Search

The gastrointestinal (GI) tract is a vitally important site for the adsorption of nutrients as well as the education of immune cells. Homeostasis of the gut is maintained by the interplay of the intestinal epithelium, immune cells, luminal Ags, and the intestinal microbiota. The well-being of the gut is intrinsically linked to the overall health of the host, and perturbations to this homeostasis can have severe impacts on local and systemic health. One factor that causes disruptions in gut homeostasis is age, and recent research has elucidated how critical systems within the gut are altered during the aging process. Intestinal stem cell proliferation, epithelial barrier function, the gut microbiota, and the composition of innate and adaptive immune responses are all altered in advanced age. The aging population continues to expand worldwide, a phenomenon referred to as the “Silver Tsunami,” and every effort must be made to understand how best to prevent and treat age-related maladies. Here, recent research about changes observed in the intestinal epithelium, the intestinal immune system, the microbiota, and how the aging gut interacts with and influences other organs such as the liver, lung, and brain are reviewed. Better understanding of these age-related changes and their impact on multi-organ interactions will aid the development of therapies to increase the quality of life for all aged individuals.

Telemedicine technology can be used to facilitate consultations from nonburn-trained referring providers. However, there is a paucity of evidence indicating these technologies influence transfer decisions and follow-up care. In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic and clinical data to the burn specialist. A retrospective review was performed on consults to our regional burn center from a Level I trauma center approximately 70 miles away with a shared electronic medical record. Patients were considered to be “down-triaged” if they could be managed locally or if the transfer could occur via personal vehicle instead of ground or air ambulance transport. During the 2-year study period, 126 consultations were made for thermal injuries. Eighty-seven patients (69%) were referred using the Burn App. Overall, 49 patients (39%) were transferred. When the subset of intermediate size (1–10% TBSA) burns were considered (n = 48), the Burn App allowed for successful “down-triage” of 12 patients (33%) referred through the app. No patient referred without the app could be “down-triaged” (P = .02). Although 57 patients (44%) were recommended for outpatient follow-up, only 42% followed up. A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow-up and transfer mode. However, only a minority of patients triaged to outpatient management actually follow up with a regional burn center. Telemedicine efforts should focus on improving not only initial triage, but also aftercare.

Background Many medical students cite an unwelcoming culture in surgery and perceive surgeons as arrogant or unfriendly. These perceptions have been reported as factors discouraging medical students from applying to surgical residency programs. This highlights an opportunity early in medical education to address these negative stereotypes and create opportunities for positive interactions with surgeons. We hypothesize that positive experiences with surgical residents and introduction to representative surgical cases early in the medical school curriculum can provide a real-world context for learning anatomy and encourage students to consider a surgical career. Methods We developed and implemented a series of structured, one-hour, cadaver-based sessions cofacilitated by anatomists and surgical residents for medical students during their anatomy didactics. Sessions included common surgical cases and focused on critical thinking and problem-solving skills, while offering opportunities to review cadaver anatomy. Students completed a postcourse survey. Results Nine sessions were implemented with involvement of eight surgical residents and 185 students; 83 students completed a postcourse survey (response rate of 45%). A majority of students rated the sessions “very helpful” in terms of highlighting the importance of anatomy in medical education (n = 52, 63%) and providing clinical context (n = 59, 71%). 54% (n = 45) indicated interest in a surgical career and 64% (n = 53) agreed that session participation had increased their interest in surgery. Conclusions Overall, students agreed that sessions provided clinical context for their learning and increased interest in a surgical career. Surgical faculty and residents should engage in preclinical medical education to bridge the basic science and clinical years and introduce positive surgical role models early during medical training.

Pulmonary and systemic insults from inhalation injury can complicate the care of burn patients and contribute to significant morbidity and mortality. However, recent progress in diagnosis and treatment of inhalation injury has not kept pace with the care of cutaneous thermal injury. There are many challenges unique to inhalation injury that have slowed advancement, including deficiencies in our understanding of its pathophysiology, the relative difficulty and subjectivity of bronchoscopic diagnosis, the lack of diagnostic biomarkers, the necessarily urgent manner in which decisions are made about intubation, and the lack of universal recommendations for the application of mucolytics, anticoagulants, bronchodilators, modified ventilator strategies, and other measures. This review represents a summary of critical shortcomings in our understanding and management of inhalation injury identified by the American Burn Association’s working group on Cutaneous Thermal Injury and Inhalation Injury in 2018. It addresses our current understanding of the diagnosis, pathophysiology, and treatment of inhalation injury and highlights topics in need of additional research, including 1) airway repair mechanisms; 2) the airway microbiome in health and after injury; and 3) candidate biomarkers of inhalation injury.

Introduction Early screening and intervention for acute stress disorder (ASD), diagnosed within 30 days of the inciting trauma, and post-traumatic stress disorder (PTSD), diagnosed after 30 days, are quality metrics in burn care. However, a considerable knowledge gap remains surrounding these psychological conditions in the outpatient burn setting. In this study, we assessed the effectiveness of ASD and PTSD screening at an academic burn center and identified risk factors for their development. Methods A retrospective cohort study of all patients treated at our ABA-verified burn center’s outpatient clinic, between July 2016 and August 2019, was undertaken. Adult patients with flame, flash, contact, or scald burns who were initially evaluated in the outpatient setting were included. ASD and PTSD were assessed using validated screening tools (ASDS and PCL-5, respectively). ASD/PTSD screening rate, screening tool appropriateness, and subsequent interventions were tracked, along with age, gender, % total body surface area (TBSA) burned, burn mechanism, operative intervention, psychiatric history, substance abuse history, and co-morbidities. Chi-square and Mann-Whitney U tests were used for univariate analysis of categorical and continuous variables, respectively. Results The analysis included 2494 clinic encounters and 1147 unique patients. Patients were screened for ASD or PTSD at 94.8% of encounters. Median age was 36 years (range of 18 to 94 years), 57.6% of patients were male (n=661), and median TBSA burned was 1% (range of 0.1 to 12%). Among all screens, the appropriate screening tool was applied 88.5% of the time. For all encounters, positive screening rates for ASD and PTSD were 13.2% (n=286) and 14.6% (n=48), respectively. Risk factors for positive ASD screens included a history of substance abuse (OR 1.9, p=0.03) and history of psychiatric illness (OR 2.6, p=0.002). Similarly, risk factors for positive PTSD screens included a prior positive ASD screen (OR 9.5, p=0.001), a history of substance abuse (OR 2.1, p=0.04), and a history of psychiatric illness (OR 3.3, p=0.002). Age, gender, burn mechanism, TBSA burned, and need for operative intervention did not predict positive screens. The intervention rate for positive PTSD screens by referral, counseling, or medication, was only 7.9%. Conclusions Demographics and burn severity do not appear to predict development of ASD or PTSD in the outpatient burn population. In contrast, a history of substance abuse or psychiatric illness warrant further attention. Despite consistent use of validated screening tools, these conditions remain under-treated in the outpatient setting, indicating a need for resource-expansion.

Introduction Alcohol has been shown to increase hospital length of stay, complications and mortality in burn patients in studies examining its effects over the past 25 years. In contrast, there is a scarcity of published data on the effects of marijuana and other drugs of abuse in the burn population. The primary aim of this study is to evaluate the clinical outcomes of marijuana use on burn patients in comparison to other drugs of abuse including alcohol. Methods A retrospective cohort study was conducted on 875 burn patients admitted to a verified burn center from July 2015 to July 2019. Patients were identified from our burn registry and additional data was obtained from chart reviews. The primary comparison was between patients with and without a positive toxicology (tox) screens on admission. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used to compare continuous variables, reporting two-tailed p values. Results Results of admission tox screens on all burn admissions were positive in 48% (423) of patients for drugs of abuse including: marijuana 41% (358), alcohol 16% (141), and stimulants 15% (134). Tox screens positive for alcohol were significant for increased: hospital length of stay (LOS) (p=0.0121), ICU LOS (p=0.0166), ventilator days (p=0.0324), number of operations (p=0.0341), and complication rates (p=0.0005). Patients with positive drug, but negative alcohol screens showed significant increases in: hospital LOS (p=0.029), hospital complications (p=0.0251), and wound infections (p=0.04). Patients testing positive for marijuana approached significance for an increased hospital LOS (p=0.0756) and was significant for increased wound infections (p=0.0476). Looking at median ages: tox positive patients (35) were significantly younger (p=< 0.0001) than negative (49). The median age for patients testing positive for marijuana (35) was significantly younger (p=< 0.0001) than those that testing negative (47). Median age regarding alcohol tox screens was insignificant. Looking at significance in median TBSA, significance was found between tox positive (4.3%) and tox negative (3.5%) patients (p=0.004). TBSA was insignificant in the other groups. Conclusions Almost half of all admitted burn patients tested positive for alcohol and other drugs of abuse. As in previous studies, patients testing positive for alcohol continue to have a more complicated hospital course and longer hospital and ICU LOS. Marijuana, positive in 41% of all burn admissions, showed significance in increased wound infections and a slight trend towards an increased hospital stay. Applicability of Research to Practice The association between burns and drugs of abuse including alcohol indicates the need for increased preventative and educational efforts especially in patients suffering from alcohol abuse/dependence and younger patients.

Introduction Acute kidney injury (AKI) in burn patients is known to increase morbidity and mortality, with significant improvement after the initiation of renal replacement therapy (RRT). Our primary objective is to characterize the sub-population of burn patients with early (≤48 hours post-injury) versus late (>48 hours post injury) onset of AKI. We hypothesize that patients with early onset AKI versus late onset AKI have different causalities, risk factors, and outcomes. A secondary aim is to investigate the timing and use of RRT in the setting of early and late AKI with the goal of improving morbidity and mortality. Methods A retrospective cohort study was conducted on all patients admitted to a verified burn center requiring RRT for AKI from 2015 – 2019. Patients were stratified by age, gender, percent total body surface area (TBSA), race, time of onset of AKI, timing of RRT initiation, hospital LOS, pre-admission co-morbidities, admission toxicology, and mortality. Results In total, 1537 burn patients were reviewed and 1.3% (n=20) required RRT for AKI. Out of this cohort, 70% developed early AKI and 30% developed late AKI. Early versus late AKI patients had the same median age (57). Patients with larger TBSA developed early AKI (median TBSA 51%) versus late AKI (median TBSA 21%). Half of the patients who developed late AKI presented with positive alcohol toxicology screens, while 86% of patients with early AKI tested negative. The patient mortality rate in early AKI was 57%, and the mortality rate in late AKI was 17%. Only 14% of early AKI patients required dialysis at discharge, while 33% of late AKI patients required dialysis at discharge. The majority of patients started on early RRT (< 48 hours post injury) did not develop sepsis (43% developed sepsis), while the majority of patients started on late RRT (>48 hours post injury) did develop sepsis (85%). Conclusions Positivity for alcohol on admission may be a predictor for development of late AKI, while larger TBSA may predict early AKI. Mortality is higher for patients with early AKI; however, the need for dialysis at discharge is higher in patients with late AKI. Our data further suggests that early initiation of RRT is negatively correlated with the development of sepsis. Applicability of Research to Practice A deeper understanding of associations and causality of early vs late onset AKI in burn patients will help guide further management and improve outcomes.

Introduction Patients with 90% or greater total body surface area (TBSA) burns of face many unique challenges, including prolonged open wounds and antibiotic use. Furthermore, increased antibiotic use can be associated with increased antibiotic resistance. Despite the commonality, the relationship between prolonged wound closure (months) combined with prolonged duration of antibiotic use (months) has not been fully explored. The specific aim of this study was to examine the evolution of burned patients’ microbiome over time in association with wound healing and antibiotic use. Methods We conducted a retrospective review of all patients admitted to our ABA-verified burn center from 2010-present with 90% TBSA or greater burns who survived to discharge. Demographic data, length of stay, percentage monthly wound closure (including donor sites), microbial culture data of bacteria, yeast, fungus, and mold (YFM), antibiotic susceptibilities, and systemic antimicrobial agents administered were recorded. Statistical analysis was performed using Pearson correlation coefficient. Results Two patients met inclusion criteria. Patient A (PtA), a 36 year old (yo) female with 95% TBSA burns and Patient B (PtB), a 45 yo male with 90% TBSA burns. Patients spent a combined 766 days (PtA 425, PtB 341) as inpatients. 347 separate positive cultures were analyzed, 180 of which were bacterial. 15 distinct species of bacteria were cultured (8 PtA, 9 PtB), along with 4 subtypes of Pseudomonas aeruginosa, and 9 distinct YFM (6 PtA, 6 PtB). Increasing antibiotic resistance was found in 57% (PtA) and 71% (PtB) of bacterial species. Pseudomonas was the most commonly isolated organism in 65% (n=118) of cultures. The relationships between percent wound closure, daily antibiotic use, and Pseudomonas antibiotic resistance are shown in the Graph below. There was a strong correlation between wound closure of >50% with decreased amount of antibiotics used per day (PtA 0.83, PtB 0.86) and decreasing % of Pseudomonas antibiotic resistance (PtA 0.66, PtB 0.8). Conclusions Antibiotic resistance increases over time and efforts should be taken to decrease number of antibiotics administered. As wound closure passes a certain threshold, the number of antibiotics needed decreases, and Pseudomonas antibiotic resistance appears to decrease as well. Applicability of Research to Practice Recognition of different environmental pressures for bacteria may point to changes in microbial resistance patterns and thus clinical management.

Background: Dementia is a progressive decline in cognition, function, behavior and activities of daily living. Many assessment scales are used in screening for cognitive impairment, making diagnosis of dementia and for follow-up. Assessment scales in the domains of cognition, function, behavior, quality of life, depression in dementia, care giver burden and dementia severity are used. There are many tools used to assess cognitive function.Methods: Authors performed the 3 object recall, 3 name recall tests, and included care-giver’s opinion about the patient’s cognitive state as the primary screening test for cognitive impairment. After this, we tested it the patient (in whom any of the above three were impaired) with the MMSE, AD8 and GPCOG instruments.Results: The result were compared of each of the preliminary screening test to each of these three standard tools by applying statistical test (chi square).Conclusions: The screening tests and care giver's opinion about patient's condition (that take 2-3 minutes) have been shown to correlate with MMSE (8 minutes), AD8 (6 minutes), GPCOG (6-9 minutes). This saves the doctor’s, patient’s and caregiver’s time. The screening can be done by trained health worker, thus sparing the geriatrician to do more advanced patient related work.

Introduction The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%). Methods This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (>10% TBSA), intermediate (1–10% TBSA), or small (< 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally. Results During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02). Conclusions A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center. Applicability of Research to Practice Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.

Introduction In the literature, the incidence of alcohol and/or drug use among burn patients ranges from 16.4%-69%. Burn patients with positive toxicology (tox) screens on admission are known to have increased rates of morbidity and mortality. To date little has been published on the effects of positive alcohol and/or drug screens on outcomes in the frostbite population. The objective of this study was to investigate the incidence of drugs and alcohol use in admitted patients with severe frostbite and their association with clinical outcomes. Methods A retrospective cohort study was conducted on 141 frostbite patients admitted to a verified burn center from November 2015 to March 2019. Patients were identified using our burn registry and relevant data was obtained through chart reviews. The primary comparison was between patients with and without a positive tox screen on admission, assessing administration of thrombolytics (tPA) and rates of amputation. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used for continuous variables, reporting, two-tailed p values. Results Tox screens were positive in 77.3% (109) of frostbite patients: 52.5% (74) for marijuana and 56.7% (80) for alcohol. Homelessness accounted for 50.4% (71) and 63.1% (89) were tobacco users. Compared to patients with negative tox screens, significantly higher rates of amputation were found in those using marijuana (p=0.016), other drugs of abuse (p=0.008) and tobacco (p=0.0093). Significantly higher limb salvage rates were found in patients presenting with a negative tox screen (p=0.0077). Only tobacco users had a significantly greater length of stay (p=0.02). 36.2% (51) of the patients received tPA with no difference in administration rates between positive and negative tox screened patients. Patients receiving tPA had significantly lower rates of amputation (p=0.02). 51.8% (73) of admitted patients were homeless, with 83.6% (61) testing tox positive. Both increased hospital length of stay (p=< 0.001) and amputation rates (p=0.0004) were observed in the homeless frostbite population. Conclusions Drugs, alcohol and homelessness significantly impact clinical outcomes in frostbite patients. Homelessness, marijuana, tobacco and other drugs of abuse are associated with significantly higher rates of amputation despite receiving tPA at the same rate. Administration of tPA is significant in lowering amputation rates. Applicability of Research to Practice The association between drugs of abuse, homelessness and frostbite highlight the need for increased preventative efforts especially in the homeless population.

Introduction E-cigarettes and vaporizers (E-cigs) have seen a dramatic surge in popularity. The Centers for Disease Control now estimates that 1 in 4 United States (US) high school students use E-cigs. Recent recognition of E-cig-related lung injury has garnered significant attention. However, relatively little is known about E-cig-related burn injuries, which are often due to battery explosion and liquid ignition. The objective of this study was to characterize population demographics and injury patterns associated with E-cig burns. Methods A retrospective review of all patients presenting with E-cig-related cutaneous burn injury to a verified US burn center between January 2015 and August 2019 was performed using an institutional database. In addition, media reports covering the same mechanism of injury and date range were collected using databases for the National Electronic Injury Surveillance System, American Nonsmokers’ Rights Foundation, and international news outlets. Demographic data and injury metrics were recorded. Results 309 international media reports and 30 institutional cases of E-cig-related burn injuries were identified. Media-reported injuries varied with respect to geographic location: US-185, United Kingdom-35, Canada-6, all other countries-8, unclear-75. Annual incidence peaked in 2016 in media reports (2019-19, 2018–61, 2017–68, 2016–106, 2015–55) and institutional records (2019-3, 2018-5, 2017-6, 2016-16, 2015-0). Injuries predominantly involved men in both media (Male 75.7%, Female 13.9%, unknown 10.4%) and institutional (Male 93.3%, Female 6.7%) datasets. Average age was 31.0 years (media) and 30.3 years (institutional). The institutional data revealed an average TBSA of 3.5% (range 1–8.5%), an average length of stay of 3.8 days (range 0–14 days), and a median number of operations of 1 (range 0–2). 90% (n=27) of patients required inpatient admission and one patient required mechanical ventilation. On admission, 58% (n=14) of patients screened positive for cannabis use. A ranking of anatomic regions by frequency of involvement was consistent between datasets: lower extremity > hands > head/neck > torso > groin. Mortality rates were also similar: 1.62% (media) and 0% (institutional). Conclusions E-cig-related burns are non-trivial injuries, most of which require inpatient admission, operative management, and substantial resource use. They disproportionately affect young men and burns often involve sensitive areas like the hands and face. Applicability of Research to Practice Combined with rising popularity, lax regulation, proliferation of counterfeit products, and associated lung injury, E-cig-related burns represent an evolving health threat. This study highlights the importance of reporting injuries to consumer product regulatory agencies and the need for further research into the causes and consequences of E-cig explosion.

SPARC (secreted protein acidic and rich in cysteine), although primarily known as a secreted, matricellular protein, has also been identified in urothelial cell nuclei. Many biological activities, including inhibition of cell adhesion and repression of DNA synthesis, have been ascribed to SPARC, but the influence of its intracellular localization on each of these activities is unknown. When exposed by epitope retrieval and nuclear matrix unmasking techniques, endogenous SPARC was found to localize strongly to the nuclei and the nuclear matrix of cultured urothelial cells. Live-cell time-lapse imaging revealed that exogenous fluorescently labeled recombinant (r) SPARC was taken up from medium over a 16 h period and accumulated inside cells. Two variants of rSPARC with alterations in its putative nuclear localization signal (NLS) were generated to investigate the existence and effects of the NLS. These variants demonstrated similar biophysical characteristics as the wild-type protein. Visualization by a variety of techniques, including live-cell imaging, deconvolution microscopy, and cell fractionation, all concurred that exogenous rSPARC was not able to localize to cell nuclei, but instead accumulated as perinuclear clusters. Localization of the rSPARC NLS variants was no different than wild-type, arguing against the presence of an active NLS in rSPARC. Imaging experiments showed that only permeabilized, dead cells avidly took up rSPARC into their nuclei. The rSPARC(no NLS) variant proved ineffective at inhibiting DNA synthesis, whereas the rSPARC(strong NLS) variant was a more potent inhibitor of DNA synthesis than was wild-type rSPARC. The motif of SPARC that inhibits the synthesis of urothelial cell DNA is therefore not a nuclear localization signal, but its manipulation holds therapeutic potential to generate a "Super-SPARC" that can quiesce proliferative tissues.

This chapter discusses the laboratory techniques available to characterize shape-memory polymers in the context of biomedical device applications. It separates the techniques into five categories: structural and chemical, mechanical and thermo-mechanical, surface, biological, and imaging, presenting the relative merits of each. Along with a theoretical and practical background, the chapter leads readers through the process of selecting the most appropriate methods of analysis for any particular material or application. Three illustrative case studies, an analysis of future trends, and a list of industry reference standards are also provided.

Cell adhesion and detachment to and from the extracellular matrix (ECM) are critical regulators of cell function and fate due to the exchange of mechanical signals between the cell and its microenvironment. To study this cell mechanobiology, researchers have developed several innovative methods to investigate cell adhesion in vitro; however, most of these culture platforms are unnaturally stiff or static. To better capture the soft, dynamic nature of the ECM, we present a PEG-based hydrogel in which the context and geometry of the extracellular space can be precisely controlled in situ via two-photon induced erosion. Here, we characterize the two-photon erosion process, demonstrate its efficacy in the presence of cells, and subsequently exploit it to induce subcellular detachment from soft hydrogels. A working space was established for a range of laser powers required to induce complete erosion of the gel, and these data are plotted with model predictions. From this working space, two-photon irradiation parameters were selected for complete erosion in the presence of cells. Micron-scale features were eroded on and within a gel to demonstrate the resolution of patterning with these irradiation conditions. Lastly, two-photon irradiation was used to erode the material at the cell-gel interface to remove cell adhesion sites selectively, and cell retraction was monitored to quantify the mesenchymal stem cell (MSC) response to subcellular detachment from soft materials.

Fibroblast growth factor-10 (FGF-10), a mitogen for the epithelial cells lining the lower urinary tract, has been identified inside urothelial cells, despite its acknowledged role as an extracellular signaling ligand. Recombinant (r)FGF-10 was determined by fluorescence microscopy optical sectioning to localize strongly to nuclei inside cultured urothelial cells. To clarify the possible role of a nuclear localization signal (NLS) in this translocation, a variant of rFGF-10 was constructed which lacked this sequence. rFGF-10(no NLS) was found in cytoplasm to a far greater degree than rFGF-10, identifying this motif as a possible NLS. Furthermore, this variant displayed poor or non-existent bioactivity compared to the wild-type protein in triggering mitogenesis in quiescent urothelial cells. The presence of rFGF-10(no NLS) in the nucleus suggested that additional interactions were also responsible for the nuclear accumulation of rFGF-10. The FGF-10 receptor was observed in cell nuclei regardless of the presence or concentration of exogenous rFGF-10 ligand. Co-localization studies between rFGF-10 and the FGF-10 receptor revealed a strong intracellular relationship between the two. This co-localization was seen in nuclei for both rFGF-10 and for rFGF-10(no NLS), although the correlation was weaker for rFGF-10(no NLS). These data show that an NLS-like motif of rFGF-10 is a partial determinant of its intracellular distribution and is necessary for its mitogenic activity. These advancements in the understanding of the activity of FGF-10 present an opportunity to engineer the growth factor as a therapeutic agent for the healing of damaged urothelial tissue.

Gloriosa superba is a plant that grows wild in several parts of South India. Tubers of this plant contain several alkaloids. Acute intoxication following the ingestion of G. superba results in gastrointestinal and haematological abnormalities, hepatic and renal insufficiency, cardiotoxicity and hair loss. We present a case with typical features of G superba toxicity.