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Background and Purpose: Repetitive sprint sport players perform high intensity exercise only for a small percentage of a total game and such periods are often instrumental in determining the eventual outcome. Recovery is a key factor for performance, and constant lack of recovery or insufficient recovery turns into overtraining which is detrimental in achieving peak performance. The purpose was to find out the effect of wheelchair running on the physical performance recovery after high-intensity intermittent exercise. Method: Ten sportsmen having the age range from 20 to 29, VO2max Ranges from 60.51 to 64.29 were randomly divided into experimental and control groups. After filling pre-participation questionnaire and 30-min of supine rest, Blood lactate and the field tests for the measurement of static balance, power, speed and agility were applied. The subjects were made to run in the treadmill and to increase the intensity to reach the Target Heart Rate (THR). After 1-min the subjects were given rest for 15-s and after that they started exercise again and thus the subjects completed several bouts of such exercises until exhaustion followed by either Passive rest or wheelchair running for the duration of 10 minutes. Parameters were measures after completed the exercise bout and after the recovery. Results: After the recovery in experimental group significant improvement found only in blood lactate (p<0.01) and no significant changes found in other parameters while in control group no significant changes found in all parameters. There was no significant difference found in all the parameters including blood lactate between the groups. Conclusion: Both wheelchair running and passive recovery are same in the efficiency of blood lactate removal and restoration of physical performance following intense intermittent exercise.

Debbie L Morton, Javin S Sandhu, Anthony KP Jones Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK Abstract: Pain is a complex sensory and emotional experience that is heavily influenced by prior experience and expectations of pain. Before the development of noninvasive human brain imaging, our grasp of the brain’s role in pain processing was limited to data from postmortem studies, direct recording of brain activity, patient experience and stimulation during neurosurgical procedures, and animal models of pain. Advances made in neuroimaging have bridged the gap between brain activity and the subjective experience of pain and allowed us to better understand the changes in the brain that are associated with both acute and chronic pain. Additionally, cognitive influences on pain such as attention, anticipation, and fear can now be directly observed, allowing for the interpretation of the neural basis of the psychological modulation of pain. The use of functional brain imaging to measure changes in endogenous neurochemistry has increased our understanding of how states of increased resilience and vulnerability to pain are maintained. Keywords: fMRI, PET, EEG, arthritis, fibromyalgia

Aim: To investigate the effects of pulsed Ultrasound (US) in recovery from Delayed Onset Muscle Soreness (DOMS). Methods: Twelve healthy male athletes (mean age 23.83±1.697 year) performed an eccentric exercise protocol of non-dominant elbow flexors to induce muscle soreness on 2 occasions separated by 3 weeks. Subjects in experimental group received pulsed US (1 MHz, intensity 0.8 W/cm2, mark space ratio 1:10), whereas control group received sham US after 24 h, 48 h and 72 h. Perception of muscle soreness, active ROM and muscle strength were the parameters measured at 0 h, 24 h, 48 h and 72 h with the help of VAS, manual goniometer and JONEX muscles master instrument respectively. Results: Post hoc t test analysis revealed significant differences (p

Sugarcane (Saccharum spp.)is an economically useful crop grown globally for sugar, ethanol and biofuel production. The crop is vulnerable to fungus Colletotrichum falcatum known to cause red rot disease. The pathogen hydrolyses stalk parenchyma cells where sucrose is accumulated resulting in upto 75% losses in sugar recovery. In this study, transgenic sugarcane having resistance against red rot was developed by introducing Trichoderma spp. endochitinase following Agrobacterium mediated transformation. The transgene introduction and expression in genetically modified plants were verified through qRT-PCR revealing upto 6-fold enhancement in endochitinase expression than non-transgenic plants. Hyperspectral Imaging of transgenic plants displayed altered leaf reflectance spectra and vegetative indices that were positively correlated with ransgene expression. The bioassay with virulent pathotypes of C. falcatumCF08 and CF13 known for epiphytotic occurrence resulted in identification of resistant plant Chit 3-13.The plants with higher reflectance also displayed improved disease resistance, implying their early classification into resistant/susceptible. The losses in sucrose content were minimized (up to 4-fold) in inoculated resistant plant Chit 3-13 as compared to susceptible non-transgenic plant, and a fewer pathogen hyphae were detected in vascular cells of the former through optical microscopy. The electron micrographs confirmed sucrose-filled stalk parenchyma cells in Chit 3-13; in contrast, cells of non-transgenic inoculated plant were depleted of sucrose. The active sites involved in cleaving 1-4 β-glycoside bonds of N-acetyl-d-glucosaminein the pathogen hyphal walls were detected through endochitinase protein structural modelling. The transgenic sugarcane is an important source for in trogressingred rot resistance in plant breeding programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introgression of disease resistance genes (R-genes) to fight against an array of phytopathogens takes several years using conventional breeding approaches. Pathogens develop mechanism(s) to escape plants immune system by evolving new strains/races, thus making them susceptible to disease. Conversely, disruption of host susceptibility factors (or S-genes) provides opportunities for resistance breeding in crops. S-genes are often exploited by phytopathogens to promote their growth and infection. Therefore, identification and targeting of disease susceptibility genes (S-genes) are gaining more attention for the acquisition of resistance in plants. Genome engineering of S-genes results in targeted, transgene-free gene modification through CRISPR-Cas-mediated technology and has been reported in several agriculturally important crops. In this review, we discuss the defense mechanism in plants against phytopathogens, tug of war between R-genes and S-genes, in silico techniques for identification of host-target (S-) genes and pathogen effector molecule(s), CRISPR-Cas-mediated S-gene engineering, its applications, challenges, and future prospects., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Burnout in the medical workforce is a growing global concern. Visual arts-based interventions can be a novel way to mitigate burnout and bolster resilience in medicine. Improving tolerance of ambiguity and uncertainty has been associated with decreased rates of burnout in clinicians. No known systematic review exists summarizing the evidence behind the use of visual arts-based interventions to mitigate burnout in clinicians. The authors conducted a systematic literature review of PubMed, EMBASE, and CINAHL in November 2022 using the terms: art, medicine, burnout, and uncertainty. The authors review the evidence for the effects of visual arts-based interventions on clinician burnout. The search identified 58 articles, of which 26 met study inclusion criteria and were assessed by 2 reviewers. These studies reported mixed methods assessments of changes in burnout, empathy, and stress. Overall, visual arts-based interventions promoted empathy, connectedness, and tolerance of ambiguity and had positive effects on burnout; however, some results were mixed. Visual arts-based interventions to mitigate burnout show promise, and additional research should focus on feasibility and longer-term outcomes., Competing Interests: Conflicts of InterestNone declared

Hull-less seed trait is preferred by nut and oil industries worldwide for snacking and oil extraction as it evades the expensive decorticating (dehulling) process. This seed trait is available in C. pepo only, which has small seed cavity, sensitive to various biotic and abiotic stresses, and restricted to temperate regions for cultivation. Contrarily, the related species C. moschata has wider adaptability, disease tolerance and high seed yield. Therefore, attempt was made to transfer this trait into C. moschata through conventional pollination and ovule culture using four parents of hull-less C. pepo and six of hulled C. moschata. Through conventional approach, few viable F 1 seeds (12-23) were obtained by using C. pepo as female parent, but in three crosses (HLP36 × HM1343, HLP36 × HM1022 and HLP44 × HM1022) only, whereas, its use as male parent was not successful. This incompatibility issue of reciprocals was resolved through ovule culture of C. moschata genotypes HM1343 and HM6711 after 17 to 19 days of pollination with C. pepo genotypes HLP53 and HLP72, respectively. The hybridity of interspecific crosses was confirmed through SSR markers (alleles inherited from both the parents), morphological characters and micromorphological leaf traits (differed from both the parents). The successful transfer through interspecific hybridization was further established with the presence of hull-less seed in fruits of F 2 populations. Outcome of this study would pave the way for enhancing the productivity and multi-season cultivation of snack-seeded pumpkin even in subtropical and tropical regions., (© 2023. The Author(s).)

Purpose: The International Prostate Symptom Score (IPSS) is a widely used tool for evaluating patient-reported lower urinary tract symptoms. In this study, we assessed patients with prostate cancer and their understanding of IPSS questions., Methods and Materials: Consecutive patients with prostate cancer (N = 144) self-completed an online IPSS questionnaire within 1 week before their visit at our radiation oncology clinic. At the visit, a nurse reviewed each IPSS question to ensure the patient understood it and then verified the patient's answer. Preverified and nurse-verified scores were recorded and analyzed for discrepancies., Results: Complete concordance between preverified and nurse-verified responses to individual IPSS questions existed for 70 men (49%). In terms of overall IPSS score, 61 men (42%) had a lower or improved IPSS after nurse verification, and 9 men (6%) had a higher or worse IPSS. Before verification, patients overstated their symptoms of frequency, intermittency, and incomplete emptying. As a result of the nurse verification, 4 of 7 patients with IPSS in the severe range (20-35) were recategorized to the moderate range (8-19). Sixteen percent of patients whose preverified IPSS were in the moderate range were recategorized after nurse verification to the mild range (0-7). Treatment option eligibility changed for 10% of patients after nurse verification., Conclusions: Patients frequently misunderstand the IPSS questionnaire, leading them to respond in ways that do not accurately reflect their symptoms. Clinicians should verify patient understanding of the IPSS questions, particularly when using the score to determine eligibility for treatments., (© 2023 The Authors.)

Objectives: To assess the clinical profile and primary treatment response and outcomes in idiopathic membranous nephropathy (IMN) patients., Methods: This study was carried out between December 2013 and January 2019 in a tertiary care hospital in North India on 2 years retrospective and 3 years prospective renal biopsy proven patients with IMN presenting with nephrotic syndrome. Basic baseline investigations carried out were urinary proteins, serum albumin, serum creatinine, other special tests wherever necessary or possible (including phospholipase A2 receptor antibodies), and different treatment regimens were offered for treatment. The patients were followed up for a minimum period of 6 months after administration of treatment., Results: The study was carried out in 120 patients with mean age of 43±14.6 years and male female ratio of 1.65:1. Hypertension was noted in 36%, microscopic hematuria in 13%, and mean 24 hours urinary proteinuria 10.5±3.1 gm. Complete or partial response at 6 months was observed in 57% and 34% cases to cyclophosphamide, 60% and 40% to modified Ponticelli treatment, 81% and 19% to tacrolimus, and 40% and 36% cases to rituximab. Relapse was observed in 6% of cyclophosphamide and 13% in tacrolimus groups., Conclusion: Our results show a good and comparable response to cyclophosphamide, tacrolimus, and rituximab at 6 months of follow up. The cases which achieved complete remission had significantly lower baseline proteinuria compared to those who did not respond., (Copyright: © Saudi Medical Journal.)

Background Renal transplantation is the optimal treatment for patients of all ages with end-stage kidney disease. The long-term outcomes of renal transplantation are assessed by graft and patient survival rates. These outcomes are, in turn, influenced by post-transplant events such as delayed graft function, rejections, post-transplant infections, and post-transplant diabetes mellitus (PTDM). Each of these short-term outcomes is, in turn, determined by the interplay of various factors in the pre-, peri-, and post-transplant period. This prospective study was designed to understand the factors affecting short-term outcomes in living donor transplantation and their effect on graft and patient survival. Methodology A total of 86 patients underwent live donor renal transplantation between January 1, 2015, and March 31, 2016, at a tertiary care hospital in north India. Of these, five were lost to follow-up, and the remaining 81 patients were prospectively followed up to December 31, 2017. Results The majority of the recipients were males (91%) and the donors were females (74%). Spousal and related donors comprised 49% and 51% of donations, respectively. The mean estimated glomerular filtration rate (eGFR) of donors was 98 ± 9.2 mL/minute/1.73m². Induction therapy with basiliximab was given to 21/81 (26%) recipients. The majority of recipients (68/81, 84%) received triple-drug immunosuppression with prednisolone, tacrolimus, and mycophenolate mofetil. Delayed graft function (DGF) occurred in 4/81 (4.9%) cases. Biopsy-proven acute rejections (BPARs) occurred in 15/81 (18.5%) cases, two-thirds of which were acute antibody-mediated rejections (ABMRs). During the follow-up period, 50 episodes of infections occurred in 35/81 (43.2%) recipients, with the most common being urinary tract infection (23/81, 28.5%). PTDM was diagnosed in 22/81 (27.2%) patients beyond six weeks of transplant. On multivariate logistic regression analysis, the most significant predictor of DGF was acute rejections and vice versa. Acute rejections also predicted the occurrence of post-transplant infections. Pre-transplant hepatitis C virus (HCV) infection and cyclosporine-based therapy were significant predictors of PTDM. At the six-month follow-up, 10/81 (12.3%) patients developed graft dysfunction. The predictors of graft dysfunction at six months were recipients of related donors and rural patients. One-year graft survival, death-censored graft survival, and patient survival rates were 85.2%, 92.6%, and 91.3%, respectively. The most common cause of death was post-transplant infections (5/7, 71.4%) of which the majority (4/5, 80%) were fungal infections. On multivariate logistic regression analysis, the most significant predictor of graft loss and patient loss was low pre-transplant donor eGFR and PTDM, respectively. Conclusions Graft and patient survival in living donor kidney transplantation are influenced by a multitude of interdependent factors during the pre-transplant (donor eGFR, type of donor, socioeconomic status, HCV infection in recipient, type of immunosuppression) and the post-transplant (DGF, rejections, infections, and PTDM) period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, John et al.)

Titanium dioxide (TiO 2 ) nanoparticles (NPs) are the most widely used nanomaterials and their expanding use raises concerns about their impacts on soil ecosystems and functioning. The present study evaluates the potential impacts of TiO 2 NPs applied at low doses (0, 1.0, 2.5, 5.0, 10.0 and 20.0 mg L -1 ) on soil chemical properties including the macro and micronutrient contents, microbial population and enzyme activities in rhizosphere soil of mung bean crop at different time intervals (7, 14, 28 and 56 days). A quantitative RT-PCR study was also performed to study the relative change in the gene expression of ammonia oxidizer and nitrogen fixers upon TiO 2 NP supplementation. An increase in soil nutrient content viz., available N, P, Cu, Fe, Mn, nitrate-N and ammonical-N was observed with NP application except available K and Zn content. The TiO 2 NPs stimulated the growth of soil microflora at low concentrations while an inhibitory effect was recorded at high concentrations. The soil fungi and actinobacteria emerged as the most sensitive groups of soil microbes towards TiO 2 NP exposure exhibiting detrimental impacts on their growth at all concentrations. Similarly, the soil enzyme activities enhanced till TiO 2 NPs (10.0 mg L -1 ) which was followed by decrease at higher concentrations. The qRT-PCR study showed that the ammonia oxidizers were more affected by TiO 2 NPs application than nitrogen fixers. These findings suggest that TiO 2 NPs can be used as stimulators of soil nutrients and soil microbial dynamics at low concentrations., (Copyright © 2022. Published by Elsevier Ltd.)

As a staple food crop, rice has gained mainstream attention in genome engineering for its genetic improvement. Genome engineering technologies such as transgenic and genome editing have enabled the significant improvement of target traits in relation to various biotic and abiotic aspects as well as nutrition, for which genetic diversity is lacking. In comparison to conventional breeding, genome engineering techniques are more precise and less time-consuming. However, one of the major issues with biotech rice commercialization is the utilization of selectable marker genes (SMGs) in the vector construct, which when incorporated into the genome are considered to pose risks to human health, the environment, and biodiversity, and thus become a matter of regulation. Various conventional strategies (co-transformation, transposon, recombinase systems, and MAT-vector) have been used in rice to avoid or remove the SMG from the developed events. However, the major limitations of these methods are; time-consuming, leftover cryptic sequences in the genome, and there is variable frequency. In contrast to these methods, CRISPR/Cas9-based marker excision, marker-free targeted gene insertion, programmed self-elimination, and RNP-based delivery enable us to generate marker-free engineered rice plants precisely and in less time. Although the CRISPR/Cas9-based SMG-free approaches are in their early stages, further research and their utilization in rice could help to break the regulatory barrier in its commercialization. In the current review, we have discussed the limitations of traditional methods followed by advanced techniques. We have also proposed a hypothesis, "DNA-free marker-less transformation" to overcome the regulatory barriers posed by SMGs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Singh, Kaur, Praba, Kaur, Tanin, Kumar, Neelam, Sandhu and Vikal.)

The gram pod borer Helicoverpa armigera is a major constraint to chickpea ( Cicer arietinum L.) production worldwide, reducing crop yield by up to 90%. The constraint is difficult to overcome as chickpea germplasm including wild species either lacks pod borer resistance or if possessing resistance is cross-incompatible. This study describes conversion of elite but pod borer-susceptible commercial chickpea cultivars into resistant cultivars through introgression of cry1Ac using marker-assisted backcross breeding. The chickpea cultivars (PBG7 and L552) were crossed with pod borer-resistant transgenic lines (BS 100B and BS 100E) carrying cry1Ac that led to the development of BC 1 F 1 , BC 1 F 2 , BC 1 F 3 , BC 2 F 1 , BC 2 F 2 , and BC 2 F 3 populations from three cross combinations. The foreground selection revealed that 35.38% BC 1 F 1 and 8.4% BC 1 F 2 plants obtained from Cross A (PBG7 × BS 100B), 50% BC 1 F 1 and 76.5% BC 1 F 2 plants from Cross B (L552 × BS 100E), and 12.05% BC 2 F 2 and 82.81% (average) BC 2 F 3 plants derived from Cross C (PBG7 × BS 100E) carried the cry1Ac gene. The bioassay of backcross populations for toxicity to H . armigera displayed up to 100% larval mortality. BC 1 F 1 and BC 1 F 2 populations derived from Cross B and BC 2 F 3 population from Cross C segregated in the Mendelian ratio for cry1Ac confirmed inheritance of a single copy of transgene, whereas BC 1 F 1 and BC 1 F 2 populations obtained from Cross A and BC 2 F 2 population from Cross C exhibited distorted segregation ratios. BC 1 F 1 plants of Cross A and Cross B accumulated Cry1Ac protein ranging from 11.03 to 11.71 µgg -1 in leaf tissue. Cry1Ac-positive BC 2 F 2 plants from Cross C demonstrated high recurrent parent genome recovery (91.3%) through background selection using SSR markers and phenome recovery of 90.94%, amongst these 30% plants, were homozygous for transgene. The performance of BC 2 F 3 progenies derived from homozygous plants was similar to that of the recurrent parent for main agronomic traits, such as number of pods and seed yield per plant. These progenies are a valuable source for H . armigera resistance in chickpea breeding programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer MST declared a past co-authorship with the author(s) SS to the handling editor., (Copyright © 2022 Kaur, Sharma, Singh, Singh, Vikal, Singh, Malik, Kaur, Singh, Bindra, Sarmah and Sandhu.)

The prevalence of this rare and fatal entity varies in different regions and ethnicities. The objective of this study was to determine clinicopathological characteristics and predictors of outcome in rapidly progressive glomerulonephritis (RPGN). We aimed to prospectively study the clinicopathological profile and determine the predictors of renal outcome in patients with RPGN. This study included 40 patients of biopsy-proven RPGN. The diagnosis of RPGN was based on renal histology showing crescents in >50% of glomeruli. All patients were given induction with intravenous (IV) methylprednisolone (0.5 g) for three days followed by maintenance with oral prednisolone (1 mg/kg/day) and six IV pulses of cyclophosphamide (0.5 g) given fortnightly followed by maintenance therapy with azathioprine (2 mg/kg/day). The outcomes were recorded. Three-fourth of the patients (77.4%) required renal replacement therapy (RRT) at diagnosis. More than half of patients (57.5%) were antineutrophil cytoplasmic antibodies mediated. Immune complex and anti-glomerular basement membrane (GBM) disease constituted 25% and 17.5%, respectively. Clinical features, biochemical parameters, histological features, and type of RPGN were analyzed for association with primary outcomes. Entry serum creatinine, entry estimated glomerular filtration rate (eGFR), RRT on admission, interstitial fibrosis, tubular atrophy, and interstitial infiltrates were the parameters which showed association with primary outcomes of the study (P <0.05). In secondary outcomes, infections were the most common (55%), followed by neutropenia (40%). One-fourth of the patients (25%) died during the course of the study. Cause of mortality was infections (50%), cardiovascular system (30%), stroke (10%), and unknown (10%). Our prospective study from north India shows that RPGN is not an uncommon cause of renal failure and there is preponderance in the elderly patients (>60 years). Pauci-immune RPGN is the most common cause of RPGN followed by immune-complex and anti-GBM disease. Entry serum creatinine, eGFR, and RRT on admission predicted the outcome., Competing Interests: None

Background: Proficiency in laparoscopy is gradually achieved. After initial simulation, it is safe to move to real patients. Simulation improves the basic attributes of laparoscopy, and its non-availability hampers training. Virtual reality and commercial simulators are exorbitantly expensive. Cheaper non-commercial latest, mobile phone-based simulators appear ergonomically unsuitable. A need for a no-cost, home-based laparoscopic endotrainer was felt by authors., Methods: The authors proposed the concept of smart TV and smart phone-based laparoscopy trainer (STELA), an almost zero cost, lightweight indigenous, cable-less box-type endotrainer, with a smart phone housed on the model, projecting to smart TV via Wi-fi direct. The simulation timings on STELA were compared with Universal Beetel endotrainer by a group of surgeons and residents using identical tasks like object transfer (OT) and knot making (KM)., Results: Data were analysed using SPSS, version 23.There was no significant difference in the mean timings of the residents (p > 0.05) on two endotrainers, for both tasks, and of surgeons for OT. Surgeons took significantly longer time (p < 0.05) in KM on STELA. Highest correlation (r = +.848) (<.05) was seen for KM on both devices by residents., Conclusion: STELA is a viable, technologically advanced, no cost alternative to the non-commercial cumbersome simulators especially for beginners., Competing Interests: The authors have none to declare., (© 2020 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

Introduction: Mineral bone disease is an important complication of chronic kidney disease ends up in increased cardiovascular morbidity and mortality in these patients. The aim of present study was to determine the pattern, prevalence and the clinical, biochemical and radiological profile of mineral bone disease in predialysis and dialysis (stage 5D) patients of chronic kidney disease., Methods: Patients of stage 3, 4, 5 and 5D of chronic kidney disease admitted to the department of nephrology were enrolled in this study., Results: 200 patients of chronic kidney disease (19, 29, 43 and 109 cases of stage 3, 4, 5 and 5D respectively) with mean age of 52.4 ± 16.7 years and male to female ratio of 2.4:1 were enrolled. Diabetic nephropathy (45%), hypertensive nephropathy (33%), and chronic glomerulonephritis (14.5%) were the most common etiologies of chronic kidney disease. Proximal muscle weakness (91.5%) bone pain (59.5%) and pruritus (25.5%) were the common symptoms. Biochemical parameters showed hypercalcemia (19%), hypocalcaemia (55%), hyperphosphatemia (75.5%) and vitamin D deficiency in 84.5% of cases. High turnover bone disease was present in all predialysis and only 7% of dialysis patients. Adynamic bone disease was observed in 92.7% of dialysis patients. On univariate analysis i-PTH was significantly associated with sex, eGFR, serum calcium, and 25(OH) vit-D level and no association was found with age and FGF-23 levels., Conclusion: Adynamic bone disease has emerged as the most common form of CKD-MBD in dialysis patients and secondary hyperparathyroidism being common in the predialysis patients of chronic kidney disease. Hyperphosphatemia and vitamin D deficiency were the most common reported biochemical abnormalities.

Purpose: To develop a cadaver model for the assessment of a male transobturator male sling (retrourethral transobturator sling [RTS], AdVance™; Boston Scientific, USA) to investigate its effect on a simulated abdominal and retrograde leak point pressures (ALPP, RLPP) and the urethral pressure profile (UPP)., Materials and Methods: Three fresh frozen human male cadaver specimens were obtained. A suprapubic tube was inserted into the bladder and connected to a digital manometer to measure bladder pressure. Manual suprapubic pressure was then applied to generate an increase in intraabdominal pressure and measure a simulated ALPP. Subsequent measurements of RLPP and UPP were recorded. All measurements were undertaken prior to and following insertion of a RTS., Results: The placement of the RTS consistently increased the simulated ALPP for all three cadaver specimens when compared to baseline measures. No leaks occurred at simulated ALPP's of 170 cm H 2 O for specimen 1, 160 cm H 2 O for specimen 2, and 170 cm H 2 O for specimen 3. There was minimal or no change in the RLPP's and UPP's following insertion of the RTS when compared to respective baseline., Conclusions: A model using fresh unfixed cadavers that incorporates a simulated measurement of ALPP is feasible for male stress urinary incontinence surgical intervention investigations., Competing Interests: CONFLICTS OF INTEREST: All authors declare that no remuneration or agreement limited in any way their ability to acquire, interpret or publish this data. Control of the primary dataset has at all times been held by the members of this investigating team. Dr William I. Jaffe declares current and Dr Jaspreet S. Sandhu declare previous lectures, consultancy work and participation in research trials for American Medical Systems, Inc. The cadaver specimens for this investigation were supplied by American Medical Systems, Inc. Minnesota, USA.

Background: There is a change in the position of the remaining anatomical structures of the lower urinary tract system following radical prostatectomy. The aims of this investigation were to describe three novel methods used to measure the displacement of i) the vesico-urethral junction (VUJ), proximal membranous urethra (PMU) and anorectal junction (ARJ) and ii) the VUJ angle of displacement in men following radical prostatectomy and determine their intra- and interrater reliability., Methods: Retrospective comparative measurement of twenty pre- and postoperative MRI scans was undertaken by one observer on two separate occasions and on one occasion by another observer. Three standardized midsagittal pelvimetry reference lines were used to describe three X, Y axis measurement systems. The displacement (mm) of the VUJ, PMU and ARJ, and the angle of displacement (degrees) of the VUJ was measured for each of the three methods. Interrater reliability of VUJ, PMU and ARJ displacement and the VUJ angle of displacement measurements was assessed using a two-way mixed-effects agreement intra-class correlation coefficient (ICC) with 95% confidence intervals (CI). Test-retest (intrarater) reliability was calculated using a two-way random effects consistency ICC with 95% CI for all displacement measures of the VUJ, PMU and ARJ for one observer between two days., Results: The pubococcygeal line (PCL) axis measurement system demonstrated good to excellent intrarater and interrater reliability (ICC 95% interval lower bound > 0.75) for the VUJ and PMU displacement and the VUJ angle of displacement measurements. Other measurement systems were less reliable and more variable., Conclusions: In this sample of 20 Korean patients with median prostate volume 27.5 mL and maximum volume 70 mL, the measurement methodology using the PCL consistently demonstrated good to excellent reliability and the lowest variability for the measurement of the displacement of the VUJ and PMU and the VUJ angle of displacement. The PCL methodology is recommended as the method of choice. Further studies should validate these results in patients with large prostate volumes.

Background: Ureteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA)., Methods: One hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded., Results: The success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p<0.05)., Conclusions: Ureteroscopy, effectively performed under TILTA, is safe with a high success rate. The acceptable pain tolerance and the shortened convalescence in addition makes the procedure's success worth the pain.

Background: There is limited evidence regarding the ways in which displacement disrupts social norms, expectations and trajectories for adolescent girls and young women and the resulting impacts on their risks of violence. This knowledge gap is especially marked with regards to Syrian adolescent girls and young women seeking refuge in Turkey. We explored risks of gender-based violence against Syrian adolescent girls and young women in Turkey and examined how these risks were shaped by their displacement., Methods: Data were collected in August 2016 in Izmir, Turkey through five sex-specific focus group discussions with Syrian adolescents and young people (aged 15-25 years) and two mixed gender focus group discussions with Syrian adults (18 years and older). Group discussions covered the issues facing Syrian adolescents and young women in Turkey, and how these were influenced by their displacement. Discussions in Arabic were audio-recorded, transcribed and translated into English. Data were coded inductively, and analysed thematically., Results: Syrian adolescent girls and young women expressed an increased sense of vulnerability to violence since their displacement. Due to financial strains and limited educational opportunities, they were often encouraged by parents to work or marry, both of which they perceived to increase the risks of violence. In contrast, some adults suggested that marriage could protect adolescent girls and young women from risks of violence associated with working. Being alone outside the home was viewed as risky by all participants due to pervasive sexual, verbal and physical harassment, aggression, and even kidnapping attempts. To limit these risks, many parents reported keeping adolescent girls and young women at home, or ensuring that they were accompanied by male relatives when in public., Conclusions: Syrian adolescent girls and young women face multiple risks of violence following displacement related to altered social trajectories. Some family-based strategies to protect young women from violence could reinforce restrictive gender norms and increase risks of violence. Interventions to address violence should include providing safe spaces, access to education and safe transport for young women, and financial support for families as well as community-based interventions to address the daily risks of sexual harassment in public spaces.

Hemodialysis patients are at higher risk of cardiovascular disease due to traditional and dialysis-related risk factors. Our aim was to study the effects of hemodialysis on the corrected QT interval (QTc) and QTc dispersion in chronic kidney disease (CKD) without clinically manifest heart disease. Two hundred cases of CKD on chronic intermittent hemodialysis of >3 months' duration were included in the study. Twelve-lead electrocardiography and samples for serum creatinine, potassium, calcium, and magnesium were taken before and after dialysis. The mean age of patients was 52.4 ± 17 years with male-to-female ratio of 3:1. QTc interval and QTc dispersion were prolonged in 47% and 59% before and 50% and 89% of patients after hemodialysis, respectively. The mean values of QTc were 433.4 ± 36.9 ms before and 451.4 ± 39.6 ms after hemodialysis ( p = 0.001) and the mean values of QTc dispersion were 60.5 ± 19.3 ms before and 81.5 ± 24.4 ms after hemodialysis ( p = 0.001). Similar pattern was observed in all etiological groups of CKD, except for QTc dispersion in malignancy-related CKD ( p = 0.216). After hemodialysis, there was a significant fall in the mean values of serum potassium ( p = 0.001), rise in serum calcium ( p = 0.001), and no change in magnesium ( p = 0.424). Patients with post hemodialysis QTc dispersion >74 ms had significantly low mean values of serum potassium and calcium as compared to <74 ms group. Large numbers of hemodialysis patients have a prolonged QTc interval and QTc dispersion with a significant increase in the mean values after hemodialysis. There is a significant fall in serum potassium and rise in serum calcium after dialysis., Competing Interests: There are no conflicts of interest.

Large staghorn calculi in unascended pelvic kidneys and in normally located kidneys with anatomy unsuitable for percutaneous nephrolithotomy have to be treated via pyelolithotomy. When performed laparoscopically, the extraction of these staghorn calculi, without extending skin incision at the port site is challenging. We describe the successful use of laparoscopic laser lithotripsy, intracorporeally, with the entrapped calculus inside the endocatch bag, for fragmentation and retrieval without extension of skin incision.

We aim to study the impact of the baby boomer (BB) generation, a birth-specific cohort (born 1945-1965) on hepatocellular carcinoma (HCC)-related liver transplantation (LT) in patients with chronic hepatitis C virus (HCV), alcoholic liver disease (ALD), and non-alcoholic steatohepatitis (NASH). We performed a retrospective analysis using the United Network for Organ Sharing (UNOS)/Organ Procurement Transplant Network (OPTN) database from 2003 to 2014 to compare HCC-related liver transplant surgery trends between two cohorts-the BB and non-BB-with a secondary diagnosis of HCV, ALD, or NASH. From 2003-2014, there were a total of 8313 liver transplant recipients for the indication of HCC secondary to HCV, ALD, or NASH. Of the total, 6658 (80.1%) HCC-related liver transplant recipients were BB. The number of liver transplant surgeries for the indication of HCC increased significantly in NASH (+1327%), HCV (+382%), and ALD (+286%) during the study period. The proportion of BB who underwent LT for HCC was the highest in HCV (84.7%), followed by NASH (70.3%) and ALD (64.7%). The recommendations for birth-cohort specific HCV screening stemmed from a greater understanding of the high prevalence of chronic HCV and HCV-related HCC within BB. The rising number of HCC-related LT among BB with ALD and NASH suggests the need for increased awareness and improved preventative screening/surveillance measures within NASH and ALD cohorts as well., Competing Interests: The authors declare no conflicts of interest.

Sugarcane (Saccharum spp.) is a commercially important crop, vulnerable to fungal disease red rot caused by Colletotrichum falcatum Went. The pathogen attacks sucrose accumulating parenchyma cells of cane stalk leading to severe losses in cane yield and sugar recovery. We report development of red rot resistant transgenic sugarcane through expression of β-1,3-glucanase gene from Trichoderma spp. The transgene integration and its expression were confirmed by quantitative reverse transcription-PCR in first clonal generation raised from T0 plants revealing up to 4.4-fold higher expression, in comparison to non-transgenic sugarcane. Bioassay of transgenic plants with two virulent C. falcatum pathotypes, Cf 08 and Cf 09 causing red rot disease demonstrated that some plants were resistant to Cf 08 and moderately resistant to Cf 09. The electron micrographs of sucrose storing stalk parenchyma cells from these plants displayed characteristic sucrose-filled cells inhibiting Cf 08 hyphae and lysis of Cf 09 hyphae; in contrast, the cells of susceptible plants were sucrose depleted and prone to both the pathotypes. The transgene expression was up-regulated (up to 2.0-fold in leaves and 5.0-fold in roots) after infection, as compared to before infection in resistant plants. The transgene was successfully transmitted to second clonal generation raised from resistant transgenic plants. β-1,3-glucanase protein structural model revealed that active sites Glutamate 628 and Aspartate 569 of the catalytic domain acted as proton donor and nucleophile having role in cleaving β-1,3-glycosidic bonds and pathogen hyphal lysis.

Background: The prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women., Methods: 20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year., Results: The objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% ( n  = 1), urethral injury in 5% ( n  = 1) and urethral tape exposure in 10% ( n  = 2), at 3 months requiring tape sectioning., Conclusions: These cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.

Context: Type 2 Diabetes Mellitus (T2DM) refers to a group of common metabolic disorders that share the phenotype of Hyperglycemia. More than 60% of the world's population with diabetes comes from Asia., Aim: To study the prevalence of Type 2 Diabetes Mellitus among Sikh individuals living in the urban localities of Amritsar., Settings and Design: The study was designed in the Faculty of Sports Medicine & Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab, India. The data collection was carried out in various urban localities of Amritsar. Blood samples were analyzed in the Biochemistry laboratory, whereas data analysis and article preparation was carried out in the Faculty of Sports Medicine and Physiotherapy., Materials and Methods: Multi-stage random sampling was done with a sample size of 1089 patients., Statistical Analysis: The data was analyzed in Stata 11.2 software. Various tests used in the study are Mean ± SD, Pearson Chi Square Test, Students' t test and multiple logistic regression test., Results: Our study showed that the prevalence rate of Type 2 Diabetes Mellitus is 23.2% with the confidence interval of 20.7-25.7. Proportionately more patients with T2DM had hypertension (46.6%). Likewise proportionately more patients, 67.5% had hypertrigylerdemia, 67.6% had low HDL levels, 59.2 % had hypercholesterolemia and 73.1% suffered from metabolic syndrome., Conclusions: Our study clearly indicates that the young Sikh adults below 40 years of age have similar high BMI, WC and WHR to that of the older adults above 40 years of age. It is necessary to adopt appropriate preventive strategies and interventions in high-risk individuals to curb the growing epidemic of diabetes. Innovative community outreach programs need to be designed and implemented to create awareness and early screening and treatment of diabetes, especially in the urban population.

Pulmonary aspergillosis presents with a variety of clinical forms including invasive pulmonary aspergillosis, chronic necrotising aspergillosis, aspergilloma, chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Haemoptysis is a devastating complication of pulmonary aspergillosis and a common indication for surgery. We report a case of a 54-year-old man with a history of pulmonary tuberculosis and diabetes mellitus, who presented with productive cough and haemoptysis for 2 months. Chest CT revealed a 30 mm diameter soft tissue mass in the upper lobe of the right lung. Haemoptysis subsided with conservative measures, but 2 weeks later the patient developed a new episode of persistent haemoptysis, which was only partially controlled with bronchial arterial embolisation. He underwent right upper and middle lobectomy. Histology examination confirmed the presence of a fungal cavitary lesion. The patient was started on voriconazole, and recovered with no recurrence at 18 months follow-up., (2015 BMJ Publishing Group Ltd.)

Since 2011 we have taught a public health innovations course at the University of California, Berkeley. Students gain skills in systematic innovation, or human-centered design, while working in small interdisciplinary teams on domestic and global health projects with client organizations. To support acquisition of meaningful problem-solving skills, we structured the course so that the majority of learning happens in scenarios that do not involve faculty. Taken by students representing 26 graduate programs (as diverse as epidemiology, city planning, and mechanical engineering), it is one of the 10 highest-rated courses offered by the School of Public Health. We present the blueprints for our course with the hope that other institutions whose students could benefit will borrow from our model.

Background: To determine the effectiveness of two goal setting pedometer based walking program for people with type 2 diabetes, one employing supervised exercise group with pedometer and the other employing self reported group with pedometer., Methods: A total of 102 type 2 diabetic outpatients (28 women, 74 men) between the age of 40-70 years were recruited and randomly allocated into 3 groups: supervised exercise group with pedometer (Group A), self reported exercise group with pedometer (Group B) and a control group (Group C) for 16 weeks. Subjects were asked to respond to the Audit of Diabetes Dependent Quality of Life (ADDQoL) and well being questionnaire at two occasions i.e. 0 week and after 16 weeks of intervention. Paired t test were used within the groups to compare Mean ± SD for all the parameters at baseline and at the end of 16 weeks. Differences between the groups were compared using analysis of variance (ANOVA). Statistical difference was further analyzed by Post hoc analysis using Bonferroni method., Results: The item "Freedom to eat" had the highest negative impact among all the subgroups. Other domains that were adversely affected by diabetes are 'leisure activity', 'do physically', 'physical appearance', 'self confidence', 'future' and 'financial situation'. In the group A significant reduction were noted among all the items except long distance journey (p<0.05). In the group B participants experienced reduction among all the domains except long distance journey, sex life and living condition., Conclusion: Pedometer determined activity has the potential to improve the quality of life. Supervised Walking using a pedometer was found more effective in improving quality of life and general wellbeing for Asian Indians with type 2 diabetes., Clinical Trial Registry India Ctri: [CTRI/2012/10/003034].

Introduction: Oral lichen planus (OLP) is a chronic inflammatory disease characterized by bilateral white striations or plaques on the buccal mucosa, tongue or gingiva that has a multifactorial etiology, where the psychogenic factors seem to play an important role., Purpose: The aim of this study was to determine the existing relation between the OLP and psychological alterations of the patient, such as stress, anxiety, and depression., Materials and Methods: Hospital anxiety and depression scale was applied for psychometric analysis., Results: The study indicates a definitive relationship between a stressful life event and onset and progression of OLP., Conclusion: Stress management and bereavement counseling should be a part of management protocol of OLP.