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A novel interpenetrating polymer network (IPN) has been synthesized through enzymatic initiation using lipase as initiator, glutaraldehyde as cross-linker, acrylic acid as primary monomer and acrylamide as secondary monomer. Biodegradability of synthesized interpenetrating polymer network was studied through soil burial and composting methods. Synthesized hydrogel was completely degraded within 70 days using composting method, while it was 86.03% degraded within 77 days using soil burial method. This was confirmed by Fourier transform Infrared spectroscopy (FTIR) and Scanning electron microscopy (SEM) techniques. Synthesized interpenetrating polymer network hydrogel was used as a device for controlled release of urea and also act as water releasing device. Their impact on soil fertility and plant growth was also studied. The initial diffusion coefficient has a greater value than the later diffusion coefficient indicating a higher fertilizer release rate during the early stage. Fertilizer release kinetic was also studied which showed Non-Fickian diffusion behavior, as the rate of fertilizer release was comparable to the relaxation time of the synthesized matrix. Synthesized IPN enhance the water uptake capacity up to 6.2% and 7.2% in sandy loam and clay soil, respectively.

Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.(1) (,2) We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation.

To evaluate drug and metabolite efficacy on a target organ, it is essential to include metabolic function of hepatocytes, and to evaluate metabolite influence on both hepatocytes and the target of interest. Herein, we have developed a two-chamber microfabricated device separated by a membrane enabling communication between hepatocytes and cancer cells. The microscale environment created enables cell co-culture in a low media-to-cell ratio leading to higher metabolite formation and rapid accumulation, which is lost in traditional plate cultures or other interconnected models due to higher culture volumes. We demonstrate the efficacy of this system by metabolism of tegafur by hepatocytes resulting in cancer cell toxicity.

Although microfluidics provides exquisite control of the cellular microenvironment, culturing cells within microfluidic devices can be challenging. 3D culture of cells in collagen type I gels helps to stabilize cell morphology and function, which is necessary for creating microfluidic tissue models in microdevices. Translating traditional 3D culture techniques for tissue culture plates to microfluidic devices is often difficult because of the limited channel dimensions. In this method, we describe a technique for modifying native type I collagen to generate polycationic and polyanionic collagen solutions that can be used with layer-by-layer deposition to create ultrathin collagen assemblies on top of cells cultured in microfluidic devices. These thin collagen layers stabilize cell morphology and function, as shown using primary hepatocytes as an example cell, allowing for the long term culture of microtissues in microfluidic devices.

Surface treatments of various layers in organic solar cells play a vital role in determining device characteristics. In this manuscript, we report on the influence of surface treatment of indium tin oxide (ITO) electrode and electron transport layer (ETL), ZnO, on the photovoltaic performance of inverted organic solar cells (IOSC) and their correlation with the surface chemistry and surface potential as studied using X-ray photoelectron spectroscopy (XPS) and Kelvin probe force microscopy (KPFM), using the device structure glass/ITO/ZnO/P3HT: PCBM/MoO3/(Au or Ag) (P3HT, poly(3-hexylthiophene-2,5-diyl), and PCBM, phenyl-C61-butyric acid methyl ester). Our results show that although ozonization of ITO leads to an improvement in the device power conversion efficiency, the ozonization of a subsequent ZnO layer results in a decreased performance mainly because of a decrease in the fill factor (FF). However, subsequent methanol (CH3OH) treatment of ZnO layer on an ozonized ITO electrode shows substantial improvement with device efficiencies exceeding ∼4% along with superior reproducibility of the devices. Furthermore, a detailed analysis of the surface wettability, chemistry, and surface potential using contact angle measurements, XPS, and KPFM attribute the improvements to the elimination of surface defects and the changes in the surface potential. Finally, impedance analysis suggests that methanol treatment of the ZnO layers leads to the development of a favorable nanophase structure with higher conductivity, which is otherwise indiscernible using microscopic methods.

Cadmium chloride (CdCl2) induced genotoxicity and cytotoxicity has been assessed in the peripheral blood erythrocytes of freshwater fish Labeo rohita exposed to 0.37 and 0.62mg/L of CdCl2 in water for 100 days. The blood samples of the fish were collected at different intervals (days 1, 3, 5, 10, 15, 30, 60 and 100) of exposure period to analyze DNA damage using comet assay and the occurrence of micronuclei and other cellular anomalies. The results of comet assay showed a significant increase in the mean percentage of tail DNA at both the concentrations. Exposure to CdCl2 also induced micronuclei in addition to many nuclear abnormalities such as nuclear bud, binucleates, lobed, notched and vacuolated nuclei. Cytoplasmic abnormalities like echinocytes, acanthocytes, notched, microcytes and cells with vacuolated cytoplasm were also observed. The metal exposed groups showed significant variation in the frequency of cellular abnormalities as well as the extent of DNA damage in comparison to controls. These frequencies increased significantly (p<0.05) in concentration dependent manner, peaking on 10th day while a decreasing trend was observed after 15 days of the exposure period., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Aims: Women with a history of gestational diabetes mellitus (GDM) have an increased risk for future glucose intolerance, and should be followed up with subsequent screening for the development of diabetes or pre-diabetes at 6-12 weeks postpartum. We studied the prevalence of glucose intolerance at 6 weeks postpartum in Indian women with GDM diagnosed according to ADA criteria., Materials and Methods: This longitudinal study, conducted at a tertiary care centre, included 75 Asian-Indian women aged ≥18 years, with a diagnosis of GDM (as per ADA criteria), who were referred to the Endocrine Department at Indraprastha Apollo Hospital, Delhi. A 2-h 75 g oral glucose tolerance test (OGTT) was performed at 6 weeks postpartum., Results: Out of the 75 women who had GDM and were recommended an OGTT at 6 weeks postpartum, 17.3% did not return for the test. Out of 62 women, one-third (33.8%) developed an abnormal OGTT at 6 weeks postpartum, while 66.1% had reverted to normal glucose tolerance. Impaired fasting glucose (IFG) was seen in 14.5%, 4.8% had impaired glucose tolerance (IGT), 8% had both IFG and IGT, and 6.4% had overt type 2 diabetes., Conclusion: Our study emphasizes the need for compulsory follow up OGTT for women with GDM in our part of the world in view of ethnicity and prevailing socio-cultural factors., (Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to evaluate and compare audio and audiovisual distraction aids in management of anxious pediatric dental patients of different age groups and to study children's response to sequential dental visits with the use of distraction aids., Study Design: This study was conducted on two age groups, that is, 4-6 years and 6-8 years with 30 patients in each age group on their first dental visit. The children of both the age groups were divided into 3 subgroups, the control group, audio distraction group, audiovisual distraction group with 10 patients in each subgroup. Each child in all the subgroups had gone through three dental visits. Child anxiety level at each visit was assessed by using a combination of anxiety measuring parameters. The data collected was tabulated and subjected to statistical analysis., Results: Tukey honest significant difference post-hoc test at 0.05% level of significance revealed audiovisual group showed statistically highly significant difference from audio and control group, whereas audio group showed the statistically significant difference from the control group., Conclusion: Audiovisual distraction was found to be a more effective mode of distraction in the management of anxious children in both the age groups when compared to audio distraction. In both the age groups, a significant effect of the visit type was also observed.

Background: Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions., Aim: To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings., Materials and Methods: A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated., Results: A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry., Conclusion: All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.

Vascularized composite allotransplantation (VCA) has emerged as a treatment option for treating nonlife-threatening conditions. Therefore, in order to make VCA a safe reconstruction option, there is a need to minimize immunosuppression, develop tolerance-inducing strategies and elucidate the mechanisms of VCA rejection and tolerance. In this study we explored the effects of hIL-2/Fc (a long-lasting human IL-2 fusion protein), in combination with antilymphocyte serum (ALS) and short-term cyclosporine A (CsA), on graft survival, regulatory T cell (Treg) proliferation and tolerance induction in a rat hind-limb transplant model. We demonstrate that hIL-2/Fc therapy tips the immune balance, increasing Treg proliferation and suppressing effector T cells, and permits VCA tolerance as demonstrated by long-term allograft survival and donor-antigen acceptance. Moreover, we observe two distinct types of acute rejection (AR), progressive and reversible, within hIL-2/Fc plus ALS and CsA treated recipients. Our study shows differential gene expression profiles of FoxP3 versus GzmB, Prf1 or interferon-γ in these two types of AR, with reversible rejection demonstrating higher Treg to Teff gene expression. This correlation of gene expression profile at the first clinical sign of AR with VCA outcomes can provide the basis for further inquiry into the mechanistic aspects of VCA rejection and future drug targets., (© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Hepatocytes and their in vitro models are essential tools for preclinical screening studies for drugs that affect the liver. Most of the current models primarily focus on hepatocytes alone and lack the contribution of non-parenchymal cells (NPCs), which are significant through both molecular and the response of the NPCs themselves. Models that incorporate NPCs alongside hepatocytes hold the power to enable more realistic recapitulation and elucidation of cell interactions and cumulative drug response. Hepatocytes and liver sinusoidal endothelial cells (LSECs) account for ∼ 80% of the liver mass where the LSECs line the walls of blood vessels, and act as a barrier between hepatocytes and blood. Culturing LSECs with hepatocytes to generate multicellular physiologically relevant in vitro liver models has been a major hurdle since LSECs lose their phenotype rapidly after isolation. To this end, we describe the application of collagen gel (1) in a sandwich and (2) as an intervening extracellular matrix layer to coculture hepatocytes with LSECs for extended periods. These coculture configurations provide environments wherein hepatocyte and LSECs, through cell-cell contacts and/or secretion factors, lead to enhanced function and stability of the cocultures. Our results show that in these configurations, hepatocytes and LSECs maintained their phenotypes when cultured together as a mixture, and showed stable secretion and metabolic activity for up to 4 weeks. Immunostaining for sinusoidal endothelial 1 (SE-1) antibody demonstrated retention of LSEC phenotype during the culture period. In addition, LSECs cultured alone maintained high viability and SE-1 expression when cultured within a collagen sandwich configuration up to 4 weeks. Albumin production of the cocultures was 10-15 times higher when LSECs were cultured as a bottom layer (with an intervening collagen layer) and as a mixture in a sandwich configuration, and native CYP 1A1/2 activity was at least 20 times higher than monoculture controls. Together, these data suggest that collagen gel-based hepatocyte-LSEC cocultures are highly suitable models for stabilization and long-term culture of both cell types. In summary, these results indicate that collagen gel-based hepatocyte-LSEC coculture models are promising for in vitro toxicity testing, and liver model development studies.

The liver performs many key functions, the most prominent of which is serving as the metabolic hub of the body. For this reason, the liver is the focal point of many investigations aimed at understanding an organism's toxicological response to endogenous and exogenous challenges. Because so many drug failures have involved direct liver toxicity or other organ toxicity from liver generated metabolites, the pharmaceutical industry has constantly sought superior, predictive in-vitro models that can more quickly and efficiently identify problematic drug candidates before they incur major development costs, and certainly before they are released to the public. In this broad review, we present a survey and critical comparison of in-vitro liver technologies along a broad spectrum, but focus on the current renewed push to develop "organs-on-a-chip". One prominent set of conclusions from this review is that while a large body of recent work has steered the field towards an ever more comprehensive understanding of what is needed, the field remains in great need of several key advances, including establishment of standard characterization methods, enhanced technologies that mimic the in-vivo cellular environment, and better computational approaches to bridge the gap between the in-vitro and in-vivo results.

Background & Aims: Emerging data suggest that changes in intestinal permeability and increased gut microbial translocation contribute to the inflammatory pathway involved in nonalcoholic steatohepatitis (NASH) development. Numerous studies have investigated the association between increased intestinal permeability and NASH. Our meta-analysis of this association investigates the underlying mechanism., Methods: A meta-analysis was performed to compare the rates of increased intestinal permeability in patients with NASH and healthy controls. To further address the underlying mechanism of action, we studied changes in intestinal permeability in a diet-induced (methionine-and-choline-deficient; MCD) murine model of NASH. In vitro studies were also performed to investigate the effect of MCD culture medium at the cellular level on hepatocytes, Kupffer cells, and intestinal epithelial cells., Results: Nonalcoholic fatty liver disease (NAFLD) patients, and in particular those with NASH, are more likely to have increased intestinal permeability compared with healthy controls. We correlate this clinical observation with in vivo data showing mice fed an MCD diet develop intestinal permeability changes after an initial phase of liver injury and tumor necrosis factor- α (TNF α ) induction. In vitro studies reveal that MCD medium induces hepatic injury and TNF α production yet has no direct effect on intestinal epithelial cells. Although these data suggest a role for hepatic TNF α in altering intestinal permeability, we found that mice genetically resistant to TNF α -myosin light chain kinase (MLCK)-induced intestinal permeability changes fed an MCD diet still develop increased permeability and liver injury., Conclusions: Our clinical and experimental results strengthen the association between intestinal permeability increases and NASH and also suggest that an early phase of hepatic injury and inflammation contributes to altered intestinal permeability in a fashion independent of TNF α and MLCK.

This study reports the microwave-assisted synthesis of gum-ghatti (Gg)-grafted poly(acrylamide-co-methacrylic acid) (AAm-co-MAA) hydrogels for the development of biodegradable flocculants and adsorbents. The synthesized hydrogels were characterized using TGA, FTIR and SEM. TGA studies revealed that the synthesized hydrogels were thermally more stable than pristine Gg and exhibited maximum swelling capacity of 1959% at 60°C in neutral pH. The optimal Gg-cl-P(AAm-co-MAA) hydrogel was successfully employed for the removal of saline water from various petroleum fraction-saline emulsions. The maximum flocculation efficiency was achieved in an acidic clay suspension with a 15 mg polymer dose at 40°C. Moreover, the synthesized hydrogel adsorbed 94% and 75% of Pb(2+) and Cu(2+), respectively, from aqueous solutions. Finally, the Gg-cl-P(AAm-co-MAA) hydrogel could be degraded completely within 50 days. In summary, the Gg-cl-P(AAm-co-MAA) hydrogel was demonstrated to have potential for use as flocculants and heavy metal absorbents for industrial waste water treatment., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Investigations were carried out on the occurrence and fate of bisphenol A (BPA) in five wastewater treatment plants (WWTPs) in Bangkok, namely, Rattanakosin, Chong Non Si, Din Daeng (DD), Nong Khaem and Thungkru (TK) during three sampling events between October 2013 and February 2014. Based on the results, the influent and effluent BPA concentrations ranged between 128.5 ng/L and 606.0 ng/L; and 38.7 ng/L and 270.5 ng/L, respectively. The effluent BPA concentrations of most of the five WWTPs were lower than the influent levels. TK had the highest removal efficiency in October 2013 (80.4%) and December 2013 (90.7%) and the second highest in February 2014 (69.2%). DD had the highest removal efficiency in February 2014 (91.8%). The treatment processes employed at TK and DD were vertical loop reactor activated sludge process and activated sludge with nutrients removal, respectively. Thus, these processes seem to be good for BPA degradation.

This article reports the development of biodegradable flocculants based on graft co-polymers of gum ghatti (Gg) and a mixture of acrylamide and acrylonitrile co-monomers (AAm-co-AN). The hydrogel polymer exhibited an excellent swelling capacity of 921% in neutral medium at 60°C. The polymer was used to remove saline water from various petroleum fraction-saline water emulsions. The flocculation characteristics of the hydrogel polymer were studied in turbid kaolin solution as a function of the amount of polymer and the solution temperature and pH. Biodegradation studies of hydrogel polymer were conducted using the soil composting method, and the degradation process was constantly monitored using scanning electron microscopy and Fourier transform infrared spectroscopy techniques. The results demonstrated an 89.47% degradation of the polymer after 60 days. Finally, the hydrogel polymer adsorbed 98% of cationic dyes from the aqueous solutions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

To assess the public's propensity for allergic contact dermatitis (ACD), many alternatives to in vivo chemical screening have been developed which generally incorporate a small panel of cell surface and secreted dendritic cell biomarkers. However, given the underlying complexity of ACD, one cell type and limited cellular metrics may be insufficient to predict contact sensitizers accurately. To identify a molecular signature that can further characterize sensitization, we developed a novel system using RealSkin, a full thickness skin equivalent, in co-culture with MUTZ-3 derived Langerhan's cells. This system was used to distinguish a model moderate pro-hapten isoeugenol (IE) and a model strong pre-hapten p-phenylenediamine (PPD) from irritant, salicylic acid (SA). Commonly evaluated metrics such as CD86, CD54, and IL-8 secretion were assessed, in concert with a 27-cytokine multi-plex screen and a functional chemotaxis assay. Data were analyzed with feature selection methods using ANOVA, hierarchical cluster analysis, and a support vector machine to identify the best molecular signature for sensitization. A panel consisting of IL-12, IL-9, VEGF, and IFN-γ predicted sensitization with over 90% accuracy using this co-culture system analysis. Thus, a multi-metric approach that has the potential to identify a molecular signature may be more predictive of contact sensitization., (Copyright © 2014. Published by Elsevier Ltd.)

Background: Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique., Materials and Methods: Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9-L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system., Results: Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration., Conclusion: CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

The liver is a heterogeneous organ with many vital functions, including metabolism of pharmaceutical drugs and is highly susceptible to injury from these substances. The etiology of drug-induced liver disease is still debated although generally regarded as a continuum between an activated immune response and hepatocyte metabolic dysfunction, most often resulting from an intermediate reactive metabolite. This debate stems from the fact that current animal and in vitro models provide limited physiologically relevant information, and their shortcomings have resulted in "silent" hepatotoxic drugs being introduced into clinical trials, garnering huge financial losses for drug companies through withdrawals and late stage clinical failures. As we advance our understanding into the molecular processes leading to liver injury, it is increasingly clear that (a) the pathologic lesion is not only due to liver parenchyma but is also due to the interactions between the hepatocytes and the resident liver immune cells, stellate cells, and endothelial cells; and (b) animal models do not reflect the human cell interactions. Therefore, a predictive human, in vitro model must address the interactions between the major human liver cell types and measure key determinants of injury such as the dosage and metabolism of the drug, the stress response, cholestatic effect, and the immune and fibrotic response. In this mini-review, we first discuss the current state of macro-scale in vitro liver culture systems with examples that have been commercialized. We then introduce the paradigm of microfluidic culture systems that aim to mimic the liver with physiologically relevant dimensions, cellular structure, perfusion, and mass transport by taking advantage of micro and nanofabrication technologies. We review the most prominent liver-on-a-chip platforms in terms of their physiological relevance and drug response. We conclude with a commentary on other critical advances such as the deployment of fluorescence-based biosensors to identify relevant toxicity pathways, as well as computational models to create a predictive tool., (© 2014 by the Society for Experimental Biology and Medicine.)

Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.

The creation of stable flow cultures of hepatocytes is highly desirable for the development of platforms for drug toxicity screening, bio-artificial liver support devices, and models for investigating liver physiology and pathophysiology. Given that hepatocytes cultured using the collagen overlay or in 'sandwich' configuration maintain a wide range of differentiated functions, we describe a simple method for adapting this culture configuration within a microfluidic device. The device design consists of a porous membrane sandwiched between two layers of PDMS resulting in a two-chambered device. In the bottom chamber, hepatocytes are cultured in the collagen sandwich configuration, while the top chamber is accessible for flow. We demonstrate that hepatocytes cultured under flow exhibit higher albumin and urea secretions and induce cytochrome P450 1A1 activity in comparison to static cultures. Furthermore, over two weeks, hepatocytes cultured under flow show a well-connected cellular network with bile canaliculi formation, whereas static cultures show formation of gaps in the cellular network that progressively increase over time. Although enhanced functional response of hepatocytes cultured under flow has been observed in multiple prior studies, the exact mechanism for this flow induced effect remains unknown. In our work, we identified that hepatocytes secrete a higher level of collagen in the flow cultures; inhibiting collagen secretion within the flow cultures reduced albumin secretion and restored the appearance of gaps in the cellular network similar to the static cultures. These results demonstrate the importance of the increased collagen secretion by hepatocytes cultured under flow as a mechanism to maintain a well-connected cellular network and a differentiated function.

A 22-year-old lactating mother presented with symptoms of uneasiness, palpitation, tachycardia and exophthalmos. She had an abdominal lump suggestive of 26 weeks uterine size but her urine pregnancy test was negative. Her thyroid profile was suggestive of hyperthyroidism. Gynaecological and ultrasonographic findings revealed a hydatidiform mole. She had a low β-human chorionic gonadotropin level that surprisingly increased after suction and evacuation. The paradoxical findings that appeared as erroneous laboratory results could be explained by the 'high-dose hook effect' after a review of literature. One week after the evacuation, the patient's thyroid profile and symptoms resolved completely without any treatment for hyperthyroidism., (2014 BMJ Publishing Group Ltd.)

The advent of newer developments in anesthesia techniques and current clinical scenario has necessitated assurance of quality anesthesia services delivery. Numerous factors including availability of newer drugs, availability of newer advanced monitoring gadgets, increased awareness among the patient population, implementation of newer medico-legal laws and professional competitiveness has mandated a quality control and assurance in anesthesia. These domains of quality control are adapted from public health and are being incorporated into daily anesthesia practice in a gradual and phased manner. Quality control and assurance can be assessed and measured with certain quality indicators, which are also helpful in determining the perioperative outcome in anesthesia and surgical practice. Patient's perception about various anesthetic procedures, drug effects and recovery state are the prime underlying basis for assessing the quality assurance and control. At the same time, a positive impact of feedback mechanism cannot be under-emphasized while aiming for improvement in delivery of quality anesthesia services. The current review is aimed at highlighting the important aspects associated with quality assurance and quality control in anesthesia practice.

The creation of stable hepatocyte cultures using cell-matrix interactions has proven difficult in microdevices due to dimensional constraints limiting the utility of classic tissue culture techniques that involve the use of hydrogels such as the collagen "double gel" or "overlay". To translate the collagen overlay technique into microdevices, we modified collagen using succinylation and methylation reactions to create polyanionic and polycationic collagen solutions, and deposited them layer-by-layer to create ultrathin collagen nanolayers on hepatocytes. These ultrathin collagen layers covered hepatocytes in microdevices and 1) maintained cell morphology, viability, and polarity, 2) induced bile canalicular formation and actin reorganization, and 3) maintained albumin and urea secretions and CYP activity similar to those observed in hepatocytes in collagen double gel hepatocytes in plate cultures. Beyond the immediate applications of this technique to create stable, in vitro microfluidic hepatocyte cultures for drug toxicity testing, this technique is generally applicable as a thin biomaterial for other 3D microtissues.

Congenital hyperinsulinism (CHI), a clinically and genetically heterogeneous disease, characterized by the unregulated secretion of insulin from pancreatic β-cells, is the most common cause of persistent hypoglycemia in infancy. Early diagnosis and maintenance of normoglycaemia are essential to prevent adverse neurodevelopmental outcomes. The most common and severe forms of CHI are caused by inactivating mutations in ABCC8 and KCNJ11 genes, encoding the two subunits of the pancreatic β-cell ATP sensitive potassium channel (KATP). We report a case of neonatal CHI due to a novel homozygous recessive mutation in the ABCC8 gene., (Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Background: Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries., Materials and Methods: Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed., Results: The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed., Conclusion: Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.

Unlabelled: This study evaluates targeted liposomes loaded with the α-particle generator (225)Ac to selectively kill prostate-specific membrane antigen (PSMA)-expressing cells with the aim to assess their potential for targeted antivascular radiotherapy., Methods: In this study, PEGylated liposomes were loaded with (225)Ac and labeled with the mouse antihuman PSMA J591 antibody or with the A10 PSMA aptamer. The targeting selectivity, extent of internalization, and killing efficacy of liposomes were evaluated on monolayers of prostate cancer cells intrinsically expressing PSMA (human LNCaP and rat Mat-Lu cells) and on monolayers of HUVEC induced to express PSMA (induced HUVEC)., Results: The loading efficiency of (225)Ac into preformed liposomes ranged from 58.0% ± 4.6% to 85.6% ± 11.7% of introduced radioactivity. The conjugation reactions resulted in approximately 17 ± 2 J591 antibodies and 9 ± 2 A10 aptamers per liposome. The average size of liposomes, 107 ± 2 nm in diameter, was not affected by conjugation or loading. LNCaP cells exhibit 2:1:0.5 relative PSMA expression, compared with MatLu and induced HUVEC, respectively, based on flow cytometry detecting association of the J591 antibody. J591-labeled liposomes display higher levels of total specific binding to all cell lines than A10 aptamer-labeled liposomes. Specific cell association of targeted liposomes increases with incubation time. Cytotoxicity studies demonstrate that radiolabeled J591-labeled liposomes are most cytotoxic, with median lethal dose values, after 24 h of incubation, equal to 1.96 (5.3 × 10(-5)), 2.92 × 10(2) (7.9 × 10(-3)), and 2.33 × 10(1) Bq/mL (6.3 × 10(-4) μCi/mL) for LNCaP, Mat-Lu, and induced HUVEC, respectively, which are comparable to the values for the radiolabeled J591 antibody. For A10 aptamer-labeled liposomes, the corresponding values are 3.70 × 10(1) (1.0 × 10(-3)), 1.85 × 10(3) (5.0 × 10(-2)), and 4.07 × 10(3) Bq/mL (1.1 × 10(-1) μCi/mL), respectively., Conclusion: Our studies demonstrate that anti-PSMA-targeted liposomes loaded with (225)Ac selectively bind, become internalized, and kill PSMA-expressing cells including endothelial cells induced to express PSMA. These findings-combined with the unique ability of liposomes to be easily tuned, in terms of size and surface modification, for optimizing biodistributions-suggest the potential of PSMA-targeting liposomes encapsulating α-particle emitters for selective antivascular α radiotherapy.

Objective: Cognitive impairments contribute significantly to inadequate functional recovery following illness episodes in bipolar disorder, yet data on treatment interventions are sparse. We assessed the cognitive effects of a standardized extract of the medicinal herb Withania somnifera (WSE) in bipolar disorder., Method: Sixty euthymic subjects with DSM-IV bipolar disorder were enrolled in an 8-week, double-blind, placebo-controlled, randomized study of WSE (500 mg/d) as a procognitive agent added adjunctively to the medications being used as maintenance treatment for bipolar disorder. Study enrollment and data analyses were completed between December 2008 and September 2012. Cognitive testing at baseline and 8 weeks assessed primary efficacy outcomes. Psychopathology and adverse events were monitored at scheduled visits., Results: Fifty-three patients completed the study (WSE, n = 24; placebo, n = 29), and the 2 groups were matched in terms of demographic, illness, and treatment characteristics. Compared to placebo, WSE provided significant benefits for 3 cognitive tasks: digit span backward (P = .035), Flanker neutral response time (P = .033), and the social cognition response rating of the Penn Emotional Acuity Test (P = .045). The size of the WSE treatment effect for digit span backward was in the medium range (Cohen d = 0.51; 95% CI, 0.25-0.77). None of the other cognitive tasks showed significant between-group differences. Mood and anxiety scale scores remained stable, and adverse events were minor., Conclusions: Although results are preliminary, WSE appears to improve auditory-verbal working memory (digit span backward), a measure of reaction time, and a measure of social cognition in bipolar disorder. Given the paucity of data for improving cognitive capacity in bipolar disorder, WSE offers promise, appears to have a benign side-effects profile, and merits further study., Trial Registration: ClinicalTrials.gov identifier: NCT00761761., (© Copyright 2013 Physicians Postgraduate Press, Inc.)

Biodegradation studies of Gum ghatti (Gg) and acrylamide-co-acrylic acid based flocculants [Gg-cl-poly(AAm-co-AA)] have been reported using the soil composting method. Gg-cl-poly(AAm-co-AA) was found to degrade 89.76% within 60 days. The progress of biodegradation at each stage was monitored through FT-IR and SEM. Polymer was synthesized under pressure using potassium persulphate-ascorbic acid as a redox initiator and N,N'-methylene-bis-acrylamide as a crosslinker. Synthesized polymer was found to show pH, temperature and ionic strength of the cations dependent swelling behavior. Gg-cl-poly(AAm-co-AA) was utilized for the selective absorption of saline from different petroleum fraction-saline emulsions. The flocculation efficiency of the polymer was studied as a function of polymer dose, temperature and pH of the solution. Gg-cl-poly(AAm-co-AA) showed maximum flocculation efficiency with 20 mol L(-1) polymer dose in acidic medium at 50 °C., (Copyright © 2013. Published by Elsevier Ltd.)

The present study deals with the limnobiotic status of three selected lakes of Himachal Pradesh using physicochemical and biological parameters (especially phytoplankton and zooplankton) over a period of 2 years. One hundred forty-eight species belonging to nine groups of phytoplankton and 79 species belonging to five groups of zooplankton were identified from the lakes. Trophic level and the pollution status of the lakes were assessed upon the basis of Shannon diversity index (H'), species richness index (S), and physicochemical parameters. Plankton population size was correlated with biotic and abiotic parameters (pH, alkalinity, temperature, dissolved oxygen, transparency, phosphate, chloride, and nitrate). The present investigation revealed that the distribution of plankton species depended upon the physicochemical parameters of the environment. Based on water quality standards given by the Central Pollution Control Board, the water quality was between "A-B" at Prashar wetland, "C-D" at Kuntbhyog Lake, and "D-E" at Rewalsar Lake. The results from the present study indicated that the potential of planktons as bioindicators of trophic status is very high.

Dendritic cells are the principal antigen presenting cells that are responsible for acquiring and transporting antigen from the peripheral tissue to the secondary lymphoid tissue. There they present it to T cells which ultimately initiate an antigen specific immune response. In vivo , the migration of dendritic cells (DCs) and T cell activation are intimately linked. However, ex vivo systems that facilitate integrated evaluation of DC chemotaxis and resulting T cell activation by migrated DCs are lacking. In this work, we have developed a microfabricated platform that integrates DC chemotaxis with T cell activation. The basic design of the microdevice includes two layers of PDMS, with the top layer comprising the chemotaxis compartment and the bottom layer containing a T cell compartment. In the chemotaxis compartment, the DCs are subjected to a chemokine gradient, and their migratory response is evaluated. In the T cell compartment, rapid DC-induced activation of T cells is evaluated by measuring the level of calcium in T cells. We demonstrate the efficacy of our approach by evaluating the integrated response of mature DCs, whereby the overall T cell activation response is governed both by the chemotaxis and the T cell activation potential of mature DCs relative to immature DCs. Our system provides a powerful platform for systematically probing various aspects of antigen induced immune responses - DC maturation, migration and T cell activation - in an integrated fashion.

A short range force constant model has been applied using normal coordinates to investigate the Raman and the infrared wavenumbers in rare earth AVO4 compounds (A=Lu, Yb, Dy, Tb, Ce) having space group I41/a and symmetry C4h(6). The calculation of zone center phonons has been made by using four stretching and five bending force constants. The calculated Raman and infrared wavenumbers are in very good agreement with the observed ones. The present calculations interpret reasonably the mode assignment of 779 cm(-1) as Eg mode and 853 cm(-1) as Ag mode in case of LuVO4, which were assigned differently in earlier observation. The potential energy distribution has also been investigated for determining the significance of contribution from each force constant toward the Raman and the infrared wavenumbers., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Biodegradable flocculants of Gum ghatti (Gg) with acrylamide (AAm) were prepared through graft co-polymerization technique using potassium persulphate (KPS)-ascorbic acid (ABC) redox pair as initiator and N,N'-methylene-bis-acrylamide (MBA) as a crosslinker. Gg-cl-poly(AAm) was found to exhibit pH and temperature responsive swelling behavior. Maximum flocculation efficiency of Gg-cl-poly(AAm) was observed with 15 mg L(-1) polymer dose in acidic medium at 50°C. Biodegradation studies of Gg and Gg-cl-poly(AAm) were done using composting method. Gg was found to degrade within 20 days, whereas, Gg-cl-poly(AAm) was found to degrade 88.18% within 60 days. Different stages of bio-degradation were characterized through FT-IR and SEM techniques., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Pyrexia can be extremely threatening during the normal progression of pregnancy if it occurs during the early phase of gestation as compared to the latter half of pregnancy. The degree of temperature rise, stage of pregnancy, and duration of the underlying illness are the important determinants for the outcome of pregnancy. Fever, resulting from the intrauterine infections, can be extremely hazardous for the newborn. Any history of fever (>24 h) during pregnancy mandate a complete clinical examination and thorough investigations. We report successful management of a rare case of prolonged high-grade pyrexia with unusual cause during mid-pregnancy.

Ash-leaf spots, a diagnostic manifestation of tuberous sclerosis complex, are sometimes difficult to differentiate from other hypopigmented lesions. Vitiligo, naevus anaemicus and naevus depigmentosus are important clinical differentials for ash-leaf spots. Among these naevus depigmentosus poses maximum difficulty because of clinical as well as histological similarities. Here we describe a 6-month-old child with multiple segmental hypopigmented macules over the face. In isolation lesions appeared to be those of naevus depigmentosus. However, the presence of other manifestations of tuberous sclerosis favoured the diagnosis of ash-leaf spots. Important similarities and differences between the two have also been discussed.

Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient. Prevention of this spinal anaesthesia induced hypotension is of utmost importance especially in pregnant population as the life of mother as well as fetus is at risk. Several techniques and methodologies have been adopted for the prevention of this neuraxial hypotension with varying degree of success. The administration of intravenous fluids to optimize the blood volume during sympathectomy has been the most popular and widely used as the first line of therapy among these techniques. The intravenous fluids can be used both before and during the administration of spinal anaesthesia, the techniques appropriately named as pre-loading and co-loading respectively. Numerous research studies and available literary evidence suggests that both of these techniques can be equally effective in prevention of hypotension. The use of colloids has been observed to be more effective for pre-loading due to their longer half-life in the intravascular compartment. However, it has also been suggested that no technique is efficient in preventing the hypotension alone and has to be coupled with judicious use of vasopressors.

Blood glucose monitoring is a way of testing the concentration of glucose in the blood. The most recent advance is the development of continuous glucose monitoring system (CGMS) which gives 24 hour trend of blood sugar levels thus helping both the patient and the physician in achieving better glycemic control. CGMS in pediatric population is generally used for those on insulin pumps and those who are having fluctuating blood glucose levels. This case highlights the use of CGMS for a child with congenital hyperinsulinemia. It helped in close monitoring of blood glucose levels thereby identifying recurrent hypoglycemia, leading to a better control of blood glucose levels.

Pharmaceuticals have been frequently detected in aquatic environment worldwide and suspected for potential ecological consequences. However, occurrences, sources and potential risks of pharmaceutical residues have rarely been investigated in Bangkok, Thailand, one of most densely populated cities in the world. We collected water samples from five wastewater treatment plants (WWTPs), six canals, and in mainstream Chao Phraya River of Bangkok, in three sampling events representing different seasonal flow conditions, i.e., June and September 2011 and January 2012. Fourteen major pharmaceuticals including acetaminophen, acetylsalicylic acid, atenolol, caffeine, ciprofloxacin, diclofenac, ibuprofen, mefenamic acid, naproxen, roxithromycin, sulfamethazine, sulfamethoxazole, sulfathiazole and trimethoprim were analyzed. Levels of pharmaceutical residues in WWTP influents on average were the highest for acetylsalicylic acid (4700 ng L(-1)), followed by caffeine (2250 ng L(-1)) and ibuprofen (702 ng L(-1)). In effluents, the concentration of caffeine was the highest (307 ng L(-1)), followed by acetylsalicylic acid (261 ng L(-1)) and mefenamic acid (251 ng L(-1)). In surface water, acetylsalicylic acid showed the highest levels (on average 1360 ng L(-1) in canals and 313 ng L(-1) in the river). Removal efficiencies of WWTPs for roxithromycin, sulfamethoxazole and sulfamethazine were determined negligible. For several compounds, the concentrations in ambient water were higher than those detected in the effluents, implying contribution of the WWTPs to be negligible. Hazard quotients estimated for acetylsalicylic acid, ciprofloxacin, diclofenac and mefenamic acid in most of the canals and that of ciprofloxacin in the river, were greater than or close to 1, suggesting potential ecological risks. Ecological implications of the pharmaceutical residues in Bangkok waterway warrant further investigation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: Comparative evaluation of the reinforcing effect of different post systems in the restoration of endodontically treated human anterior teeth at two different lengths of post space preparation- an in vitro study., Materials and Methods: 135 extracted human incisors were endodontically treated, out of which 120 teeth were decoronated 2mm above the cementoenamel junction and divided into four experimental groups based on the post system to be used: Glass fiber post (GFP) and stainless steel post (SSP), titanium post (TTP), cast metal post (CMP). Each group was divided into two sub-groups according to the length of post space preparation: 5mm and 10mm. All the samples were restored with metal crowns. The fracture resistance was measured by applying loads at an angle of 135º to the long axis of teeth in an instron universal testing machine. Fracture mode was analyzed for all the samples. Results from the four test groups were compared and analysed using one-way ANOVA test and the Post-hoc Bonferroni test to demonstrate differences between pairs of groups., Results: The results revealed that SSP group at 10mm post space length showed the significantly ("P-value< 0.05") highest fracture resistance (793.7787 N). Decrease in post length resulted in the decrease in fracture resistance in all the groups reduced to values even lesser than the control (437.8733N)., Conclusion: The different post systems used in the study were able to reinforce endodontically treated teeth only at 10mm post space length.

Epilepsy is one of the most common encountered neurological disorders. Surgical procedures in epileptic patient throw numerous challenges to the attending anesthesiologist during the perioperative period. Various anesthetic drug interactions with antiepileptics, intraoperative and postoperative seizures management and management of status epilepticus are few considerations which an anesthesiologist can confront both during emergency or elective surgery. The role of anesthesiologist acquires significant dimensions in management of epilepsy ranging from operative procedure, status epilepticus to the intensive care management of such patients. It requires a skilful and clinically precise handling of such patients during pre-op, peri-op and post-op period. Majority of times these patients present with co-morbidities which makes the prophylactic management of epilepsy extremely difficult during surgical procedures. The responsibilities of anesthesiologist involve management of epileptic patients not only during epilepsy and nonepilepsy surgery but for other diagnostic and therapeutic procedures as well where sedation or anesthesia services are required. Postoperative management of such patients include careful observation for any seizures and/or pseudo-seizures so as to manage appropriately. The knowledge regarding various antiepileptic agents and their potential side effects and interactions with anesthetic agents are of prime concern during surgical procedures for epilepsy and nonepileptic surgeries. The present article discusses the various anesthetic implications and considerations during management of such patients for epilepsy and nonepilepsy surgery.

Although the process of drug development requires efficacy and toxicity testing in animals prior to human testing, animal models have limited ability to accurately predict human responses to xenobiotics and other insults. Societal pressures are also focusing on reduction of and, ultimately, replacement of animal testing. However, a variety of in vitro models, explored over the last decade, have not been powerful enough to replace animal models. New initiatives sponsored by several US federal agencies seek to address this problem by funding the development of physiologically relevant human organ models on microscopic chips. The eventual goal is to simulate a human-on-a-chip, by interconnecting the organ models, thereby replacing animal testing in drug discovery and development. As part of this initiative, we aim to build a three-dimensional human liver chip that mimics the acinus, the smallest functional unit of the liver, including its oxygen gradient. Our liver-on-a-chip platform will deliver a microfluidic three-dimensional co-culture environment with stable synthetic and enzymatic function for at least 4 weeks. Sentinel cells that contain fluorescent biosensors will be integrated into the chip to provide multiplexed, real-time readouts of key liver functions and pathology. We are also developing a database to manage experimental data and harness external information to interpret the multimodal data and create a predictive platform.

Ribbond is a biocompatible, esthetic material made from high-strength polyethylene fiber. Lenowoven polyethylene ribbon (Ribbond) has been used successfully for tooth splinting, replacement of missing teeth, reinforcement of provisional acrylic resin fixed partial dentures, and orthodontic retention. This article presents the application of this polyethylene ribbon - RIBBOND - for the treatment of nursing bottle caries. To conclude we suggest that this combined technique of polyethylene fibers and composite material could be a very efficient alternative procedure to conventional treatment plans in pedodontic practice, with excellent esthetics and functional results.

Gliptins have revolutionised the treatment of Type 2 Diabetes Mellitus, addressing the hyperglycemia through its effects on the alpha and beta cells of the pancreas. In this article,we review the extra-glycemic effects of gliptins on central nervous system, cardiovascular biology and the bone health and concerns regarding pancreatitis and pancreatic cancer.

Objectives: The aim of this study was to evaluate the effect of post system and length on the fracture resistance of endodontically treated human anterior teeth., Material and Method: Seventy-five extracted human incisors were endodontically treated, out of which 60 were decoronated 2 mm above the cementoenamel junction and divided into two experimental groups based on the type of post system to be used: glass fiber post (GFP) and Ribbond fiber post groups (RFP). Endodontically treated human anterior teeth in which no post was placed served as control group. Each group was divided into two subgroups according to the length of post space: 5 and 10 mm and all the samples were restored with metal crowns. The fracture resistance was measured by applying loads at an angle of 130° to the long axis of teeth in an Instron universal testing machine., Results: The results revealed that GFP group at 10-mm post space length showed the significantly highest fracture resistance (740.2133 N) among all groups and subgroups. Decrease in post length resulted in the decrease in fracture resistance in GFP group (425.1867 N), whereas in group RFP 5-mm subgroup (299.6200 N) showed significantly higher fracture resistance than 10-mm subgroup (216.9300 N) but lesser than the control (437.8733 N) in both the subgroups., Conclusion: Glass fiber posts efficiently increase the fracture resistance of an endodontically treated tooth but the determination of optimal post length is also essential., Clinical Relevance: The present investigation highlights the significance of using glass fiber posts in the restoration of endodontically treated teeth. Endodontically treated teeth restored with glass fiber posts showed increased fracture strength and favorable mode of fracture, and are therefore highly recommended to achieve better clinical outcomes.

Sweet's syndrome is a neutrophilic inflammatory dermatosis presenting with sudden onset tender red to purple papules and nodules, fever and neutrophilia. Gastrointestinal and urinary tract infections, pregnancy, inflammatory bowel disease, drugs and malignancy are some of the known aetiological factors. Paraneoplastic Sweet's syndrome accounts for 15-20% cases and thus forms an important subset. At times its onset helps in suspecting an underlying malignancy, thus making timely intervention possible. In the present case report Sweet's syndrome was the presenting feature of gall bladder adenocarcinoma; an association that has been rarely reported before.

The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.