULTS: There was a significant difference between the groups in the mean onset time of sensory blockade at T8, 12.85 ± 2.32 min in Group M and 16.75 ± 1.74 min in Group C. Median level of sensory blockade was comparable. Mean onset time of motor blockade was 13.85 ± 3.28 min in Group M and 23.25 ± 3.35 min in Group C which was clinically and statistically significant. Time for two segment regression of sensory blockade was 95.75 ± 11.84 min in Group M and 55.5 ± 8.57 min in Group C which was significant. Hemodynamic parameters and side effects were comparable. CONCLUSION: Magnesium sulphate as an adjuvant provides rapid onset of epidural anesthesia and prolongs the duration of analgesia with minimal side effects.

EFFECT OF DEXMEDETOMIDINE ON HEMODYNAMIC PARAMETERS DURING EXTUBATION. A PROSPECTIVE RANDOMIZED DOUBLE BLIND STUDY.

BACKGROUND: Extubation is known to produce significant hemodynamic disturbances. There is a need to avoid increase in heart rate and blood pressure in hypertensive and cardiac patients and in vascular, neuro and intraocular surgeries. AIMS: To study the ability of dexmedetomidine to attenuate the hemodynamic responses during extubation. MATERIALS AND METHODS: 80 patients of ASA Grade I-II aged 18-50 years received standard anesthesia. At the closure of skin incision, patients were randomly allocated to receive either dexmedetomidine 0.5 µg/kg (Group D) or saline placebo (Group C) intravenously over 10 minutes in a double-blind design. Heart rate (HR), systolic, diastolic and mean arterial pressures (SBP, DBP, MAP) were assessed before, during- and after extubation. Time to eye opening and extubation, sedation, complications such as coughing, laryngospasm, bronchospasm and desaturation were recorded. RESULTS: HR, SBP, DBP and MAP were comparable to basal values in group D at extubation and lower than baseline values post-extubation but significant increase was noted in group C (P <0.001). Time to extubation and eye opening were prolonged in Group D (P <0.001). Incidence of hypotension was more in group D (22%) but was transient. Incidence of coughing was lower in Group D than in group C (P <0.001). Patients in group D were more sedated for 30 minutes post extubation. CONCLUSION: Dexmedetomidine 0.5 µg/kg given before extubation attenuates hemodynamic reflexes during emergence from anesthesia without causing undue sedation, but prolongs time to extubation.

Evolution of the regulatory subunits for the heteromeric acetyl-CoA carboxylase.

The committed step for de novo fatty acid (FA) synthesis is the ATP-dependent carboxylation of acetyl-coenzyme A catalysed by acetyl-CoA carboxylase (ACCase). In most plants, ACCase is a multi-subunit complex orthologous to prokaryotes. However, unlike prokaryotes, the plant and algal orthologues are comprised both catalytic and additional dedicated regulatory subunits. Novel regulatory subunits, biotin lipoyl attachment domain-containing proteins (BADC) and carboxyltransferase interactors (CTI) (both three-gene families in Arabidopsis) represent new effectors specific to plants and certain algal species. The evolutionary history of these genes in autotrophic eukaryotes remains elusive, making it an ongoing area of research. Analyses of potential protein-protein and co-occurrence interactions, informed by gene network patterns using the STRING database, in Arabidopsis thaliana and Chlamydomonas reinhardtii unveil intricate gene associations with ACCase, suggesting a complex interplay between FA synthesis and other cellular processes. Among both species, a higher number of co-expressed genes was identified in Arabidopsis, indicating a wider potential regulatory network of ACCase in plants. This review investigates the extent to which these genes arose in autotrophic eukaryotes and provides insights into their evolutionary trajectory. This article is part of the theme issue 'The evolution of plant metabolism'.

Association between the M268T polymorphism in the angiotensinogen gene and essential hypertension in a South Indian population.

Essential hypertension is a complex multifactorial disease caused by interactions between genetic and environmental factors. It is an independent determinant of cardiovascular risk. The main aim of this study was to investigate the possible influence of angiotensinogen M268T polymorphisms on hypertension in two endogamous caste populations of South India. Systolic and diastolic blood pressure, anthropometric variables, and lipid profiles were assessed. Direct sequencing of PCR products was adopted for genotyping. This polymorphism was found to be in Hardy-Weinberg equilibrium in the patients and controls of both populations. Binary odds ratios showed significant association between the M268T polymorphism and hypertension in both populations. Multivariate analysis revealed significant differences in body mass index, chest girth, calf circumference, skinfold measurements, total cholesterol, and triglyceride levels between these genotypes in the Gavara and Vaishya populations. These data further support the hypothesis that hypertension is influenced by the AGT M268T polymorphism.

Role of different cytokines and seizure susceptibility: a new dimension towards epilepsy research.

Epilepsy is a common health problem. Although variety of factors influence the incidence and prevalence of seizures, cytokines are considered to play an important role in seizures. Cytokines are also known to be involved in other neurodegenerative disorders. Proinflammatory cytokines like IL-1, IL-6, TNF-alpha and growth factor vascular endothelial growth factor (VEGF) as well as anti-inflammatory cytokine IL-10 and related molecules have been described in CNS and plasma of experimental models of seizures and clinical cases of epilepsy. There are reports suggesting more predispositions to seizures during inflammatory conditions like colitis, pneumonia and rheumatoid arthritis. These inflammatory cytokines and growth factors are also known to have dual roles in affecting seizure susceptibility. It remains to be seen if cytokine modulators can be therapeutically exploited for patients with inflammatory disorder and suffering from epilepsy.

Correlation of Symphysiofundal Height and Abdominal Girth with the Incidence of Hypotension in Cesarean Section Under Spinal Anesthesia using Bupivacaine with Fentanyl as Adjuvant: A Clinical Study.

BACKGROUND AND AIMS: A decreased lumbosacral subarachnoid space volume is a major factor in cephalad intrathecal spread of local anesthetic in term parturients due to compressive effect of the gravid uterus. The aim of this study was to assess the relationship of symphysiofundal height (SFH) and abdominal girth (AG) with the incidence of hypotension and the highest level of sensory blockade. SETTINGS AND DESIGN: This study was a prospective observational study. MATERIALS AND METHODS: Ninety parturients under the American Society of Anesthesiologists physical status class II within the age range of 20-30 years, weighing between 60 and 65 kg, and height between 150 and 155 cm were studied, and the SFH and AG of all parturients had been measured just before spinal anesthesia. Hyperbaric bupivacaine 9 mg with 12.5 µg intrathecal fentanyl was administered for subarachnoid block. The incidence of hypotension and the highest level of sensory block were assessed. STATISTICAL ANALYSIS: Correlation analysis (Spearman's rank test) was applied to analyze the data, and P < 0.05 was considered to be statistically significant. RESULTS: The incidence of hypotension was higher with increasing SFH (16.9% with SFH of 30-35 cm, 78.37% with SFH of 36-40 cm; correlation coefficient ρ =0.338) and with increasing AG (5.3% with AG between 85 and 89 cm, 35.7% with AG 90-94 cm, 62.8% with AG 95-99 cm; ρ =0.341), and both were statistically significant (P < 0.001). There was a statistically significant correlation between increasing SFH and maximum sensory block achieved (ρ =0.157, P < 0.001). There was increased level of sensory blockade with increased AG but was not statistically significant (ρ =0.011, P = 0.32). CONCLUSION: In term parturients undergoing cesarean section under spinal anesthesia, the SFH has a significant positive correlation with the incidence of hypotension and ascent of spinal anesthesia. AG also has a positive correlation with the incidence of hypotension but is not significant with the ascent of spinal anesthesia.

Progressive dysregulation of autonomic and HPA axis functions in HIV-1 clade C infection in South India.

Human immunodeficiency virus type 1 (HIV-1) infection causes a wide spectrum of abnormalities in neurological, neuropsychological, and neuroendocrinological functions. Several studies report disturbance in autonomic nervous system (ANS) and hypothalamic pituitary-adrenal (HPA) axis function in HIV-1B infected individuals. However, no such investigations on the effect of HIV-1 clade C infection, particularly during the initial phase of the disease progression, have been reported. The present investigations were carried out longitudinally over a 2-year period at 12 monthly intervals in clinically asymptomatic HIV-1 clade C seropositive patients (n=120) and seronegative control subjects (n=29). We determined both the basal levels and the dynamic changes in plasma levels of norepinephrine (NE), epinephrine (E), adrenocorticotrophic hormone (ACTH) and cortisol (CORT). Studies were also extended longitudinally (at three separate yearly visits of each participant), to evaluate the response of autonomic and HPA axis to mirror star tracing challenge test (MSTCT) and the values were determined as area under the curve (AUC, corrected for baseline levels of NE, E, ACTH, and CORT). The findings show that the values of basal plasma NE levels, as well as NE response to MSTCT (AUC) at the first visit of HIV-1 seropositive individuals did not differ from those found in the control subjects (NE, pg/ml, HIV-1C=313.5+/-12.7 vs. controls=353.0+/-21.3; p=NS; AUC, HIV-1C=225+/-14.75 vs. controls=232.7+/-19.34; p=NS, respectively). At the subsequent two visits of HIV-1 positive patients however, NE response to MSTCT challenge was progressively attenuated (AUC=235+/-19.5 and 162.7+/-13.6; p<0.01 and 0.05, respectively) compared to that found at the first visit. On the other hand, plasma levels of E as well as E response to MSTCT at the first visit were significantly lower in HIV-1C seropositive individuals compared to those in the control subjects (pg/ml, HIV-1C=77.30+/-5.7 vs. controls=119.1+10.5; p<0.05; AUC, HIV-1C =83.29+/-7.5 vs. controls=172.3+/-18.9; p<0.001), but no further change was observed in AUC of E in response to MSTCT at the two subsequent yearly visits. The basal plasma levels of ACTH in HIV-1C seropositives were not different than in the control subjects (pg/ml: HIV-1C=20.0+/-0.9 vs. controls=23.1+/-1.6; p=NS), but ACTH response to MSTCT in HIV-1C seropositive patients at the first visit was lower than in the controls (AUC, HIV-1C=23.57+/-1.5 vs. controls=30.94+/-3.5; p<0.05), and fluctuated between high and low at the second and third visits (AUC, 28.89+/-2.3 and 21.69+/-2.36, respectively). However, the baseline plasma levels of cortisol as well as the response of cortisol to MSTCT (AUC) in HIV-1C seropositive individuals were higher than in the control subjects at the first visit (mug/dl, HIV-1C=9.83+/-0.39 vs. controls=6.3+/-0.56; p<0.05; AUC, HIV-1C=12.31+/-0.7 vs. control=9.18+/-0.9; p<0.05), and remained high at the two subsequent yearly follow up visits of HIV-1C (AUC, 11.8+/-0.86 and 11.98+/-0.77, respectively). These findings demonstrate attenuated autonomic functions, a disconnection between response of ACTH and cortisol to the MSTCT challenge, and an inverse relationship between plasma levels of catecholamine(s) and cortisol. Since plasma catecholamines and cortisol are the peripheral mediators of the autonomic and HPA axis function, the findings of this study reflect the overall adverse effect of HIV-1C infection on autonomic as well as HPA axis functions. The findings, apart from being the first to demonstrate the progressive dysregulation of autonomic nervous system and HPA axis function among HIV-1C infected seropositive individuals much ahead of the onset of acquired immunodeficiency syndrome (AIDS), also suggest that MSTCT, involving visuoconstructive cognitive abilities, is an effective stressor for unraveling the underlying dysfunctions in the neuroendocrine functions in health and disease.

Experimentally induced various inflammatory models and seizure: understanding the role of cytokine in rat.

BACKGROUND: The mechanism of epileptogenesis is not well established. There is higher incidence of seizures among patients with chronic inflammatory disease. Cytokines are rapidly induced in the brain after a variety of stimuli including inflammation. Aim of this study was to produce various inflammatory models and seizure to understand the role of TNFalpha in above mentioned models. MATERIALS AND METHODS: A total of 54 male rats were included in the study. Animals were divided into 3 groups of colitis, arthritis, and cotton wool granuloma. Each group had 3 subgroups of control, model and treatment. At the end of 3 days in colitis, 17 days in arthritis and 7 days in cotton wool granuloma groups a subconvulsive dose of PTZ (40 mg/kg i.p) was injected to note seizure onset and seizure score. Brain samples were subjected to DNA fragmentation testing. Presence of inflammation was confirmed by morphology and histology. Plasma and brain TNFalpha levels were measured. RESULTS: The models of colitis, arthritis and CWG were effectively produced as evidenced by morphology and histology scores (p<0.001). Seizure onset was reduced and grade was increased (p<0.001). Thalidomide reduced the morphological, histological (p<0.002), DNA fragmentation and seizure grade (p<0.001) while increased seizure onset (p<0.001) in the arthritis group. TNFalpha levels in both plasma and brain were reduced following thalidomide treatment (p<0.002) in arthritis group. There were no significant findings in colitis or cotton wool granuloma groups. CONCLUSION: Inflammation was associated with decreased threshold to PTZ induced seizure. Thalidomide is effective in reducing the extent of arthritis as well as reducing the seizure scoring and increasing seizure onset in the adjuvant arthritis group. Thalidomide was also effective in reducing TNFalpha levels thus contributing to its antiepileptic activity.

Isolation and characterization of ethanol-producing yeasts from fruits and tree barks.

AIMS: Isolation and identification of yeasts converting xylose to ethanol. METHODS AND RESULTS: A total of 374 yeasts were isolated from a variety of rotten fruits and barks of trees. Out of these, 27 yeast strains were able to assimilate xylose and produce 0.12-0.38 g of ethanol per gram of xylose. Based on phylogenetic analysis of D1/D2 domain sequence of LSU (Large Subunit) rRNA gene and phenotypic characteristics the ethanol-producing strains were identified as member(s) of the genera Pichia, Candida, Kluyveromyces, Issatchenkia, Zygosacchraomyces, Clavispora, Debaryomyces, Metschnikowia, Rhodotorula and Cryptococcus. CONCLUSION: Yeast strains producing ethanol from xylose have been isolated from a variety of rotten fruits and barks of trees and identified. SIGNIFICANCE AND IMPACT OF THE STUDY: Environmental isolates of yeasts which could convert xylose to ethanol could form the basis for bio-fuel production and proper utilization of xylan rich agricultural and forest wastes.

Effectiveness of reproductive health education among rural adolescent girls: a school based intervention study in Udupi Taluk, Karnataka.

BACKGROUND: Adolescence is the most important and sensitive period of one's life [1] . According to the World Health Organization (WHO) Expert Committee, adolescence is defined as the period between 10 and 19 years, the second decade of life. OBJECTIVE: To determine the effectiveness of an educational intervention program on knowledge of reproductive health among adolescent girls. SETTINGS AND DESIGN: This educational intervention study was carried out over a period of one year. A total of 791 rural girls in the age group 16-19 years were randomly selected from coastal villages in Udupi District, Karnataka. MATERIALS AND METHODS: Adolescent girls were educated regarding reproductive health and their awareness levels were evaluated immediately following intervention. STATISTICAL ANALYSIS: Data was tabulated and analyzed using SPSS version 11.0 for Windows. Findings were described in terms of proportions and percentages. Chi square test was used to test the effect of the intervention. RESULTS: A significant increase in overall knowledge after the intervention (from 14.4 to 68%, P < 0.01) was observed regarding contraception. Knowledge regarding ovulation, first sign of pregnancy and fertilization improved by 37.2% (95% CI = (35.2, 39.2), P < 0.001). Knowledge regarding the importance of diet during pregnancy improved from 66 to 95% following the intervention. CONCLUSION: This study clearly showed that an educational intervention program can bring about a desirable change in knowledge among adolescent girls regarding reproductive health.

Clonidine as a Sole Epidural Adjuvant in Combined Spinal-epidural: Clinical Study.

BACKGROUND AND AIMS: Clonidine has been used as an epidural adjuvant along with local anesthetics; however, its use as a sole epidural adjuvant in combined spinal-epidural (CSE) anesthesia has not been explored; thus, this study aimed to assess the effects of clonidine as a sole epidural adjuvant in CSE on sensory and motor characteristics of 0.5% hyperbaric bupivacaine given by subarachnoid route. METHODOLOGY: A total of 60 patients belonging to the American Society of Anesthesiologists Classes I and II aged 18-60 years were randomized in two groups; group G300 and group GNS. G300 group received 300 mg clonidine and GNS received normal saline through epidural route followed by 15 mg of 0.5% hyperbaric bupivacaine as subarachnoid block. Onset of sensory block (time to T10) and motor block (time to Bromage 3), level of sedation (using Modified Ramsay Sedation Score), and hemodynamic changes were recorded. Two-segment regression, duration of analgesia (time for 1st rescue analgesia), and motor block (time to Bromage 0) were recorded. Student's t-test (two-tailed, independent) and Chi-square/Fisher's exact probability test were used for statistical analysis. RESULTS: The demographic data were comparable between the groups. The onset of sensory and motor block was significantly faster in G300 (sensory-71.63 ± 4.51 s, motor-55.63 ± 2.54 s) as compared to GNS (sensory-90.13 ± 4.88 s, motor-118.43 ± 9.50 s) (P < 0.001 and < 0.001, respectively). The two-segment regression was 199.33 ± 19.11 min and 79 ± 9.77 min in G300 and GNS, respectively, (P < 0.001). Duration of analgesia was 317.90 ± 15.32 min and 207 ± 20.66 min for G300 and GNS, respectively (P < 0.001), and duration of motor block was 409.9 ± 34.87 min and 204 ± 22.79 min for G300 and GNS, respectively (P < 0.001). The side effects such as hypotension and bradycardia were statistically and clinically not significant. CONCLUSION: Clonidine used as a sole epidural adjuvant in dose of 300 mg, for infraumbilical surgeries, has significantly faster onset of sensory and motor block with prolonged duration of analgesia and motor blockade and no significant side effects on a conventional subarachnoid block performed with 0.5% hyperbaric bupivacaine.

The Effect of Single-dose Intravenous Dexamethasone on Postoperative Pain and Postoperative Nausea and Vomiting in Patients Undergoing Surgery under Spinal Anesthesia: A Double-blind Randomized Clinical Study.

BACKGROUND: The use of neuraxial anesthesia has dramatically increased. Acute postoperative pain is an undesirable outcome that can delay functional recovery for patients undergoing surgery. Nausea and vomiting in the postoperative period occurs in 20%-30% of the patients and together are the second-most common complaint reported (pain is the most common). Efficacy of glucocorticoids for reducing pain and inflammation after surgery is being explored. Glucocorticoids are strong anti-inflammatory agents, which can be used for a short-time postoperative pain control in various surgeries. Dexamethasone is a glucocorticoid with little mineralocorticoid effect commonly used perioperatively to reduce postoperative nausea and vomiting (PONV) and has a beneficial role in postoperative analgesia. Dexamethasone has also an antiemetic effect, in addition to its anti-inflammatory and analgesic effects. AIM: The main purpose of this study is to evaluate the effect of administration of single-dose intravenous (i.v.) dexamethasone on postoperative pain and PONV in patients undergoing surgery under spinal anesthesia. SETTINGS AND DESIGN: A double-blind randomized clinical study was performed in our institute between November 2014 and October 2015 after obtaining clearance from the ethical committee. MATERIALS AND METHODS: A double-blind randomized clinical study was performed on 60 patients posted for surgery under spinal anesthesia. Patients were randomly assigned into two groups: A (study: 2 ml [8 mg] dexamethasone) and B (control: 2 ml saline). In both the groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate, severity of pain (based on visual analog scale), and other symptoms such as nausea and vomiting were recorded at different time points during the first 24 h after surgery. Statistical methods using Student t-test (two-tailed, independent) and Fischer's exact test were used for analyzing the data. RESULTS: Between-group comparisons indicated significant differences in terms of severity of postoperative pain and PONV (P < 0.001), MAP (P = 0.063), and HR (P = 0.071), which in the study group were lower than the control group. CONCLUSION: i.v. dexamethasone is efficient in reducing postoperative pain, requirement of rescue analgesia on the first postoperative day, and incidence of PONV with no significant changes in vital signs.

MU-LOC: A Machine-Learning Method for Predicting Mitochondrially Localized Proteins in Plants.

Targeting and translocation of proteins to the appropriate subcellular compartments are crucial for cell organization and function. Newly synthesized proteins are transported to mitochondria with the assistance of complex targeting sequences containing either an N-terminal pre-sequence or a multitude of internal signals. Compared with experimental approaches, computational predictions provide an efficient way to infer subcellular localization of a protein. However, it is still challenging to predict plant mitochondrially localized proteins accurately due to various limitations. Consequently, the performance of current tools can be improved with new data and new machine-learning methods. We present MU-LOC, a novel computational approach for large-scale prediction of plant mitochondrial proteins. We collected a comprehensive dataset of plant subcellular localization, extracted features including amino acid composition, protein position weight matrix, and gene co-expression information, and trained predictors using deep neural network and support vector machine. Benchmarked on two independent datasets, MU-LOC achieved substantial improvements over six state-of-the-art tools for plant mitochondrial targeting prediction. In addition, MU-LOC has the advantage of predicting plant mitochondrial proteins either possessing or lacking N-terminal pre-sequences. We applied MU-LOC to predict candidate mitochondrial proteins for the whole proteome of Arabidopsis and potato. MU-LOC is publicly available at http://mu-loc.org.

Downstaging for cervical cancer: a community-based study in the rural areas of Udupi district, Karnataka, India.

The objective of this study is to determine the feasibility of utilizing trained auxiliary nurse midwives (ANMs) in downstaging for cancer cervix in a rural area. The study population included all married women in the age group of 35-59 years in two villages of the field practice area. It was a cross-sectional study. Two ANMs were trained in history taking, visual inspection of the cervix, using of speculum and collecting Papanicolaou smears. After training, they made home visits and identified women with gynaecological symptoms suggestive of cervical cancer. These women were asked to report to Rural Maternity and Child Welfare whom homes where the ANMs did a visual inspection of the cervix and made a cervical smear. A total of 1402 women were registered of the ANMs could identify 368 women (26%) with symptoms. Only 192 (52.2%) of these women reported for examination. Chronic cervicitis accounted for the largest proportion of the cases (44.8%). In all, three cases were diagnosed as suspected cases of cancer cervix. On cytology, three cases (1.5%) turned out to be malignant. When clinical findings of the ANM were compared with results of cytological examination, a high degree of sensitivity (78.4%) and positive predictive value (97.1%) were observed in diagnosing abnormal cytological findings. However, the sensitivity for detecting specific conditions was generally low. Sensitivity for detecting erosion was 45%, for chronic cervicitis 30%, and malignancies were totally missed. In conclusion, this study clearly shows that ANMs, if trained, would be capable of identifying symptomatic women, differentiating a normal cervix from an abnormal one and taking an adequate smear for cytological examination.

Perfusion index as a predictor of hypotension following spinal anaesthesia in lower segment caesarean section.

BACKGROUND AND AIMS: Perfusion index (PI) is a new parameter tried for predicting hypotension during spinal anaesthesia for the lower segment caesarean section (LSCS). This study aimed at investigating the correlation between baseline perfusion index and incidence of hypotension following SAB in LSCS. METHODS: In this prospective observational study, 126 parturients were divided into two groups on the basis of baseline PI. Group I included parturients with PI of ≤3.5 and Group II, parturients with PI values >3.5. Spinal anaesthesia was performed with 10 mg of injection bupivacaine 0.5% (hyperbaric) at L3-L4 or L2-L3 interspace. Hypotension was defined as mean arterial pressure <65 mmHg. Statistical analysis was performed using Chi-square test, independent sample t-test and Mann-Whitney U-test. Regression analysis with Spearman's rank correlation coefficient was done to assess the correlation between baseline PI and hypotension. Receiver operating characteristic (ROC) curve was plotted for PI and occurrence of hypotension. RESULTS: The incidence of hypotension in Group I was 10.5% compared to 71.42% in Group II (P < 0.001). There was significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs0.416, P < 0.001) and total dose of ephedrine (rs0.567, P < 0.001). The sensitivity and specificity of baseline PI of 3.5 to predict hypotension was 69.84% and 89.29%, respectively. The area under the ROC curve for PI to predict hypotension was 0.848. CONCLUSION: Baseline perfusion index >3.5 is associated with a higher incidence of hypotension following spinal anesthesia in elective LSCS.

The proteome of higher plant mitochondria.

Plant mitochondria perform a wide range of functions in the plant cell ranging from providing energy and metabolic intermediates, via coenzyme biosynthesis and their own biogenesis to retrograde signaling and programmed cell death. To perform these functions, they contain a proteome of >2000 different proteins expressed in some cells under some conditions. The vast majority of these proteins are imported, in many cases by a dedicated protein import machinery. Recent proteomic studies have identified about 1000 different proteins in both Arabidopsis and potato mitochondria, but even for energy-related proteins, the most well-studied functional protein group in mitochondria, <75% of the proteins are recognized as mitochondrial by even one of six of the most widely used prediction algorithms. The mitochondrial proteomes contain proteins representing a wide range of different functions. Some protein groups, like energy-related proteins, membrane transporters, and de novo fatty acid synthesis, appear to be well covered by the proteome, while others like RNA metabolism appear to be poorly covered possibly because of low abundance. The proteomic studies have improved our understanding of basic mitochondrial functions, have led to the discovery of new mitochondrial metabolic pathways and are helping us towards appreciating the dynamic role of the mitochondria in the responses of the plant cell to biotic and abiotic stress.

Electronic topological and structural transitions in AuGa(2) under pressure.

Results of electronic band structure calculations, electrical resistance, thermoelectric power (TEP), and x-ray diffraction measurements, under pressure carried out on AuGa(2) to investigate its anomalous behaviour are reported. The first principles electronic band structure calculations confirm that a flat band close to the Fermi level along the Γ-X direction of the Brillouin zone is responsible for the unusual behaviour of AuGa(2). In synchrotron-based high-pressure x-ray diffraction measurements, it is observed to undergo a structural phase transition above 7 GPa. The TEP variation with pressure and the P-V data up to 7 GPa transformed to the universal equation of state (UEOS) indicate the existence of an electronic topological transition (ETT) near 3.2 GPa. Consistent with this, in electronic structure calculations carried out at reduced sample volume corresponding to 4 GPa, it is seen that the flat band crosses the Fermi level. The structure above 7 GPa is a distortion of the CaF(2) phase. This structure continuously evolves with increasing pressure. The continuous variation of electrical resistance across the transition is consistent with this.

Oral contraceptive use and risk of gestational trophoblastic tumors.

BACKGROUND: Gestational trophoblastic disease refers to a spectrum of rare benign and malignant gynecologic disorders whose pathogenesis is not well understood. Recent studies from China and the United States have raised the hypothesis that long-term use of oral contraceptives before conception may increase the risk of gestational trophoblastic tumors. A multicenter case-control study of gestational trophoblastic tumors was undertaken to test this hypothesis. METHODS: Telephone interviews were conducted with 235 case patients, including 50 with gestational choriocarcinoma, and 413 control subjects matched on recentness of pregnancy, age at pregnancy, and area of residence. Relative risks (odds ratios) were computed by conditional logistic regression. Reported P values are two-sided. RESULTS: The relative risk estimate for ever having used oral contraceptives before the index pregnancy was 1.9 (95% confidence interval [CI] = 1.2-3.0), and the risk increased with duration of use (P for trend = .05). The estimate was highest for women who used oral contraceptives during the cycle in which they became pregnant (relative risk = 4.0; 95% CI=1.6-10), but there was no consistent pattern according to the time interval since last use. Separate analyses of choriocarcinoma and persistent mole yielded similar results, i.e., the relative risk estimates for oral contraceptive use were 2.2 (95% CI=0.8-6.4) and 1.8 (95% CI=1.0-3.0), respectively. Control for the number of sexual partners, which was independently associated with risk (P for trend = .05), did not materially change the results. CONCLUSIONS: This study, the largest to date, indicates that long duration of oral contraceptive use before conception increases the risk of gestational trophoblastic tumors. These findings may provide clues to the pathogenesis of this rare disease. Changes in use of oral contraceptives are not warranted, however, because the incidence attributable to oral contraceptive use is very low.

PIP: Recent studies in the US and China have suggested that long-term use of oral contraceptives (OCs) before conception increases the risk of gestational trophoblastic tumors. This association was investigated further in a study conducted at 8 US medical centers that specialize in the treatment of this gynecologic disorder. 235 cases, including 50 women with gestational choriocarcinoma, were matched with 413 controls on recentness of pregnancy, age at pregnancy, and area of residence. The relative risk estimate for ever-use of OCs before the index pregnancy was 1.9 (95% confidence interval [CI], 1.2-3.0) and the risk increased with duration of OC use. The relative risk was highest (4.0; 95% CI, 1.6-10.0) for women who used OCs during the cycle in which they became pregnant, but there was no consistent pattern according to the time interval since last OC use. The relative risks for choriocarcinoma and persistent mole associated with OC use were 2.2 (95% CI, 0.8-6.4) and 1.8 (95% CI, 1.0-3.0), respectively. This study, the largest to date, suggests that a long duration of OC use before conception does, indeed, increase the risk of gestational trophoblastic tumors.

Ergonomical aspects of anaesthetic practice.

Anaesthesiologist's service begins as a general physician, goes on as an investigator cum data analyser leading to the architectural planning of a forthcoming surgical event, but only after articulately convincing the subject along with his kith and kin. In the era of rapid developments in the field of medicine which includes relevant developments in anaesthetic care, an adequate work environment has to be provided to the anaesthesia team so that all anaesthetic procedures can be carried out safely and efficiently and an optimal workflow can be established in the operating room environment. Such ecological state demands an updated knowledge and ergonomics to aid him. Unfortunately, ergonomics is an area of anaesthesia that has received little attention and should be addressed through more education and training for workplace well-ness. Hence, an attempt is made to discuss few aspects on ergonomics for the interface between anaesthesiologist-machine-patient systems regarded as human-machine-system.