Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period.

BACKGROUND: Adductor canal block (ACB) is a peripheral nerve blockade technique that provides good pain control in patients undergoing total knee arthroplasty which however does not relieve posterior knee pain. The recent technique of an ultrasound-guided local anesthetic infiltration of the interspace between popliteal artery and the capsule of posterior knee (IPACK) has shown promising results in providing significant posterior knee analgesia without affecting the motor nerves. MATERIALS AND METHODS: A prospective study was conducted from September 2016 to March 2017 in a total of 120 patients undergoing unilateral total knee arthroplasty. The initial 60 consecutive patients received ACB + IPACK (Group 1, n = 60), and the subsequent 60 patients received ACB alone (Group 2, n = 60). All patients were evaluated with VAS score for pain recorded at 8 h, postoperative day (POD) 1 and POD 2 after the surgery. The secondary outcome measures assessed were the range of movement (ROM) and ambulation distance. RESULTS: VAS score showed significantly (p < 0.005) better values in ACB + IPACK group compared to the ACB group. The mean ROM of knee and ambulation distance also showed significantly better values in ACB + IPACK group compared to the ACB group. CONCLUSION: ACB + IPACK is a promising technique that offers improved pain management in the immediate postoperative period without affecting the motor function around the knee joint resulting in better ROM and ambulation compared to ACB alone.

Perspectives of Indian traditional and allopathic professionals on religion/spirituality and its role in medicine: basis for developing an integrative medicine program.

Allopathic medical professionals in developed nations have started to collaborate with traditional, complementary, and alternative medicine (TCAM) to enquire on the role of religion/spirituality (r/s) in patient care. There is scant evidence of such movement in the Indian medical community. We aim to understand the perspectives of Indian TCAM and allopathic professionals on the influence of r/s in health. Using RSMPP (Religion, Spirituality and Medicine, Physician Perspectives) questionnaire, a cross-sectional survey was conducted at seven (five TCAM and two allopathic) pre-selected tertiary care medical institutes in India. Findings of TCAM and allopathic groups were compared. Majority in both groups (75% of TCAM and 84.6% of allopathic practitioners) believed that patients' spiritual focus increases with illness. Up to 58% of TCAM and allopathic respondents report patients receiving support from their religious communities; 87% of TCAM and 73% of allopaths believed spiritual healing to be beneficial and complementary to allopathic medical care. Only 11% of allopaths, as against 40% of TCAM, had reportedly received 'formal' training in r/s. Both TCAM (81.8%) and allopathic (63.7%) professionals agree that spirituality as an academic subject merits inclusion in health education programs (p = 0.0003). Inclusion of spirituality in the health care system is a need for Indian medical professionals as well as their patients, and it could form the basis for integrating TCAM and allopathic medical systems in India.

Efficacy of MLC based cobalt-60 plans: A DVH comparison and analysis with 6 MV plans.

The purpose of this study was to compare 3D treatment plans implemented using 6 MV Linac with a retrofitted multileaf collimator (MLC) based cobalt-60 plans. In this retrospective study, DVH analysis was used to compare homogeneity of dose within the target and the dose received by critical organs. A prototype MLC designed and developed as a retrofit to current cobalt-60 teletherapy machines with a dedicated 3D treatment planning system was used. Cases representing 5 tumor sites like head & neck, glottis, lung, gall bladder, stomach were taken for the study, which were planned using Eclipse treatment planning system and treated with 6 MV photon beams. The plans were re-planned using the retrofit cobalt-60 MLC with same beam arrangement and dose prescription in Radiation Oncology planning system (ROPS). For each case, DVH data was evaluated for both types of beam energies. Conformity index (CI) and homogeneity index (HI) for target were calculated and compared. The conformal plans created using cobalt MLC for five sites were found to be similar to those planned using 6 MV photon beams. CI values close to unity reflected dose uniformity in the target volume while HI evaluated the hotspots in the target volume. It was concluded that plans created using retrofit prototype MLC developed for cobalt-60 teletherapy machines can provide dose distributions comparable to 6 MV photon beams. The prototype MLC developed can provide a promising treatment option for existing telecobalt machines in implementing conformal therapy in developing countries.

Estimation of Skin doses for Retrofit Prototype Multileaf Collimators Designed for Telecobalt Therapy Machine.

AIM: The objective of this study was to evaluate skin dose based on retrofit prototype multileaf collimators (MLCs), designed for cobalt-60 teletherapy machine. Since patient's skin is sensitive to radiation, evaluation of skin dose is of utmost importance for investigating the risk of late effects. MATERIALS AND METHODS: Measurements were performed with a Phoenix cobalt-60 teletherapy machine and the detector used was EBT3 radiochromic film. The experiments were performed in a solid water phantom with two prototype MLCs mounted to the machine. Dose readings were taken by placing the films at source-to-surface distance (SSD) of 60 cm, 65 cm, 70 cm, 75 cm, 80 cm, 85 cm, and 90 cm for various MLC-generated field sizes starting from 2 cm × 2 cm to 14 cm × 14 cm. The films were analyzed using custom made programs. The measured doses were normalized to the dose at dmax for that particular measurement of SSD. RESULTS: The skin dose is expressed as a percentage of dose at dose maximum. In general, the skin dose increases with field size and decreases with SSD. The measurements indicate surface doses within 20%-60% for the investigated SSD range. Furthermore, there is no significant difference between the surface doses of two prototype MLCs studied. CONCLUSIONS: From the measurements, it can be concluded that there is good skin sparing even at close distance to the MLCs. The skin dose is <50% for SSDs >65 cm. A minimum gap of 5 cm is required to produce acceptable skin dose.

Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study.

PURPOSE: Pain management after total knee arthroplasty has seen many recent advances such as peripheral nerve blocks in order to improve the functional outcome and reduce morbidity after surgery. Adductor canal block (ACB) and multimodal periarticular infiltration (MPI) are two techniques that have been proven to be efficacious individually. We hypothesized that the combination of ACB with MPI would reduce pain and improve knee range of movement (ROM) compared to ACB alone. METHODS: A prospective non-randomized study was conducted from July 2015 to December 2015 in our institution in a total of 200 consecutive patients undergoing unilateral total knee arthroplasty who were either given ACB alone (Group 1, n = 100 patients) or ACB + MPI (Group 2, n = 100 patients). All the patients were assessed for severity of pain by Visual Analogue Scale (VAS) at 8, 24, 48 h postoperatively and knee ROM after 48 h. RESULTS: Patients in ACB + MPI group had significantly better VAS scores at 8 h postoperatively but showed no significant difference at 24 and 48 h compared to ACB group. Patients in ACB + MPI group showed significantly better knee ROM after 48 h. CONCLUSIONS: Our study concludes that patients receiving ACB + MPI have demonstrated better VAS scores in the immediate postoperative period but have no significant difference at the time of discharge.

Contraceptive, cerebral vein thrombosis and choked discs.

PURPOSE: To raise awareness of the importance of prompt and appropriate imaging in patients presenting with signs and symptoms suggestive of idiopathic intracranial hypertension. METHODS: Case report with diagnostic tests and discussion of management options. RESULTS: A 15-year-old girl presenting with bilateral optic disc swelling was noted to have extensive thrombosis of intracerebral venous sinuses with the clot extending along the internal jugular vein as inferior as the root of the neck demonstrable on magnetic resonance venography. CONCLUSIONS: Ophthalmologists should be vigilant in obtaining appropriate imaging in cases of optic disc swelling.

Requirements for double-strand cleavage by chimeric restriction enzymes with zinc finger DNA-recognition domains.

This study concerns chimeric restriction enzymes that are hybrids between a zinc finger DNA-binding domain and the non-specific DNA-cleavage domain from the natural restriction enzyme FOK:I. Because of the flexibility of DNA recognition by zinc fingers, these enzymes are potential tools for cleaving DNA at arbitrarily selected sequences. Efficient double-strand cleavage by the chimeric nucleases requires two binding sites in close proximity. When cuts were mapped on the DNA strands, it was found that they occur in pairs separated by approximately 4 bp with a 5' overhang, as for native FOK:I. Furthermore, amino acid changes in the dimer interface of the cleavage domain abolished activity. These results reflect a requirement for dimerization of the cleavage domain. The dependence of cleavage efficiency on the distance between two inverted binding sites was determined and both upper and lower limits were defined. Two different zinc finger combinations binding to non-identical sites also supported specific cleavage. Molecular modeling was employed to gain insight into the precise location of the cut sites. These results define requirements for effective targets of chimeric nucleases and will guide the design of novel specificities for directed DNA cleavage in vitro and in vivo.

Genetic control of quercetin formation in the aleurone tissue of maize.

The genes C, C2, R, A, A2, Bz, Bz2 and Pr are required for the formation of purple anthocyanin in the aleurone tissue of maize, and the recessive gene(s) result in non-purple (red, bronze and colorless). Aleurone extracts of recessive a and certain double recessive combinations were analyzed by paper chromatography, absorption spectra in the ultraviolet (UV) and infrared, mass spectra, and other analytical techniques. Homozygous recessive a tissue accumulates the flavonol, quercetin, while the double combinations a c and a r lack it, suggesting that dominant genes C and R are required for its formation and act prior to A in the synthesis of flavonols, as in the gene action sequence for anthocyanin synthesis. Dominant C-I inhibits the formation of quercetin, whereas Bz, Bz2 and In do not affect its formation. These results suggest a close biogenetic relationship between quercetin and cyanidin-3-glucoside and also independently confirm the position of A in both sequences.

Ultraviolet-B-Responsive Anthocyanin Production in a Rice Cultivar Is Associated with a Specific Phase of Phenylalanine Ammonia Lyase Biosynthesis.

Seedlings of 17 rice (Oryza sativa L.) cultivars were classified on the basis of anthocyanin pigmentation into three groups: an acyanic group with 9 cultivars, a moderately cyanic group with 5 cultivars, and a cyanic group with 3 cultivars. Seedlings of the cyanic group were deep purple in color, possessing copious amounts of anthocyanin in shoots. Sunlight (SL)-mediated anthocyanin and phenylalanine ammonia lyase (PAL) induction in a cyanic cultivar, purple puttu, was compared with an acyanic cultivar, black puttu. A brief exposure of dark-grown purple puttu seedlings to SL induced anthocyanin formation during a subsequent dark period with a peak at 24 h. The magnitude of SL-mediated anthocyanin induction is age dependent, the 4-d-old seedlings being the most responsive to SL. The anthocyanin induction in purple puttu seedlings is mediated exclusively by the ultraviolet-B (UV-B) component of SL. The SL-triggered anthocyanin induction was reduced by about 30% by a terminal far-red light pulse and was restored by a red light pulse, indicating the role of phytochrome in modulation of anthocyanin level. The SL-mediated induction of PAL showed two peaks, one at 4 h and the other at 12 h. Whereas the first PAL peak (4 h) was induced by phytochrome and was seen in both cultivars, the second PAL peak (12 h) was inducible by UV-B only in the cyanic purple puttu cultivar.

DNA helix destabilization by proline and betaine: possible role in the salinity tolerance process.

Evidence is provided for the ability of proline, a salinity induced osmoprotectant, to destabilize the double helix and lower the Tm of DNA in a concentration dependent manner. At the reported salinity-adaptive bio-accumulation of 1 M and above, proline could considerably decrease the Tm and partially counteract the effect of sodium chloride and spermidine on DNA stability. On the contrary, several other amino acids tested did not show any such destabilizing effect on DNA helix. Enhanced susceptibility to S1 nuclease and insensitivity to DNase I in presence of increasing proline concentrations have further suggested a clear destabilization of the double helix. Such an effect is somewhat reminiscent of the interaction between betaine, another salinity induced osmolyte, and DNA resulting in decreased Tm values. These interactions may be significant in view of the abundance of such osmolytes in cells under salinity stress-adapted conditions, with many a bacterial mutant accumulating them exhibiting improved tolerance to salinity.

Nucleosides. 150. Synthesis and some biological properties of 5-monofluoromethyl, 5-difluoromethyl, and 5-trifluoromethyl derivatives of 2'-deoxyuridine and 2'-deoxy-2'-fluoro-beta-D-arabinofuranosyluracil.

A new synthesis of 5-(monofluoromethyl)- and 5-(difluoromethyl)-2'-deoxy-2'-fluoro-beta-D-arabinofuranosyluracil (F-FMAU and F2-FMAU) is reported. 3',5'-Di-O-(tert-butyldiphenyl)silylated thymidine or FMAU was photochemically brominated with NBS to the corresponding alpha-monobromide, which was hydrolyzed to the 5-hydroxymethyl derivative. Further oxidation of the latter with MnO2 afforded the 5-formyluracil nucleoside. Treatment of these nucleosides with DAST in CH2Cl2 gave the protected alpha-fluorinated nucleosides. Desiylation with TBAF afforded the desired free nucleosides. Also, 5-(trifluoromethyl)-2'-deoxy-2'-fluoro-beta-D-arabinofuranosyluracil (F3-FMAU) was synthesized by copper-catalyzed trifluoromethylation of 5-iodo-2'-fluoro-ara-U (FIAU). These new nucleosides were studied in comparison with the corresponding 2'-deoxy-erythro-pentofuranosyl derivatives, for their inhibitory activity against cellular thymidylate synthase (TS) and [3H]TdR incorporation into DNA, cytotoxicity against HL-60 cells, and antiviral activity against herpes simplex types 1 and 2 (HSV-1 and -2). F2-TDR and F3-TDR strongly inhibited TS and were also quite cytotoxic and antiherpetic, whereas FTDR was only active in the antiviral assay. In the 2'-fluoroarabino series, fluorine substitution at the alpha-methyl function did not alter significantly the antiherpetic activity. Although FMAU and F-FMAU did not inhibit TS to any significant extent, F2-FMAU and F3-FMAU were weakly inhibitory. The latter nucleosides did not inhibit [3H]TDR incorporation into DNA, while all the other alpha-fluorinated thymine nucleosides inhibited the incorporation of radioactivity of [3H]TDR into DNA to various extents. F2-FMAU and F3-FMAU were about 2 orders of magnitude less cytotoxic against HL-60 cells than were F2-TDR and F3-TDR. The results strongly suggest that in both the 2'-deoxy-2'-fluoroarabino and the 2'-deoxy-erythro-pentofurano series the cytotoxic action of the alpha,alpha-difluoro and alpha,alpha,alpha-trifluoro derivatives may involve the inhibition of TS. The synthesis of [2-14C]F2-FMAU, as an experimental imaging agent, is also described. Unfortunately, the highly selective uptake of the labeled compound within infected brain regions previously noted with [2-14C]FMAU was not detected with the derivative [2-14C]F2-FMAU.

Inhibition of cellular thymidylate synthesis by cytotoxic propenal derivatives of pyrimidine bases and deoxynucleosides.

A series of cytotoxic propenal (3-oxoprop-1-enyl) derivatives of pyrimidine bases and deoxynucleosides was evaluated for their ability to block thymidylate synthesis in intact and permeabilized murine leukemia L1210 cells. Several were potent inhibitors of this process, likely contributing to their cytotoxicity. The IC50 values of thymidine-3-propenal, the prototype of this series, in intact and permeabilized L1210, L-M and L-M(TK-) cells were 21, 7.5, and 75 microM and 1.5, 1.7, and 3.5 microM, respectively. The related base analogue, thymine-1-propenal, is a product of bleomycin-induced DNA strand-scission; the results of the present study bear on the mode of action of this antibiotic.

Comparison of tryptic peptide profiles of alcohol dehydrogenase from Drosophila melanogaster at different ages: a rapid procedure using high performance liquid chromatography.

Age-related changes in the primary structure of alcohol dehydrogenase (ADH) from three different strains (Adh-F, Adh-D and Adh-S) of Drosophila melanogaster have been investigated by tryptic peptide analysis. The procedure involves isolation of 14C-labelled ADH, immunoprecipitation and HPLC separation of tryptic peptides. This method is rapid, reproducible and sensitive. By using this procedure it is demonstrated that there are no significant differences between the ADH tryptic peptide profiles of young (10-day-old) and old (50-day-old) flies. The usefulness of this procedure for screening mutant and variant enzymes is discussed.

A modified geometric factor approach to internal gamma ray dosimetry.

In internal gamma-ray dosimetry, the conventional geometric factor approach, where the "effective absorption coefficient" is taken as 0 or 0-028 cm-1, irrespective of source energy, leads to significant errors especially in the low energy region. An ettempt has been made in this paper to modify the approach to increase the accuracy of calculation and to extend its usefulness to low energies while retaining its inherent simplicity. The modification consists in replacing the effective absorption coefficient by the attenuation coefficients appropriate to the source energies and taking into account the effects due to multiple scattering by using point source build-up factor. The method has been applied for the particular case of dosimetry of a sphere. Comparison of the results obtained by this method with those got from Monte Carlo computations indicates excellent agreement at higher energies and a departure of around 15 per cent only at lower energies (as against a variation of 400 per cent when conventional geometric factor approach is used).

Organ weights in autopsy cases from an urban apex hospital.

The available limited anatomical and physiological data have been compiled for Indian adult as a part of ongoing efforts in the country to formulate an Indian Reference Man for radiation protection purposes. The parameters included weight, height, body surface area, weight of various organs (brain, heart, kidney, lung, liver etc.), total body water, extra-cellular water, blood volume, specific gravity, total lung capacity, vital capacity etc. The data have been drawn from post-mortem studies (566 males and 185 females) and other data from published work on 433 healthy male and 137 female volunteers. Data gaps have been filled by the method of pooling wherever necessary. This paper presents the intercomparison of the present data with the data available from other sources. The data from various Indian sources indicate a similar trend. However, a significant difference (P less than 0.01) was observed in organ weights and total body weights, in comparison to the Bhabha Atomic Research Centre (BARC) values. The present data are not comprehensive enough to suggest definitive norms of the Indian Reference Man.

Design of SAW bandpass filters using new window functions.

Simple analytical expressions involving Bessel functions are obtained for various window functions. Some of the windows take the form of Kaiser-Bessel and Dolph-Chebyshev functions. The performance of various windows is evaluated with respect to shape factor and sidelobe level. Design data is presented for designing the surface acoustic-wave (SAW) filters using smooth window functions. The design of SAW filters using sin (t)/t-type apodization profile is outlined for various window functions. For given filter specifications, such as center frequency, 3-dB bandwidth, shape factor, and sidelobe level, the design procedure is used to compute the apodized transducer length and apodization profile.

Formulation of the reference Indian adult: anatomic and physiologic data.

Data on heights and weights of Indian males and females of various ages are presented. The weights of specific organs obtained from post-mortem records of accident cases of Indian adults and children are also presented to provide some inputs towards formulation of an Indian Reference Man for radiation protection purposes. An intercomparison of the present data with the data available from other sources including those for ICRP Reference Man, Woman, and Child has been made. The daily intakes of air, water, and dietary constituents of an average Indian adult are also given.

Structural characterization of impurities in pioglitazone.

In the pioglitazone bulk drug three prominent impurities I-III were detected up to concentrations of 0.1% (ranging from 0.05-0.1%) by reversed phase HPLC. These impurities were isolated from enriched mother liquor samples and characterized as 5-(4-hydroxybenzyl)-1,3-thiazolidine-2,4-dione (I) 5-(4-fluorobenzyl)-1,3-thiazolidine-2,4-dione (II), 2-[2-(4-bromophenoxy) ethyl-5-ethyl pyridine (III) based on their 1H, and 13C NMR, DEPT, Mass and IR spectral data. Structure elucidation and synthesis of these impurities is discussed.

Photosynthesis and kinetic characteristics of rubisco in Hibiscus cannabinus L.

Photosynthetic characteristics in kenaf (Hibiscus cannabinus L.), a C3 plant, were compared with Abelmoschus esculentus (L.) Moench, another member of Malvaceae. Kenaf leaves exhibited significantly higher rate of photosynthesis (40 mg CO2 dm(-2) hr(-1)) which was 24.6 mg dm(-2) hr(-1) in A. esculentus. Rate of photo and dark respiration was similar in both the species. Kenaf leaf photosynthesis had a higher optimum temperature (32 degrees C) than that of A. esculentus (26 degrees C). Photosynthesis in kenaf leaves required higher saturation irradiance (1,600 micromole m(-2) sec(-1)). There was a significant correlation between photosynthetic rate and biomass yield in these species. The primary product of photosynthesis after 5 seconds of 14C-assimilation was 3-PGA in both the species. The kinetic properties of RuBP carboxylase/oxygenase were determined in the leaf extracts. Higher carboxylase activities were recorded with kenaf leaf extracts (245 pmole mg chl(-1) hr(-1)). Km (CO2) for kenaf leaf carboxylase was significantly lower (7.8 microM) than A. esculentus (13.5 microM) and corresponding difference in Vmax values of carboxylase was recorded between the two species. The kinetic characteristics of oxygenase were similar in both the extracts. These results indicated the variation in carboxylase activity and its kinetic characteristics reflected a significant difference in CO2 assimilation in C3 plants.

Enhanced photosynthesis in cytozyme-treated blackgram, Phaseolus mungo L.

Foliar application of cytozyme to 30-day-old black-gram plants resulted 48% increase of dry matter accumulation. The increase in fresh and dry weights of total plants was largely due to enhanced CO2 assimilation rates which were associated with increased RuBP carboxylase activities. The photochemical characteristics in the isolated chloroplasts exhibited an increase of 32, 28 and 40%, measured as the photoreduction of DCPIP, FeCN and NADP, respectively. Cytozyme treatment also resulted an increase in the chlorophyll content in leaves.