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Ecoregion comprises all the environmental factors such as climate, vegetation, geomorphology, and soil taken together. The objectives of this study were to (1) assess differences in growth and body composition (BC) in 9-18-year-old children and adolescents (CA), across six ecoregions of India, (2) evaluate and compare the magnitude of the effect of ecoregional and lifestyle factors (LSF) on growth and BC in urban (U) and rural (R) children and adolescents, and (3) reassess the applicability of Bergmann's Rule and Allen's Rule to humans.Data on 1845 CA (925 boys; 920 girls) were collected (2016-2017) from urban and rural areas of six ecoregions of India. Anthropometric and BC parameters were measured; Z-scores were computed. Lifestyle Index score (LIS) based on LSF-(socioeconomic status [SES], diet, physical activity) was computed (categorized as low, medium, high-indicates better LSF). Univariate analysis was performed to estimate effect size.Significant differences were observed in growth and BC across urban and rural ecoregions. CA with high LIS were taller and heavier than those with low LIS (p .05). Ecoregion had greater effect on growth (Partial eta square (ηDisparities among the six ecoregions were not large enough to fully support Bergmann's Rule and Allen's Rule. Ecoregion had greater effect on growth and BC of rural CA than urban, while lifestyle factors had more effect on the BC of urban CA.

Cone-beam computed tomography scans exhibiting a second mesiobuccal (MB2) canal were examined. The vertical distance of the MB2 orifice from the pulp floor (depth), inter-orifice distance (IOD) of MB2 from mesiobuccal (MB) and palatal (P) orifices, the horizontal distance of the MB2 orifice from the line joining MB-P orifices [mesial deviation (MD)] and root canal configuration (RCC) were evaluated on 330 scans. The Student's t-test, ANOVA, Spearman's correlation and linear regression analysis were applied. The MB2 depth was 1.69 ± 0.86 mm. IOD (MB-MB2, MB2-P) was 2.18 ± 0.58 mm and 4.63 ± 1.06 mm, respectively. MD was 1.02 ± 0.37 mm. The predominant RCC was Vertucci's type II (75.5%). No correlation of depth with IOD of MB-MB2 (rho = 0.0367, p = 0.506) was observed. Significant correlation of depth with IOD of MB2-P (rho = 0.696, p 0.001) and MD (rho = 0.174, p = 0.001) was established. No association of depth with age and IOD (MB-MB2) was observed on linear regression analysis. However, a significant positive association was established with IOD (MB2-P) (p 0.001) and MD (p = 0.001).

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low- and middle-income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high-income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health-related behaviors, or the risk of calcium-related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population-level interventions to safely improve calcium intake and status where necessary.

Introduction Chronic immune polyradiculopathies (sensory, motor, and mixed) are uncommon. Methods In this single-center, retrospective study, the inclusion criteria for participants were progressive sensory ataxia and/or areflexic limb weakness; tibial somatosensory evoked potential (SSEP) abnormalities of the N22 and P40 potentials with normal sensory and motor nerve conduction studies or root involvement, according to magnetic resonance imaging (MRI); and albuminocytological dissociation. Results Eight patients were included in our study. Two had weakness, two had sensory ataxia, and four had both weakness and ataxia. Patients with weakness had abnormal SSEPs and patients with sensory ataxia also had absent F waves. Electromyography showed chronic denervation. MRI scans confirmed thickening and enhancement of roots. The patients responded to corticosteroid treatment. Discussion The overlapping clinicoelectrophysiological findings and similarities in radiological and therapeutic responses suggest that these entities are clinical variants of the same disease. The terms CIS(m)P, CI(s)MP, and CISMP (for chronic immune sensory motor polyradiculopathy) could be used to denote the predominant clinical involvement.

Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut‐points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population‐based cross‐sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6‐17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex‐specific, age‐specific, and study population‐specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as “percentile‐based cut‐points”) and the static cut‐points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74‐3.17) and 3.07 (2.20‐4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut‐points and percentile‐based cut‐points (P for difference > .05). In conclusion, the static cut‐points performed similarly well when compared with the percentile‐based cut‐points in predicting childhood increased arterial stiffness. Use of static cut‐points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.

Author(s): Nallamilli, Babi Ramesh Reddy; Chakravorty, Samya; Kesari, Akanchha; Tanner, Alice; Ankala, Arunkanth; Schneider, Thomas; da Silva, Cristina; Beadling, Randall; Alexander, John J; Askree, Syed Hussain; Whitt, Zachary; Bean, Lora; Collins, Christin; Khadilkar, Satish; Gaitonde, Pradnya; Dastur, Rashna; Wicklund, Matthew; Mozaffar, Tahseen; Harms, Matthew; Rufibach, Laura; Mittal, Plavi; Hegde, Madhuri | Abstract: ObjectiveLimb-girdle muscular dystrophies (LGMDs), one of the most heterogeneous neuromuscular disorders (NMDs), involves predominantly proximal-muscle weakness with g30 genes associated with different subtypes. The clinical-genetic overlap among subtypes and with other NMDs complicate disease-subtype identification lengthening diagnostic process, increases overall costs hindering treatment/clinical-trial recruitment. Currently seven LGMD clinical trials are active but still no gene-therapy-related treatment is available. Till-date no nation-wide large-scale LGMD sequencing program was performed. Our objectives were to understand LGMD genetic basis, different subtypes' relative prevalence across US and investigate underlying disease mechanisms.MethodsA total of 4656 patients with clinically suspected-LGMD across US were recruited to conduct next-generation sequencing (NGS)-based gene-panel testing during June-2015 to June-2017 in CLIA-CAP-certified Emory-Genetics-Laboratory. Thirty-five LGMD-subtypes-associated or LGMD-like other NMD-associated genes were investigated. Main outcomes were diagnostic yield, gene-variant spectrum, and LGMD subtypes' prevalence in a large US LGMD-suspected population.ResultsMolecular diagnosis was established in 27% (1259 cases; 95% CI, 26-29%) of the patients with major contributing genes to LGMD phenotypes being: CAPN3(17%), DYSF(16%), FKRP(9%) and ANO5(7%). We observed an increased prevalence of genetically confirmed late-onset Pompe disease, DNAJB6-associated LGMD subtype1E and CAPN3-associated autosomal-dominant LGMDs. Interestingly, we identified a high prevalence of patients with pathogenic variants in more than one LGMD gene suggesting possible synergistic heterozygosity/digenic/multigenic contribution to disease presentation/progression that needs consideration as a part of diagnostic modality.InterpretationOverall, this study has improved our understanding of the relative prevalence of different LGMD subtypes, their respective genetic etiology, and the changing paradigm of their inheritance modes and novel mechanisms that will allow for improved timely treatment, management, and enrolment of molecularly diagnosed individuals in clinical trials.

Epstein-Barr viral infection is one of the known environmental factors involved in development of Systemic Lupus Erythematous (SLE). Though not much is known about the exact role of EBV in SLE pathogenesis, the theory of switching of lytic and lysogenic cycles of Epstein-Barr virus in memory B-cells fits well with the periods of waning disease activity and intermittent flares in SLE patients. In this study, we investigate the association of EBV antibody profile with clinical and serological parameters in SLE. Eighty-seven clinically diagnosed SLE patients fulfilling the American College of Rheumatology (ACR) Classification criteria and fifty healthy individuals were enrolled in this case control study. Anti-VCA IgM, anti-VCA IgG and anti-EBNA IgG were detected by ELISA technique. Antibodies concentrations between two groups were compared using Mann-Whitney whereas the difference in categorical data was compared using Chi-square considering statistical significance at p

Introduction Although few studies have demonstrated utility of 18F- fluoro-2-deoxy-d-glucose positron emission tomography/computerised tomography (18F-FDG PET/CT) in benign pheochromocytoma/paragangliomas (PCC/PGLs), there limited data on factors predicting the FDG uptake in PCC/PGL. Methods The study was conducted at a tertiary health care centre. In addition to the routine investigations, all patients (n = 96) with PCC/PGL were evaluated with 18F-FDGPET/CT and majority (n = 78) underwent 131I-metaiodobenzyl guanidine (131I-MIBG) scintigraphy. Forty-three patients also underwent testing for germline mutations in five PCC/PGL susceptibility genes (VHL, RET, SDHB, SDHC and SDHD) and all patients were evaluated clinically for neurofibromatosis-1. Results The study included 96 patients with PCC/PGL(82 benign and 14 malignant). FDGSUVmax was significantly higher for malignant than benign PCC/PGL(P = 0.009) and for extra-adrenal PGL than adrenal PCC (P = 0.017). In subgroup analysis, metanephrine-secreting PCC and non-secretory PCC had significantly lower FDG SUVmax than normetanephrine-secreting PCC (P = 0.017, P = 0.038 respectively), normetanephrine-secreting-sympathetic PGL (P = 0.008, P = 0.019 respectively) and non-secretory sympathetic PGL (P = 0.003, P = 0.009 respectively). Patients with mutations in cluster 1 genes (n = 14) had significantly higher FDG SUVmax than those with mutations in cluster 2 genes (n = 4) (P = 0.04). Sensitivities of 131I-MIBG and 18F-FDG PET/CTwere 77.78% and 100% for cluster 1 genes-related PCC/PGL whereas they were 100% and 50% for cluster 2 genes-related PCC/PGL, respectively. Multivariate regression analysis of mutation positive patients identified genetic status as the only independent predictor of FDG SUVmax. Conclusion The study suggests that the underlying genetic status determines FDG uptake in PCC/PGL and not location, secretory status or malignancy.

Introduction Immune-mediated demyelinating radiculopathies restricted to proximal sensory or motor roots are uncommon. Methods We report the clinical, electrophysiological, biochemical, and radiological features in 2 patients with chronic immune sensorimotor polyradiculopathy (CISMP). Results The patients presented with sensory ataxia, weakness of the lower limbs, and areflexia. Electrophysiological studies revealed involvement of proximal sensorimotor roots, as evidenced by changes in somatosensory evoked potentials, F-waves, and H-reflexes. In contrast, the distal nerve segments were normal. Magnetic resonance neurography findings of thickened and enhanced roots supported the electrophysiological findings. The response to immunosuppressive therapy was favorable in both patients. Conclusion The findings from these 2 patients further expand the knowledge spectrum of immune polyradiculopathies. Muscle Nerve 55:135-137, 2017.

Introduction Clinical heterogeneity of limb-girdle muscular dystrophies (LGMDs, 24 known subtypes), which includes overlapping phenotypes and varying ages of onset and morbidity, adds complexity to clinical and molecular diagnoses. Methods To diagnose LGMD subtype, protein analysis, using immunohistochemistry (IHC) and immunoblotting, was followed by gene sequencing through a panel approach (simultaneous sequencing of known LGMD genes) in 9 patients from unrelated families of the Indian Agarwal community. Haplotype studies were performed by targeted SNP genotyping to establish mutation segregation. Results We identified 2 founder mutations in CAPN3, a missense (c.2338G>C; p.D780H) and a splice-site (c.2099-1G>T) mutation, on 2 different haplotype backgrounds. The patients were either heterozygous for both or homozygous for either of these mutations. Conclusions Founder mutations have immediate clinical application, at least in selected population groups. Clinically available gene panels may provide a definitive molecular diagnosis for heterogeneous disorders such as LGMD. Muscle Nerve 47: 931–937, 2013

Pyridostigmine relieved episodic weakness in a family with paramyotonia congenita resulting from the R1448C mutation in the sodium channel gene. The transmission was autosomal dominant and the patients had paradoxical myotonia and exercise-induced weakness. On electrophysiological studies there were myotonic potentials, and there was progressive reduction of compound muscle action potential (CMAP) amplitudes after short exercise associated with clinical weakness. Pyridostigmine in doses of 60 mg three times daily abolished the drop in the postexercise CMAP amplitude and reduced the amplitude decrement to slow rate repetitive stimulation, but there continued to be a drop in amplitude on exposure to cold. The decline of the CMAP amplitude on exposure to cold was controlled by treatment with phenytoin. The clinical and electrophysiological features are discussed in relation to therapy with pyridostigmine and phenytoin.

AIM: To obtain a gestational reference range for the amniotic fluid index (AFI) among Indian women. METHODS: An analysis of AFI estimations was undertaken in 517 Indian women with normal pregnancy between 16 and 42 weeks of gestation. It was a prospective, cross-sectional study conducted in a university teaching hospital. Women with fetal anomalies, pregnancy-induced hypertension, diabetes mellitus, and other maternal complications were excluded from the study. The median, the 5th and the 95th percentile values were calculated for each gestational week and these values were compared with other studies. RESULTS: The median reached its peak at the 27th week of gestation. We observed approximately 6 cm as the lower limit of normal (5th percentile) and approximately 18 cm (95th percentile) as upper limit of normal AFI at term for our population, whereas in the Caucasian population, the values were approximately 7 cm and approximately 20 cm, respectively. All gestation specific AFI values were lower in the studied population of Indian women compared with other studies on Caucasian population (P < 0.01 for 5th percentile & P < 3.26 x 10(-7) for 95th percentile), but slightly higher than the Chinese population. CONCLUSION: Amniotic fluid index values differ in different populations. We standardized the reference values for normal AFI in Indian women. We found that they are lower in the population studied compared with reported values in the Caucasian population, but slightly higher than the Chinese population.

The Eulerian k-fluid CFD model was used to simulate the macroscale multiphase flow in packed beds. The geometric complexity of the bed structure is resolved by statistically describing the porosity distribution. The complicated multiphase interactions are computed using the Ergun type of formula developed based on bench-scale hydrodynamic experiments. The work is presented in two sequential articles. Part I discusses implementation issues of the k-fluid CFD model for packed beds. The drag exchange coefficients are obtained from the model of Holub et al. for the particle-fluid interfaces Xks and from the model of Attou et al. (1999) for the gas–liquid interface, Xgl. The effect of particle external wetting on flow distribution was incorporated into the model through the capillary pressure evaluated by either the J-function of Leverett (1941) for air–water or by the expression of Attou and Ferschneider (1999) for other fluids. In the framework of CFDLIB, the choice of the grid size and boundary conditions are discussed. An appropriate relationship between the section size and variance of the sectional porosity distribution was used for flow simulation. Part II discusses the extensive numerical results, and the CFD model is compared with experimental data in the literature.

Numerical simulations of multiphase flow using the k-fluid CFD model described in Part I of this issue are presented for packed beds at various operating conditions. Both steady-state and unsteady-state (e.g., periodic operation) feed conditions were studied numerically. Predictions of the k-fluid CFD model are comparable with the experimental data in the literature for liquid upflow in a cylindrical packed bed. In addition to the mean porosity and the longitudinally averaged radial porosity profile, the variance of the porosity distribution is needed for predicting the probability density function of the sectional flow velocity. In the trickling flow regime, the k-fluid CFD model provides reasonable predictions of the global liquid saturation and the pressure gradient. Relevant applications of the k-fluid CFD model are identified in quantifying the relationship between bed structure and flow distribution in various-scale packed beds. The combined flow-reaction modeling scheme is proposed through the “mixing-cell” network concept, in which the k-fluid CFD simulation can provide the information on sectional flow distribution.

In a 5 dm3 stirred tank reactor, bioconversion of 30 g benzaldehyde by cells of Torulaspora delbrueckii yielded 22.9 g of pure L-phenylacetylcarbinol (L-PAC). Facile functional group transformation of 4.5 g of L-PAC to 2-(methylimino)-1-phenyl-1-propanol by exposure to microwave irradiation for 9 min resulted in 2.48 g of product. Conversion of 4.8 g of 2-(methylimino)-1-phenyl-1-propanol to 3.11 g of ephedrine was achieved by exposure to microwaves in a reaction time of 10 min. The identity of all the products was confirmed by 1H NMR and FT-IR analysis. © 2002 Society of Chemical Industry

As very low birthweight (VLBW) infants are at a high risk of developmental handicap, it is important to establish predictors of long-term adverse outcome at an early age so that early intervention can be instituted. Longitudinal neurodevelopmental assessments were performed in 107 VLBW infants at 1, 4, 8 and 12 months corrected age. Eighteen were diagnosed as 'dystonic' at 4 months of age. This study compared the outcomes at 4 and 6 years for 15 of the 18 dystonic with 75 of the 89 non-dystonic VLBW infants, respectively. At 9 years of age, nine dystonic and 54 non-dystonic infants were assessed on the Rutter Behaviour Questionnaire. Dystonic children had a lower mean General Cognitive Index (GCI; P = 0.001) and a higher incidence of disability as measured by the Burns Neuro-Sensori-Motor Developmental Assessment Scale (P = 0.0005) and Kitchen disability grading (P = 0.001). Even if the minor neurological aberrations of the premature dystonia syndrome in VLBW infants abate by one year of life, these infants still constitute a high-risk group for subsequent neurodevelopmental disability and therefore require close observation and probably early intervention.

A high-pressure trickle-bed reactor was used to achieue high productivity and selectivity for the manufacture of a key herbicide intermediate (α-aminomethyl-2-furanmethanol) (amino alcohol, AA) from α-nitromethyl-2-furanmethanol (nitro alcohol, NA). Raney Nickel catalysts of varying activity were prescreened for suitability in tricklebed operation. The effect of operating parameters such as reactant feed concentration, liquid mass uelocity, and temperature on the yield of amino alcohol (A) for RNi-a are discussed. The superiority of trickle-bed reactors ouer others such as semibatch and batch sluny systems is demonstrated. The AA yield increases with decrease in feed reactant concentration and liquid mass velocity, as well as with lowering of the operat ing temperature. A maximum product yield of 90.1% was obtained at 8.3 wt. % feed concentration of nitroalcohol (NA), while at the highest feed concentration of 40 wt. % NA, the maximum product yield was 58%. The volumetric productivity of AA was significantly higher at higher reactant feed concentrations, even though the yield was lower under these conditions. The operating temperature was also an important parameter, with a lower temperature being preferable for trickle-bed experiments. Bed dilution with inert fines improued catalyst utilization and increased the AA yield and productivity in the laboratory-scale trickle-bed reactor.

Conventional strategies for discrimination of intrinsic and apparent kinetics from crushed- and whole-catalyst-pellet experimental data, respectively, do not yield satisfactory results for the reaction network in the manufacture of (α-aminomethyl-2-furanmethanol) (aminoalcohol) from αnitromethyl-2-furanmethanol (nitroalcohol). Laboratory trickle-bed reactor tests in the range of concentration and product yield of commercial interest are utilized to yield a reasonable set of kinetic parameters, which are otherwise unobtainable. This is accomplished by proposing a reaction network, a plausible mechanism, and optimizing the kinetic parameters based on the reactor-model-generated peformance data to fit experimental output concentrations of all species for the entire set of experiments. A complex reaction network for the key reactions in the system is developed based on the reaction scheme in Part I. Fitting of trickle-bed reactor data to this model is attempted to yield an insight into the actual kinetics. The results show promise of obtaining an overall network kinetic model, even with the limited data available.

Lewis acids such as FeCl 3 and ZnCl 2 were supported on silica gel, alumina, zirconia and titania by co-grinding with anhydrous Lewis acids in appropriate proportions in an agate mortar. The catalysts have good shelf life and reusability. Synthesis of diphenylmethanes with these catalysts was studied; silica gel was the best support.

OBJECTIVE To study the mechanism through which mifepristone interrupts folliculogenesis. DESIGN Normally ovulating women undergoing donor intrauterine insemination (IUI) treatment were investigated during two menstrual cycles treated with gonadotrophins. In the first cycle (FSH cycle), the women were given 150 IU recombinant FSH (rFSH) s.c. on days 2, 4, 6, 8 and daily thereafter until the administration of hCG. During the second cycle (FSH + mifepristone cycle), the women received rFSH as above plus mifepristone tablets at a dose of 50 mg/day from cycle day 2 until the hCG injection. IUI was performed only in the FSH cycles. PATIENTS Eleven normally ovulating women were studied. The women were used as their own controls during the cycle treated with rFSH only. RESULTS Two women became pregnant during the FSH cycle and, therefore, data for comparison between the two cycles were available in nine women. In both cycles, only one follicle reached the preovulatory stage. However, during treatment with FSH + mifepristone the growth of the dominant follicle was temporarily arrested after day 8 of the cycle and ovulation was postponed by 2 days on average. Serum FSH values increased significantly in both cycles only during the daily administration of rFSH, i.e. towards the end of the experimental period when a normal growth of the follicle was re-established. On the day of hCG injection, an endogenous LH surge had already started in six of the nine cycles treated with FSH (67%) but in none of the FSH + mifepristone cycles despite the preovulatory oestradiol (E2) levels. Endometrial thickness during the follicular phase and serum E2 and progesterone concentrations during the luteal phase, although in the normal limits, were significantly lower in the FSH + mifepristone than in the FSH cycles. CONCLUSIONS These results suggest that mifepristone arrests follicular development at a stage beyond the recruitment-selection point by delaying the growth of the dominant follicle. This is probably achieved through an effect of mifepristone on the ovary where it reduces the sensitivity of the selected follicle to FSH. Mifepristone may have a potential application for the inhibition of the LH surge in superovulation induction programmes.

To determine the incidence of and organisms responsible for neonatal nosocomial infection (after 72 h of age).A 1-year evaluation of 321 consecutive septic work-ups performed on 130 of 1008 babies admitted to a neonatal intensive care unit (NICU) for more than 72 h. Fifty-seven (89%) of 64 infants of birthweight 500-999 g, 36 (34%) of 105 infants 100-1499 g, 27 (6%) of 422 infants 1500-2499 g and 10 (28%) of 477 infants of birthweight2500 g had at least one septic work-up.In addition to blood culture, the evaluations included haematological score on full blood count in 94.7%, abdominal X-ray in 48%, endotracheal tube tip culture in 32.7% and lumbar puncture in only 13.1%. Blood culture was positive on 92 occasions in 75 infants (28.7% of work-ups and 7.4% of all babies admitted). Infection status was classified as definite on 40 occasions in 30 babies, and due to contamination 52 in 45 babies. Twenty of the 30 babies with definite infection were of birthweight 500-999 g. Of the 40 definite infections coagulase-negative staphylococci (CONS) were cultured from 23 babies, Gram negative bacilli in 14 and Candida spp. in three babies. Sepsis caused or contributed to the deaths of six babies.This study identifies infants of birthweight1000 g as the highest risk group for nosocomial infection especially CONS. New strategies in prevention, surveillance and treatment are required for extremely low birthweight infants.

The condensation of benzaldehydes with acetoacetic esters and ammonia was carried out in aqueous solutions of aliphatic hydrotropes. Substantial enhancement in the rates of the reactions along with easy recovery of the product were noted. The recyclabilty of the hydrotropes has also been tested.