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Aim: The objective of this study was to analyze the pharmacognostical, phytochemical and antioxidant studies of aqueous ethanolic extract, petroleum ether, chloroform, ethyl acetate and butanol fractions of Dichrostachys cinerea root (Veerataru). Materials and Methods: The pharmacognostical studies on D. cinerea root including parameters such as powder microscopy, extractive values, ash values, and fluorescence and the phytochemical studies are established. The aqueous ethanolic extract and all the fractions were screened against few free radicals, such as diphenylpicrylhydrazyl radical, hydroxyl radical, nitric oxide radical and superoxide anion radical. Results: Powder microscopy revealed the presence of lignified crystal fibers, stone cells, and prism-shaped crystals. All the fractions were rich in steroids, flavonoids, phenolic compounds, and carbohydrates. High level of total phenolic content (158 mg gallic acid equivalent/g) and flavonoids (32 mg rutin equivalent/g) was observed in ethyl acetate fraction. Conclusions: It is concluded that the ethyl acetate fraction followed by butanol fraction of D. cinerea root has strong antioxidant potential. Further study is required for the isolation of bioactive component, which may serve as a potent natural antioxidant.

Background: The inability to evaluate host immunity in a rapid quantitative manner in patients with sepsis has severely hampered development of novel immune therapies. The ELISpot assay is a functional bioassay that measures the number of cytokine-secreting cells and the relative amount of cytokine produced at the single-cell level. A key advantage of ELISpot is its excellent dynamic range enabling a more precise quantifiable assessment of host immunity. Herein, we tested the hypothesis on whether the ELISpot assay can detect dynamic changes in both innate and adaptive immunity as they often occur during sepsis. We also tested whether ELISpot could detect the effect of immune drug therapies to modulate innate and adaptive immunity., Methods: Mice were made septic using sublethal cecal ligation and puncture (CLP). Blood and spleens were harvested serially and ex vivo IFN-γ and TNF-α production were compared by ELISpot and ELISA. The capability of ELISpot to detect changes in innate and adaptive immunity due to in vivo immune therapy with dexamethasone, IL-7, and arginine was also evaluated., Results: ELISpot confirmed a decreased innate and adaptive immunity responsiveness during sepsis progression. More importantly, ELISpot was also able to detect changes in adaptive and innate immunity in response to immune-modulatory reagents, for example dexamethasone, arginine, and IL-7 in a readily quantifiable manner, as predicted by the reagents known mechanisms of action. ELISpot and ELISA results tended to parallel one another although some differences were noted., Conclusion: ELISpot offers a unique capability to assess the functional status of both adaptive and innate immunity over time. The results presented herein demonstrate that ELISpot can also be used to detect and follow the in vivo effects of drugs to ameliorate sepsis-induced immune dysfunction. This capability would be a major advance in guiding new immune therapies in sepsis.

BACKGROUND: Hospitalised TB patients are at heightened risk for developing drug-drug interactions (DDIs) due to overlapping CYP450 enzyme and/or drug transporter biotransformation of anti-TB drugs and co-medications given for treating TB-associated comorbidities. We aimed to compare the occurrence, characterisation and determinants of database identified potential DDIs (pDDIs) associated with first-line anti-TB drugs and other co-medications using a subscription and free access drug information database. METHOD: This was a single-centre retrospective study to assess pDDIs between first-line anti-TB drugs and other medications for comorbidities among hospitalised TB patients using IBM Micromedex ® and Drugs.com. RESULTS: On multivariate regression analysis, hospitalised TB patients with comorbidities such as diabetes mellitus, HIV infection and hypertension, longer hospitalisation, and patients administered with more than seven drugs during their hospital stay were associated with increased risk for the occurrence of pDDIs. Significant discrepancies were observed in the detection and severity of pDDIs between IBM Micromedex and Drugs.com. CONCLUSION: We recommend using free access drug information database to a subscription drug information database in drug interaction screening protocols in clinics for enhanced identification of pDDIs and reducing monetary burden in resource-limited settings.

Aim: To assess the feasibility of preoperative computed tomography (CT) prediction of torsion angle for stratifying the risk of necrosis in patients with adnexal torsion., Materials and Methods: In this multicentre, retrospective study, 72 patients underwent preoperative CT and surgically verified adnexal torsion. Surgeons identified the torsion angle and adnexal necrosis requiring adnexectomy. The twisted angles were compared between conservative surgery group and salpingo-oophorectomy group. Variables included demographic, pathological and CT details. Logistic analysis was used to identify the indicators of twisted angle associated with high-risk necrosis., Results: The necrosis associated with adnexal torsion treated with adnexectomy was performed more often in patients with a torsion angle of ≥720° (odds ratio [OR]=7, 95% confidence interval [CI]: 1.314-37.295, p=0.023). The enlarged twisted pedicle (OR=14.592, 95% CI: 2.048-103.953, p=0.007) and pedicle haemorrhage (OR=5.612, 95% CI: 1.088-28.941, p=0.039) can predict a torsion angle of ≥720°, and area under the receiver operating characteristic (ROC) curve (AUC=0.758±0.058) was generated with the combined variables., Conclusion: The risk of adnexal necrosis is high in patients with torsion angle of ≥720°. CT findings of enlarged twisted pedicle and pedicle haemorrhage can be used to predict torsion angle of ≥720° and can imply adnexal necrosis indirectly., (Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function tests. A purulent sinus developed in the popliteal fossa and computed tomography of the abdomen revealed a right-sided retroperitoneal collection with gas, extending to the right pelvis and inguinal region. The popliteal fossa sinus and retroperitoneal collection were identified as a single pathology through computed tomography, magnetic resonance imaging and culture of identical organisms. At laparotomy, perforated duodenal ulcer disease was identified as the cause of the retroperitoneal abscess. Clinicians should seek to exclude retroperitoneal sources of infection in cases of lower leg infection, including perforated duodenal ulcer, caecal adenocarcinoma and appendicitis.

Introduction: The ORNATE India project is funded by the UK Research and Innovation (UKRI) through the Global Challenges Research Fund. The aim is to build research capacity and capability in India and the UK to tackle global burden of diabetes-related visual impairment. As there are over 77 million people with diabetes in India, it is challenging to screen every person with diabetes annually for sight-threatening diabetic retinopathy (DR). Therefore, alternate safe approaches need to be developed so that those at-risk of visual impairment due to DR is identified promptly and treated., Methods: The project team utilised diverse global health strategies and research methods to co-design work packages to build research capacity and capability to ensure effective, affordable and efficient DR services are made available for the population. The strategies and methods employed included health system strengthening; implementation science; establishing care pathways; co-designing collaborative studies on affordable technologies, developing quality standards and guidelines to decrease variations in care; economic analysis; risk modelling and stratification. Five integrated work packages have been developed to deal with all aspects of DR care. These included implementation of a DR screening programme in the public health system in a district in Kerala, evaluating regional prevalence of diabetes and DR and assessing ideal tests for holistic screening for diabetes and its complications in 20 areas in India, utilising artificial intelligence on retinal images to facilitate DR screening, exploring biomarker and biosensor research to detect people at risk of diabetes complications, estimating cost of blindness in India and risk modelling to develop risk-based screening models for diabetes and its complications. A large collaborative network will be formed to propagate research, promote shared learning and bilateral exchanges between high- and middle-income countries to tackle diabetes-related blindness.

Introduction: The Brachioradialis (BR) muscle flap is easy to harvest, provides a stable coverage to the cubital fossa as it is well vascularized. The BR andflexor carpi radialis (FCR) tendons are utilized in tendon transfer to restore the normal hand function. Therefore, the present study describes the morphology of the muscle bellies and the tendons of BR and FCR along with their pattern of innervation., Materials and Methods: The study was carried out on 27 upper limbs of formalin-fixed, adult human cadavers. Length and width of the bellies of BR and FCR were measured. The number of motor branches and their distances from the bi-epicondylar line was measured., Results: The mean lengths of BR and FCR bellies were 21.22±2.18cm and 16.15±2.39cm, and the lengths of their tendons were, 12.67±1.13cm and 12.48±1.72cm respectively. BR received a single motor branch in 19 upper limbs. However, FCR received single motor branch in 25 limbs as a common trunk. One upper limb received three motor branches to BR, and two upper limbs received two motor branches to FCR. The most proximal and distal branches to the BR were ranged between 6.3-2.2cm proximal to the bi-epicondylar line. Those to the FCR were ranged between 3.5-6.9cm distal to the bi-epicondylar line., Conclusion: The motor branches to the BR and FCR are variable in their origin, and the knowledge of such variations is essential for identifying them while performing selective neurotomy surgeries., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Bariatric surgery is an effective treatment for obesity and the associated comorbidities but carries a number of important risks. The Royal College of Surgeons advises patients to utilise online resources as part of the shared decision-making process. The aim of this study was to assess the quality of online materials on bariatric surgery., Methods: A systematic review was performed of online healthcare information relating to bariatric surgery. Common search terms were entered into three main search engines according to a defined search strategy. Websites were assessed according to readability (Flesch-Kincaid Reading Ease Score), quality and content (DISCERN and IPDAS Scores) and standards of accreditation (HONcode and Information Standard Certification). This systematic review was registered on the PROSPERO database CRD42019132188., Results: The average readability of all sources extracted was higher than that recommended for patient literature. Over half the studies contained had received HONcode or Information Standard accreditation, suggesting a quality marker for the content. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level., Conclusion: Patient information online related to bariatric surgery is of poor quality. Such resources require improvement to aid in the shared decision-making process., Competing Interests: Declaration of competing interest No Conflicts of Interest Declared., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Introduction: Many studies looked at outcomes and risk factors in laparoscopic cholecystectomies in general, including a few studies on risk factors and scoring systems in predicting conversion to open surgery. Little data has been produced on high-risk patients undergoing cholecystectomy. Identifying risk factors in this group could help stratify decision making regarding best management strategies.The aim of this study was to investigate outcomes of laparoscopic cholecystectomies in patients with ASA 3 and 4., Methods: Data was collected and collated from a prospectively maintained database of all laparoscopic cholecystectomies performed by 13 general surgeons in a single unit. Case notes were reviewed for all patients with ASA 3 and 4 between 2013 and 2017. Data analysis was performed using R studio v 3.4., Results: 244 cases were reviewed. Common bile duct was dilated in 52 cases (21.31%). Gall bladder wall was thick in 102 (41.8%) of the patients. Surgery was elective in 203 (83.2%) of the patients. ERCP was performed in 41 (16.9%) of the patients prior to surgery. 150 patients (62.2%) stayed for 1 day while 36 (14.9%) stayed for 2 days and the remaining 55 (22.9%) stayed for 3 days or more. Complications occurred in 37 (15.16%) of the patients while 23 (9.43%) of the patients were readmitted. 7 patients (2.87%) returned to theatre and 8 (3.28%) stayed in ITU post-op. Two patients died (0.82%)., Conclusion: Laparoscopic cholecystectomies in higher risk populations are safe. Alternative methods such as cholecystostomy and ERCP may be of benefit in these patients., Competing Interests: No conflict of interest., (© 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: Humanin has reportedly been expressed in testis and spermatozoa, but no study has yet reported its presence in human seminal plasma (SP)., Objective: The aim of this study was to investigate the presence of humanin in human SP and to determine the correlation between humanin levels in SP/spermatozoa and sperm quality., Materials and Methods: Semen samples for SP/sperm humanin level measurement were collected from 164 patients who attended our andrology clinic for fertility evaluation. The localization of humanin in spermatozoa was evaluated using an immunofluorescence method, and SP/sperm humanin levels were measured with ELISA. Correlations between SP/sperm humanin levels and sperm parameters were analyzed., Results: Humanin was expressed in the midpiece of the spermatozoa. Humanin concentrations in the SP ranged from 24.4 to 285.1 pg/mL, with a median of 89.7 pg/mL. The SP humanin concentrations in patients with normospermia were significantly higher than those in patients with oligospermia (p < 0.001), asthenospermia (p = 0.002), and oligoasthenospermia (p < 0.001). Spearman analysis showed a positive and significant correlation between SP humanin concentration and sperm concentration (r = 0.75, p < 0.001), and progressive sperm motility (r = 0.29, p < 0.001). Sperm humanin level was significantly and positively associated with progressive sperm motility (r = 0.70, p < 0.001). In addition, a significantly higher level of humanin was found in swim-up spermatozoa than in non-swim-up spermatozoa (p = 0.03)., Conclusions: Seminal plasma and sperm humanin levels were significantly and positively correlated with sperm quality, especially sperm motility. Further studies of the origin of SP humanin and its role in spermatogenesis should be conducted., (© 2019 American Society of Andrology and European Academy of Andrology.)

Background: Cold-inducible RNA-binding protein (CIRBP) is associated with cell stress. However, its upstream regulatory factors are still largely unknown., Objectives: This study investigated whether CIRBP expression was regulated by transforming growth factor beta (TGF-β) during the process of heat-induced testicular damage., Materials and Methods: Ten male adult ICR mice were allocated to heat treatment (scrotal hyperthermia at 43 °C for 30 min, n = 5) and control group (n = 5); CIRBP and TGF-β1, TGF-β2, and TGF-β3 expression levels in the testis in mRNA and protein were analyzed. Then, we conducted in vivo and in vitro studies to investigate the regulatory effects of TGF-β on CIRBP. In the in vivo study, male adult ICR mice were subjected to testicular hyperthermia followed by a local testicular injection of TGF-β antagonist (non-selective TGF-β I/II receptor inhibitor, 5 μg or 10 μg). In the in vitro study, GC2-spd cells were cultured under 43 °C for 30 min or with different TGF-β isoforms (10 ng/mL), and CIRBP expression levels in the testis and GC2-spd cells were analyzed 24 and 48 h, respectively, after treatment., Results: As a result, heat treatment significantly downregulated the relative CIRBP mRNA and protein expression (p = 0.006 and 0.011), and significantly upregulated TGF-β2 and TGF-β3 expression levels (p = 0.022 and 0.04, for mRNA, and p = 0.001 for both protein levels). Local testicular injection of 10 μg TGF-β antagonist significantly attenuated heat-induced histological damage to the testes and CIRBP downregulation (p = 0.038). Furthermore, TGF-β2 and TGF-β3 significantly downregulated CIRBP mRNA and protein expression in GC2-spd cells (all p < 0.01), exerting a similar effect to heat treatment., Discussion and Conclusion: Our in vivo and in vitro experiments demonstrated that heat-induced CIRBP downregulation in the testes was mediated by the upregulation of TGF-β. Further studies are needed to clarify the molecular mechanisms underlying these processes., (© 2018 American Society of Andrology and European Academy of Andrology.)

Here we present a Rb-^{129}Xe spin-exchange optical pumping polarizer capable of rapid generation of large volumes of highly polarized ^{129}Xe gas. Through modeling and measurements we maximize the ^{129}Xe nuclear spin polarization output to enable the generation of polarized ^{129}Xe gas imaging volumes (300  cm^{3}) every 5 min within a clinical setting. Our model is verified by experiment to correctly predict the optimum Rb vapor density for maximum ^{129}Xe nuclear polarization for a flux 3.4  W/cm^{2} of circularly polarized Rb D&#95;{1} photons incident on an 80 cm long cylindrical optical cell. We measure a ^{129}Xe magnetization production efficiency of η&#95;{pr}=1.8%, which approaches the photon efficiency limit η&#95;{γ}=3.3% of this system and enables the polarization of 2.72×10^{22} ^{129}Xe spins per hour, corresponding to 1013  cm^{3} of 100% polarized ^{129}Xe at STP. This magnetization production rate is threefold higher than the highest previously published ^{129}Xe magnetization production rate and has enabled routine clinical lung magnetic resonance imaging (MRI) with hyperpolarized ^{129}Xe doses available on demand at run time, as well as high-SNR ^{129}Xe MRI of the human brain and kidneys.

We investigate the effect of stress fluctuations on the stochastic dynamics of an inclusion embedded in a viscous gel. We show that, in nonequilibrium systems, stress fluctuations give rise to an effective attraction towards the boundaries of the confining domain, which is reminiscent of an active Casimir effect. We apply this generic result to the dynamics of deformations of the cell nucleus, and we demonstrate the appearance of a fluctuation maximum at a critical level of activity, in agreement with recent experiments [E. Makhija, D. S. Jokhun, and G. V. Shivashankar, Proc. Natl. Acad. Sci. U.S.A. 113, E32 (2016)PNASA60027-842410.1073/pnas.1513189113].

Cystatin C and beta-2-microglobulin (B2M) are filtration markers associated with adverse outcomes in nontransplant populations, sometimes with stronger associations than for creatinine. We evaluated associations of estimated glomerular filtration rate from cystatin C (eGFR cys ), B2M (eGFR B 2M ), and creatinine (eGFR cr ) with cardiovascular outcomes, mortality, and kidney failure in stable kidney transplant recipients using a case-cohort study nested within the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial. A random subcohort was selected (N = 508; mean age 51.6 years, median transplant vintage 4 years, 38% women, 23.6% nonwhite race) with enrichment for cardiovascular events (N = 306; 54 within the subcohort), mortality (N = 208; 68 within the subcohort), and kidney failure (N = 208; 52 within the subcohort). Mean eGFR cr , eGFR cys , and eGFR B 2M were 46.0, 43.8, and 48.8 mL/min/1.73m 2 , respectively. After multivariable adjustment, hazard ratios for eGFR cys and eGFR B 2M <30 versus 60+ were 2.02 (95% confidence interval [CI] 1.09-3.76; p = 0.03) and 2.56 (1.35-4.88; p = 0.004) for cardiovascular events; 3.92 (2.11-7.31) and 4.09 (2.21-7.54; both p < 0.001) for mortality; and 9.49 (4.28-21.00) and 15.53 (6.99-34.51; both p < 0.001) for kidney failure. Associations persisted with additional adjustment for baseline eGFR cr . We conclude that cystatin C and B2M are strongly associated with cardiovascular events, mortality, and kidney failure in stable kidney transplant recipients., (© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.)

This prospective randomized clinical study is aimed to evidence the reproductive impairment of frequent scrotal heat exposure. A total of 20 normozoospermic subjects were randomly divided into two groups to undergo testicular warming in a 43 °C water bath 10 times, for 30 min each time; the subjects in group 1 underwent testicular warming for 10 consecutive days and those in group 2 once every 3 days. Sperm chromatin structure assay (SCSA), sperm mitochondrial membrane potential (MMP), apoptosis, and seminal plasma-soluble Fas (sFas) were analyzed before treatment and every 2 weeks after, for a total of 10 times. In group 1, some critical proteins involved in heat stress, hypoxia, structure, and function of sperm mitochondria and flagella were evaluated before hyperthermia and 2, 6, 10, and 16 weeks after hyperthermia. Both groups showed a reversible increase in the proportion of spermatozoa with a disrupted MMP (both p < 0.05 when the minimums were compared with baseline levels, the same below), sperm apoptosis (both p < 0.01) and high DNA stainability (both p < 0.05). The sFas concentration in both groups showed no obvious changes except one: the value at week 2 was significantly increased over baseline in group 1 (p = 0.036). The level of Bcl-2 decreased significantly at weeks 6 and 10 (p = 0.017 and 0.05, respectively) and recovered to baseline at week 16. Proteins involved in heat stress and mitochondria functions were up-regulated, whereas in flagella structure and function was down-regulated (all p < 0.05). This study demonstrated that transient and frequent scrotal hyperthermia severely and reversibly damaged spermatogenesis, consecutive heat exposure had more serious effects than intermittent exposure, whereas intermittent exposure led to a later recovery of sperm damage., (© 2016 American Society of Andrology and European Academy of Andrology.)