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Type 2 diabetes (T2D) is a growing problem in children. Children with NAFLD are at potentially high risk for developing T2D; however, the incidence of T2D in this population is unknown. This study aimed to determine the incidence of T2D in children with NAFLD and identify associated risk factors.Children with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network were followed longitudinally. Incidence of T2D was determined by using clinical history and fasting laboratory values. Cumulative incidence curves were developed for time to T2D. A Cox regression multivariable model was constructed using best subsets Akaike's Information Criteria selection.This study included 892 children with NAFLD and with a mean age of 12.8 years (2.7) followed for 3.8 years (2.3) with a total 3234 person-years at risk. The incidence rate of T2D was 3000 new cases per 100,000 person-years at risk. At baseline, 63 children had T2D, and during follow-up, an additional 97 children developed incident T2D, resulting in a period prevalence of 16.8%. Incident T2D was significantly higher in females versus males (hazard ratio [HR], 1.8 [1.0-2.8]), associated with BMI z-score (HR, 1.8 [1.0-3.0]), and more severe liver histology including steatosis grade (HR, 1.3 [1.0-1.7]), and fibrosis stage (HR, 1.3 [1.0-1.5]).Children with NAFLD are at high risk for existing and incident T2D. In addition to known risk factors for T2D (female and BMI z-score), severity of liver histology at the time of NAFLD diagnosis was independently associated with T2D development. Targeted strategies to prevent T2D in children with NAFLD are needed.

Parenteral Nutrition (PN) is a therapy that delivers essential nutrients intravenously to patients that are unable to meet their nutritional requirements via standard enteral feeding. This methodology is often referred to as Parenteral Nutrition (PN) when accompanied by minimal or no enteral nutrition. While PN is lifesaving, significant complications can arise such as intestinal failure associated liver disease (IFALD) and gut-mucosal atrophy. The exact mechanism of injury remains ill defined. This review was designed to explore available literature related to the drivers of injury mechanisms. The Farnesoid X Receptor (FXR) and Fibroblast Growth Factor-19 (FGF19) signaling pathway seems to play an important role in gut-systemic signaling and its alteration during PN provides insights into mechanistic links. Central line infections also play a key role in mediating PN associated injury. While lipid reduction strategies as well as the use of multicomponent lipid emulsions and vitamin E have shown promise, the cornerstone of preventing injury is early establishment of enteral nutrition.

Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care.This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients.Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in 48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months.The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for48 hours (48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses.Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.

NAFLD is the most common chronic liver disease in children. Large pediatric studies identifying single nucleotide polymorphisms (SNPs) associated with risk and histologic severity of NAFLD are limited. Study aims included investigating SNPs associated with risk for NAFLD using family trios and association of candidate alleles with histologic severity.Children with biopsy-confirmed NAFLD were enrolled from the NASH Clinical Research Network. The Expert Pathology Committee reviewed liver histology. Genotyping was conducted with allele-specific primers for 60 candidate SNPs. Parents were enrolled for trio analysis. To assess risk for NAFLD, the transmission disequilibrium test was conducted in trios. Among cases, regression analysis assessed associations with histologic severity. A total of 822 children with NAFLD had mean age 13.2 years (SD 2.7) and mean ALT 101 U/L (SD 90). PNPLA3 (rs738409) demonstrated the strongest risk (p = 2.24 × 10This study demonstrated disease-associated SNPs in children with NAFLD. In particular, rs6006473 was highly associated with severity of fibrosis. These hypothesis-generating results support future mechanistic studies of development of adverse outcomes such as fibrosis and generation of therapeutic targets for NAFLD in children.

To date, no pharmacotherapy exists for pediatric NAFLD. Losartan, an angiotensin II receptor blocker, has been proposed as a treatment due to its antifibrotic effects.The Nonalcoholic Steatohepatitis Clinical Research Network conducted a multicenter, double-masked, placebo-controlled, randomized clinical trial in children with histologically confirmed NAFLD at 10 sites (September 2018 to April 2020). Inclusion criteria were age 8-17 years, histologic NAFLD activity score ≥ 3, and serum alanine aminotransferase (ALT) ≥ 50 U/l. Children received 100 mg of losartan or placebo orally once daily for 24 weeks. The primary outcome was change in ALT levels from baseline to 24 weeks, and the preset sample size was n = 110. Treatment effects were assessed using linear regression of change in treatment group adjusted for baseline value. Eighty-three participants (81% male, 80% Hispanic) were randomized to losartan (n = 43) or placebo (n = 40). During an enrollment pause, necessitated by the 2019 coronavirus pandemic, an unplanned interim analysis showed low probability (7%) of significant group difference. The Data and Safety Monitoring Board recommended early study termination. Baseline characteristics were similar between groups. The 24-week change in ALT did not differ significantly between losartan versus placebo groups (adjusted mean difference: 1.1 U/l; 95% CI = -30.6, 32.7; p = 0.95), although alkaline phosphatase decreased significantly in the losartan group (adjusted mean difference: -23.4 U/l; 95% CI = -41.5, -5.3; p = 0.01). Systolic blood pressure decreased in the losartan group but increased in placebo (adjusted mean difference: -7.5 mm Hg; 95% CI = -12.2, -2.8; p = 0.002). Compliance by pill counts and numbers and types of adverse events did not differ by group.Losartan did not significantly reduce ALT in children with NAFLD when compared with placebo.

This article is aimed at exploring the relevance of the concept of emotional intelligence (EI) from a pragmatic perspective. Although the empirical and conceptual articles are written and published on EI, however it does not suffice the purpose for a practitioner of EI who is naïve to the field of EI, either s/he does not understand the psychological literature or does not have time to study EI in great details. Hence, this article is written from a naïve perspective to make the concept useful and that could be used in our daily life. Drawn from psychological literature, this article is simplifying a complex relationship between human intelligence and emotions and clarifies our understanding about the cognitive and affective spheres of human personality. Further, the article also explains the evolutionary or biological basis of EI and also suggests a managerial use of EI for the field of leadership and decision making. The chapter concludes with a developmental focus of EI. The article is mainly using observations and anecdotes based on the author’s personal experience from his training programs with more than ten thousand managers in India and taught students in Denmark, Italy and South Africa.

Objectives: To describe outcomes following percutaneous coronary intervention (PCI) in patients who would usually have undergone coronary artery bypass grafting (CABG). Background: In the United Kingdom, cardiac surgery for coronary artery disease (CAD) was dramatically reduced during the first wave of the COVID-19 pandemic. Many patients with “surgical disease” instead underwent PCI. Methods: Between 1 March 2020 and 31 July 2020, 215 patients with recognized “surgical” CAD who underwent PCI were enrolled in the prospective UK-ReVasc Registry (ReVR). 30-day major cardiovascular event outcomes were collected. Findings in ReVR patients were directly compared to reference PCI and isolated CABG pre-COVID-19 data from British Cardiovascular Intervention Society (BCIS) and National Cardiac Audit Programme (NCAP) databases. Results: ReVR patients had higher incidence of diabetes (34.4% vs 26.4%, P =.008), multi-vessel disease with left main stem disease (51.4% vs 3.0%, P

The proposed work described the synthesis of neutral ionophores; 4,8-diaza-3,3,10,10-tetramethyl-1,2-dithiacyclodecane (S1), 5,8-diaza-3,3,10,10-tetramethyl-1,2 dithiacyclodecane-N,N''-diacetic acid (S2) and N,N''-bis(2,2-dimethyl-2-mercaptoethyl)ethylenediamine-N,N-diacetic acid (S3) used for comparative analysis in determination of molybdenum(v) as PVC-based membrane sensors. The best result was obtained with sensor no. 7 based on S3 ionophore with membrane composition (w/w, mg%); 5.0(S) : 30.0(PVC) : 5.0(KTpClPB) : 60.0(o-NPOE) showing a working range of 2.3 × 10-7-1.0 × 10-2 M with a detection limit of 1.2 × 10-7 M and a toleration of non-aqueous media up to 15% with slope of 11.7 mV/decade of activity. The sensor no. 7 can also be used to assess the Mo(v) concentration in different natural samples (water bodies, soils, root nodules and urine samples) with comparative analysis of ETAAS and spectrophotometric methods. The proposed sensor no. 7 can be used 2.5 months without any distortion in results after that leaching of ionophore was observed from the membrane phase in aqueous solutions of Mo(v). The proposed sensor has shown a good dynamic response time of 11 s.

Parenteral nutrition (PN) has revolutionized the care of patients with intestinal failure by providing nutrition intravenously. Worldwide, PN remains a standard tool of nutrition delivery in neonatal, pediatric, and adult patients. Though the benefits are evident, patients receiving PN can suffer serious cholestasis due to lack of enteral feeding and sometimes have fatal complications from liver injury and gut atrophy, including PN-associated liver disease or intestinal failure–associated liver disease. Recent studies into gut-systemic cross talk via the bile acid–regulated farnesoid X receptor (FXR)–fibroblast growth factor 19 (FGF19) axis, gut microbial control of the TGR5–glucagon-like peptide (GLP) axis, sepsis, and role of prematurity of hepatobiliary receptors are greatly broadening our understanding of PN-associated injury. It has also been shown that the composition of ω−6/ω−3 polyunsaturated fatty acids given parenterally as lipid emulsions can variably drive damage to hepatocytes and cell integrity. This manuscript reviews the mechanisms for the multifactorial pathogenesis of liver disease and gut injury with PN and discusses novel ameliorative strategies.

The technological challenges of the so-called fourth industrial revolution, innovative inter-organizational network relations, integration in corporate strategies of sustainability challenges, or unsatisfactory levels of staff commitment stemming from complexity and related uncertainty are some of the main key issues that organizations have to face in the near future. In this context, the appearance of the &lsquo, evolutionary organization&rsquo, model marks an important milestone in terms of a renewed identification of fundamental principles for organizations, arguably as an update or revision of systemic thinking. This model allows organizations, functioning as living beings, to be more agile and humanistic and better prepared to establish agile and trustworthy inter-organizational relationships. Collaborative platforms are possible from that ability to add value between organizations while also being closely aligned with the principles and values of evolutionary organizations. The purpose of this paper is to provide insights into how these (teal) organizations work with respect to their common principles of wholeness, evolutionary purpose, and self-management. In the end, the study intends to highlight relevant practical organizational aspects that can better facilitate the management of current and increasing complexity, as well as the transition to more humanistic-oriented organizations.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common pediatric chronic liver disease. Little is known about outcomes in recognized youth. METHODS: We compared paired liver biopsies from 122 of 139 children with NAFLD (74% male; 64% white; 71% Hispanic; mean age, 13 ± 3 years; age range, 8–17 years) who received placebo and standard of care lifestyle advice in 2 double-blind, randomized clinical trials within the nonalcoholic steatohepatitis (NASH) clinical research network from 2005 through 2015. We analyzed histologic changes with respect to baseline and longitudinal change in clinical variables using regression analysis. RESULTS: At enrollment, 31% of the children had definite NASH, 34% had borderline zone 1 NASH, 13% had borderline zone 3 NASH, and 21% had fatty liver but not NASH. Over a mean period of 1.6 ± 0.4 years, borderline or definite NASH resolved in 29% of the children, whereas 18% of the children with fatty liver or borderline NASH developed definite NASH. Fibrosis improved in 34% of the children but worsened in 23%. Any progression to definite NASH or in fibrosis occurred in 36% of the children, and both occurred in 11% of the children. Any improvement in NASH or fibrosis occurred in 52%, and both occurred in 20% of children. Type 2 diabetes developed in 5% of the cohort. Any progression to NASH and/or fibrosis was associated with adolescent age, higher waist circumference, levels of alanine or aspartate aminotransferase, total and low-density lipoprotein-cholesterol at baseline, increasing level of alanine aminotransferase, and hemoglobin A1C (P < .05). Progression to NASH and/or fibrosis were also associated with increasing level of gamma-glutamyl transferase and development of type 2 diabetes (P < .01). Increasing level of gamma-glutamyl transferase also associated with reduced odds of any improvement (P = .003). CONCLUSIONS: One-third of children with NAFLD enrolled in placebo groups of clinical trials had histologic features of progression within 2 years, in association with increasing obesity and serum levels of aminotransferases and loss of glucose homeostasis.

Resistant hypertension is associated with high morbidity and mortality despite numerous pharmacological strategies. A wealth of preclinical and clinical data have demonstrated that resistant hypertension is associated with elevated renal and central sympathetic tone. The development of interventional therapies to modulate the sympathetic nervous system potentially represents a paradigm shift in the strategy for blood pressure control in this subset of patients. Initial first-in-man and pivotal, randomised controlled trials of endovascular, radio-frequency renal sympathetic denervation have spawned numerous iterations of similar technology, as well as many novel concepts for achieving effective renal sympatholysis. This review details the current knowledge of these devices and the evidence base behind each technology.

OBJECTIVES: This study aimed to determine the effect on long-term survival of using optical coherence tomography (OCT) during percutaneous coronary intervention (PCI). BACKGROUND: Angiographic guidance for PCI has substantial limitations. The superior spatial resolution of OCT could translate into meaningful clinical benefits, although limited data exist to date about their effect on clinical endpoints. METHODS: This was a cohort study based on the Pan-London (United Kingdom) PCI registry, which includes 123,764 patients who underwent PCI in National Health Service hospitals in London between 2005 and 2015. Patients undergoing primary PCI or pressure wire use were excluded leaving 87,166 patients in the study. The primary endpoint was all-cause mortality at a median of 4.8 years. RESULTS: OCT was used in 1,149 (1.3%) patients, intravascular ultrasound (IVUS) was used in 10,971 (12.6%) patients, and angiography alone in the remaining 75,046 patients. Overall OCT rates increased over time (p < 0.0001), with variation in rates between centers (p = 0.002). The mean stent length was shortest in the angiography-guided group, longer in the IVUS-guided group, and longest in the OCT-guided group. OCT-guided procedures were associated with greater procedural success rates and reduced in-hospital MACE rates. A significant difference in mortality was observed between patients who underwent OCT-guided PCI (7.7%) compared with patients who underwent either IVUS-guided (12.2%) or angiography-guided (15.7%; p < 0.0001) PCI, with differences seen for both elective (p < 0.0001) and acute coronary syndrome subgroups (p = 0.0024). Overall this difference persisted after multivariate Cox analysis (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.26 to 0.81; p = 0.001) and propensity matching (hazard ratio: 0.39; 95% CI: 0.21 to 0.77; p = 0.0008; OCT vs. angiography-alone cohort), with no difference in matched OCT and IVUS cohorts (HR: 0.88; 95% CI: 0.61 to 1.38; p = 0.43). CONCLUSIONS: In this large observational study, OCT-guided PCI was associated with improved procedural outcomes, in-hospital events, and long-term survival compared with standard angiography-guided PCI.

The purpose of this empirical study is to study women entrepreneurs’ psychological well being as supported by their family members in terms of support network so that effect of role overload and dependent care could be minimized. In any society, women receive relatively less support in order to fulfill their career aspirations. In a study on south Indian women entrepreneurs, researchers have examined the factors of work life balance for women entrepreneurs. These factors are termed as, role overload, dependent care, quality of health, time management and support network.

Hydrocarbon pollution due to activities of petroleum industry is a major problem worldwide especially in developing countries like India. Hydrocarbon utilizing bacterial consortium (HUBC) consisting of six (06) bacterial isolates viz. Ochrobactrum sp. (01), Stenotrophomonas maltophilia (02) and P. aeruginosa (03) isolated from crude oil polluted sites of ONGC fields of Gujarat, India. The isolates were identified by using VITEK®2 Compact and 16S rDNA gene sequencing. Scale up study of crude oil degradation (K#X, 3% v/v) by HUBC using Bushnell-Hass medium was performed under optimized growth conditions up to 75 days. Gravimetric and gas chromatographic analysis showed 83.70% and 83.49% (C8–C35) degradation, respectively. Presence of paraffins (C20–C40) in crude oil causes well clogging problem during exploration activities. The HUBC utilized paraffin content of crude oil and hence can be used to solve this problem. The findings of ex-situ bioaugmentation studies by halotolerant HUBC suggests its utility for effective in situ bioremediation of hydrocarbon contaminated sites as well as management of sea surface oil spills.

Two new Schiff base receptors 1 and 2 have been synthesized and characterized by FT-IR, HRMS and 1 H NMR spectroscopic techniques. Both the receptors show large fluorescence enhancement after addition of Al 3+ which is recognized by calorimetry. Furthermore, the stability constant and the detection limit of the receptor–Al 3+ complex were found to be 1.41 × 10 4 M −1 and 1.59 × 10 4 M −1 ; and 4.79 × 10 −8 M and 8.28 × 10 −8 M for receptors 1 and 2 respectively, concluded through the titration method. Not only this, the synthesized receptors work glowing in physiological pH range. Thus these receptors could be employed for the estimation of Al 3+ qualitative as well as quantitative.

A new azo compound, 1-(2-pyridylazo)-2-naphthol, has been prepared and characterized. The synthesized compound shows a very high affinity for aluminium. The complexation reaction of aluminium has been explored by Colorimetry, FT-IR, 1 H NMR, HRMS and fluorescence spectroscopy. The detection limit has been found to be 1.81 × 10 −8 M estimated by the titration method. The turn-on fluorescence behaviour of aluminium interaction with ligand has been found to be so fast (

Objectives: Uncontrolled hypertension, whether due to drug resistance or poor adherence and persistence, remains a problem in many patients. The ROX coupler is a novel technology designed to reduce arterial blood pressure consequent to the predicted physical effects of reducing vascular resistance and improving arterial compliance. This article describes the technical aspects of the device and implantation procedure, results from a preclinical study, patient selection criteria, and potential complications of this therapy for uncontrolled hypertension. Background: The coupler is a self-expanding, stent-like device that exploits the mechanical effects of the creation of a low-resistance, high-compliance venous segment to the central arterial tree, and can be implanted in a standard catheterization laboratory under fluoroscopic guidance. Methods: Preclinical studies were conducted in sheep with acute or chronic hypertension. The devices were implanted in the aorta for up to 12 months. The anastomoses were evaluated for patency, healing, conformation into the artery and vein, and complications. Results: Deployment of the anastomotic device in ovine aortas for up to 12 months showed optimal anastomotic patency in all animals with proper healing and conformation of the device into the artery and the vein. There was no significant residual mural thrombus and minimal to moderate intimal thickening at the vein outflow, consistent with expected arterialization. Conclusions: A novel arteriovenous coupler for percutaneous placement in the iliac vasculature is under clinical investigation as a potential treatment modality for selected patients with uncontrolled hypertension. Initial results from patients with uncontrolled hypertension are expected in Autumn 2014. © 2014 Wiley Periodicals, Inc.

The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver.

AIM The aim of this study was to investigate the effects of baseline anaemia on the outcome in patients treated by primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction. METHODS This study was a retrospective cohort study of 2418 patients with ST-elevation myocardial infarction treated by PPCI between January 2004 and August 2010 at a single centre. We investigated the outcome in patients with anaemia compared with that in patients with a normal haemoglobin (Hb) level. Anaemia was defined according to the WHO definition as an Hb level less than 12 g/dl for female individuals and less than 13 g/dl for male individuals. We also calculated hazard ratios using a stratified model according to the Hb level. RESULTS A total of 471 (19%) patients were anaemic at presentation. The anaemic cohort was older (72.2 vs. 62.4 years, P

Simultaneous determination of ascorbic acid (AA) and caffeine (CAF) in pharmaceutical preparation is important and it has been achieved by square wave voltammetry (SWV) using a glassy carbon electrode (GCE) modified with multiwall carbon nanotubes (MWCNT). The oxidation of AA and CAF at MWCNT occurred at ∼−10 mV and ∼1103 mV at a much lower potential, than that observed (∼202 mV and ∼1402 mV) for their oxidation at bare GCE. The mechanistic study has shown that the equal number of electrons and protons are involved in the oxidation of drugs. The electrodes could be used for the determination of AA and CAF in a wide concentration range 10–500 μM, respectively, whereas the detection limit has been found to be 1.0 × 10 −2 μM and 3.52 × 10 −3 μM respectively. In view of high sensitivity for the detection of the drugs, the technique has been used for the reliable determination of AA and CAF in tea leaves, coffee, cold drink (mountain dew), pharmaceutical preparations and urine samples.

Background Drug-eluting stents (DES) may be associated with an increased risk of late stent thrombosis (ST) compared with bare metal stents (BMS). We compared major adverse cardiac events (MACE) and long term all cause mortality in patients with isolated proximal LAD disease treated with DES or BMS. Method and Results This study of 1653 patients with isolated proximal LAD disease, includes 643 treated with BMS and 1010 treated with DES. All patients received standard dual antiplatelet treatment. MACE after 5 years were less frequent in DES compared with BMS (12.1% 95% CI 9.3–14.2 versus 21.3% 95% CI: 16.9–25.1, P < 0.0001), driven largely by a decreased rate of both target vessel and lesion revascularization (TVR: 6.3%, 95% CI 4.0–7.5% versus 14.7%, 95% CI 11.0–17.3%, P < 0.0001, TLR: (5.3%, 95% CI 3.2–7.1% versus 13.2%, 95% CI 9.8.0–15.4%, P < 0.0001). There was no difference in the rate of death, myocardial infarction, or CVA. Incidence of stent thrombosis was also comparable (1.2% 95% CI: 0.6–2.6% versus 1.1% 95% CI: 0.6–2.5%, P = 0.8). Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.55 (95% confidence intervals 0.41–0.73) with no difference in the hazard of all cause mortality (HR: 1.04 95% CI: 0.67–1.61). Conclusion When treating proximal LAD disease, use of DES was associated with a lower MACE rate than BMS, with no differences in the incidence of stent thrombosis, myocardial infarction or 5 year all cause mortality. Our data suggests that despite the adverse prognostic correlates of proximal LAD disease, DES deployment in this location is both safe and clinically more effective than BMS. © 2012 Wiley Periodicals, Inc.

Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims.

Introduction Upper tract damage (UTD) is a life-threatening complication of neurogenic bladder (NB). Early identification of risk factors for UTD and institution of remedial measures may probably prevent UTD. The aim was to study the predictors of UTD in children 2 years or older with NB. Method This cross-sectional, observational study over 2 years included 30 children. UTD was defined as serum creatinine of >1 mg/dL or society of fetal urology grade III–IV hydronephrosis or hydroureteronephrosis on ultrasonography or renal scars on 99mtechnetium dimercaptosuccinic scan or subnormal glomerular filtration rate (GFR) for age. The evaluated clinical variables were age at presentation, gender, palpable bladder lump, and recurrent urinary tract infection (UTI). Bladder wall thickness (BWT), grade and laterality of vesicoureteric reflux (VUR), status of the bladder neck, post-void residue (PVR), and level and type of intraspinal lesions were also noted. Urodynamic studies were performed for functional bladder assessment. A p-value 1 mg% (2, 6%), SFU III–IV (11, 36%), renal scars (12, 40%), and subnormal GFR in (2, 6%) patients. Clinical risk factors for UTD were delayed presentation (p = 0.034), palpable bladder lump (p ≤ 0.001; OR 38.5; CI 5.6–262.5), and recurrent UTI (p = 0.033, OR 4.125, CI 0.913–18.630). The presence of significant PVR, trabeculated bladder, spin-top urethra, and bilateral VUR were identified as radiological risk factors for UTD. Mean BWT in patients with and without UTD was 4.69 ± 1.78 mm and 2.91 ± 1.08 mm respectively. BWT predictive of UTD was 3.05 mm ( Figure). The mean detrusor leak point pressure (DLPP) did not vary significantly in those with and without UTD (36.82 ± 14.74 and 29.09 ± 10.44 cmH2O, respectively), yet 75% patients with DLPP > 40 cmH2O had UTD (p = 0.038, OR 5.4, CI 0.84–34.84). DLPP 40 cm H2O were identified as potential risk factors for UTD. This study highlights the significance of BWT as a predictor of UTD in NB. Figure. Ultrasonogram of a child with neurogenic bladder with increased bladder wall thickness (BWT) and SFU grade IV hydroureteronephrosis. Yellow cross denotes BWT. Figure options Download full-size image Download high-quality image (236 K) Download as PowerPoint slide

Novel ligand 5,5ʹ-((3-nitrophenyl)methylene)bis(2,6-diaminopyrimidin-4(3H)-one) (L) was synthesised and characterised. Preliminary studies on L have showed that it has more affinity towards the Ni2+ ion. Thus, the L was used as the electroactive material in the fabrication of poly(vinyl chloride) (PVC)-based membrane sensors such as coated graphite electrode (CGE) and coated pyrolytic graphite electrode (CPGE). Several polymeric membranes were fabricated by incorporating L as ionophore, NaTPB as anion excluders and BA, 1-CN, DBP, DOP and o-NPOE as solvent mediators and their effect on potentiometric response studied. Comparative electroanalytical studies performed on the CGE and CPGE depict that the CPGE with optimised membrane composition of L:PVC:o-NPOE:NaTPB in the ratio of 7:33:58:2 (w/w, mg) exhibited the best response in terms of wide working concentration range from 2.0 × 10−8 to 1.0 × 10−1 mol L−1, (3.64 µg L−1 –18.2 g L−1) lower detection limit of 8.1 × 10–9 mol L−1 (1.47 µg L−1) with Nernstian compliance of 29.4 ± 0.2 mV decade−1 of activity of Ni2+ ion in the pH range of 3.5–9.0. The sensor can work satisfactorily in water–acetonitrile and water–methanol mixtures. It can tolerate 30% acetonitrile and 20% methanol content in the mixtures. The sensor showed fast response time of 8 s and could be used successfully for a period of 4 months. The sensor reflects its utility in the quantification of Ni2+ ion in real samples and has been successfully employed as an indicator electrode in the potentiometric titration of Ni2+ ion with EDTA.

In 2010, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on ulcerative colitis. This consensus, produced through a modified Delphi process, reflects our current understanding of the definition, diagnostic work up, treatment and complications of ulcerative colitis. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

Inflammatory bowel disease (IBD), both ulcerative colitis (UC) and Crohn's disease (CD), once thought to be uncommon, is now seen commonly in India. The Indian Society of Gastroenterology (ISG) Task Force on IBD decided to collate data on the clinical spectrum of IBD currently prevailing in India.An open call to members of ISG was given through publication of a proforma questionnaire in the Indian Journal of Gastroenterology and the web portal of ISG. The proforma contained questions related with demographic features, family history, risk factors, clinical manifestations and characteristics, course of disease, and pattern of treatment of IBD.Of 1,255 filled questionnaires received, 96 were rejected and 1,159 (92.3 %) were analyzed. This comprised data on 745 (64.3 %) patients with UC, 409 (35.3 %) with CD, and 5 with indeterminate colitis. The median duration of illness was longer in patients with CD (48 months) compared to those with UC (24 months) (p = 0.002). More than one half of patients (UC 51.6 %, CD 56.9 %) had one or more extraintestinal symptoms. A definite family history of IBD was present in 2.9 % (UC 2.3 % and CD 4.6 %; p = 0.12). The extent of disease in UC was pancolitis 42.8 %, left-sided colitis 38.8 %, and proctitis alone in 18.3 %. The extent of disease involvement in CD was both small and large intestine in 39.6 %, colon alone in 31.4 % and small intestine alone in 28.9 %. Stricturing and fistulizing disease were noted in 18.8 % and 4.4 % of patients with CD respectively. Chronic continuous and intermittent disease course were present in 35.5 % and 47.2 % of UC patients respectively, and in 23.1 % and 68.8 % of CD patients. Four percent of patients with UC had undergone colectomy, while 15.2 % of patients with CD underwent surgical intervention.The present survey provides a reasonable picture of the demographic features and clinical manifestations of Indian patients with IBD, their risk factors, course of disease, and the treatment given to them.

Aim Primary percutaneous coronary intervention (PPCI) produces more effective coronary reperfusion and allows immediate risk stratification compared with fibrinolysis. We investigated the safety and feasibility of very early discharge at 2 days following PPCI in selected low-risk cases. Methods This was a prospective observational cohort study of 2779 patients who underwent PPCI between 2004 and 2011. Patients meeting the following criteria were deemed suitable for very early discharge; TIMI III flow, left ventricle (LF) ejection fraction >40%, and rhythmic and haemodynamic stability out to 48 h. Higher-risk patients who did not fulfil these criteria were discharged later according to physician preference. All patients were offered outpatient review by a multidisciplinary team. Endpoints included 30 day readmission rates and major adverse cardiac events (MACE) out to a median of 2.8 years (IQR range: 1.3–4.4 years). Results 1309 (49.3%) PPCI patients met very early discharge criteria, of whom 1117 (85.3%) were actually discharged at 2 days. 620 (23.4%) were discharged at 3 days, and 916 (34.5%) >3 days after admission (median 5, IQR: 4–8) days). Patients discharged at 2 days were younger, and had lower rates of diabetes, renal dysfunction, multivessel coronary artery disease, previous myocardial infarction, and previous coronary artery bypass surgery, compared with patients discharged later. 30-day readmission rates for non-MACE events were 4.8%, 4.9% and 4.6% for patients discharged 2 days, 3 days and >3 days after admission, respectively. MACE rates were lowest in patients discharged at 2 days (9.6%, 95% CI 4.7% to 16.6%) compared with patients discharged at 3 days (12.3% 95% CI 6.0% to 19.2%) and >3 days (28.6% 95% CI 22.9% to 34.7%, p Conclusions Our data suggest that discharge of low-risk patients 2 days after successful PPCI is feasible and safe. Over 40% of all patients with ST-elevation myocardial infarction may be suitable for early discharge with important implications for healthcare costs.

Four ligands (M 1 –M 4 ) have been synthesized and characterized by IR, 1 H NMR, spectroscopic investigations indicate good affinity of these ligands for fluoride anion. Different polyvinyl chloride (PVC) based membranes of ligands have been synthesized using different cationic excluders; CTAB, TDMAC, HTAB, ToMACI and plasticizers; DBBP, DBP, o -NPOE, CN, DOP, TEHB and investigated as F − selective sensors. The best performance is observed by the sensor with a membrane of composition (%, w/w) M 1 :PVC: o -NPOE:CTAB 3.5:30.0:63.0:3.5. The sensor generates linear potential response over a wide concentration range of 2.5 × 10 −7 to 1.0 × 10 −2 M with Nernstian slope (59.8 mV decade −1 of activity) over a pH range of 2.5–6.5 with a fast response time of ∼11 s. It shows good selectivity for fluoride anion (F − ) in preference to many anions. The sensor exhibits a shelf life of two and half months and could be successfully used for the comparative determination of fluoride in different Indian tea samples. The proposed method is faster, cheaper, and more accurate in comparison to already used methods.