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Poorna Gopal Azad Sreeramaneni,1 Rajesh K Ghanta2 1Department of Endocrinology, Sreeramaneni Sumanth Krishna Endocrinology, Diabetes and Thyroid Hospitals, Vijayawada, India; 2Department of Neurosurgery, Suraksha Hospitals, Vijayawada, IndiaCorrespondence: Poorna Gopal Azad SreeramaneniDepartment of Endocrinology, Sreeramaneni Sumanth Krishna Endocrinology, Diabetes and Thyroid Hospitals, Vijayawada 520002, IndiaTel +91 8662436156Email drpurnagopal@gmail.comAbstract: Excess serum growth hormone (GH) induces insulin resistance leading to reduced uptake of glucose in peripheral tissues, gluconeogenesis in the liver and lipolysis and finally an increase in the blood glucose levels. We report a case where a 54-year-old woman presented with uncontrolled blood glucose levels since 5 years. On examination, she had signs and symptoms consistent with acromegaly including recurrent headaches, sleep apnea, soft tissue swelling, enlargements of the feet, hands, ears and lips, mandibular overgrowth, forehead protrusio and teeth spacing. She was on oral hypoglycemic agents (OHAs) for 12 years before she visited our hospital, but the blood glucose levels have been uncontrolled for the past 5 years with recurrent hyperglycaemic and occasional hypoglycaemic events. She underwent pituitary surgery for GH producing tumor and 2 years post surgery, we had to stop all the medications for the diabetes mellitus. This indicates that even long-standing diabetes mellitus can resolve in some patients with acromegaly.Keywords: diabetes control in growth hormone pituitary tumor, surgery for growth hormone producing pituitary tumor

Soymida febrifuga (Roxb.)A.Juss. (Meliaceae) is an indigenous lofty deciduous medicinal tree endemic to India. Traditional multiplication of this plant is limited by difficulty in rooting of stem cuttings, high seedling mortality rates and low seed viability. Recently we published an alternative mode of shoot multiplication by in vitro culture to propagate and conserve genetic stock of this medicinal plant. In the present study, prior to in vitro shoot multiplication, attempts were made to understand the seed germination capabilities of S. febrifuga under in vivo and in vitro conditions. An emphasis has been laid on various factors such as sterilants, type of media, hormones, sucrose concentration and seed viability influencing in vitro seed germination which is used as a starting material for in vitro morphogenic studies. Our results clearly demonstrate 95% of in vitro seed germination but not in vivo led to the raising of healthy seedlings with appropriate root system. Strikingly we observed duration and rate of seed germination were high on MS full strength compared to MS half and quarter strength medium. Nonetheless, seed germination and its growth was found effective on MS full strength medium containing 1% and 1.5% sucrose medium unfortified with growth hormones. These findings have implications for the conservation of recalcitrant seed germplasm. [ABSTRACT FROM AUTHOR]

Background: It has been argued that the use of artificial turf football fields in the National Football League (NFL) increases player injury risk compared with natural grass surfaces., Purpose/hypothesis: The purpose of this study was to quantify the rate of lower extremity injuries occurring in NFL players on artificial turf compared with natural grass surfaces and characterize the time missed due to injury and proportion of injuries requiring surgery. It was hypothesized that lower extremity injuries requiring surgical intervention would occur at a higher rate on artificial turf than on natural grass., Study Design: Descriptive epidemiology study., Methods: Lower extremity injury data for the 2021 and 2022 NFL seasons were obtained using publicly available records. Data collected included injury type, player position, player age, playing surface, weeks missed due to injury, and whether the patient underwent season-ending or minor surgery. Multivariable logistic regression was performed to determine the risk of season-ending surgery according to playing surface., Results: When combining injuries for the 2021 and 2022 seasons (N = 718 injuries), the incidence rate of lower extremity injury was 1.22 injuries/game for natural grass and 1.42 injuries/game for artificial turf. The odds of a season-ending surgery were found to be significantly higher on artificial turf compared with natural grass (odds ratio = 1.60; 95% CI, 1.28-1.99; P < .05), while additional variables, including weather, age, position, week of injury occurrence, and history of prior injury, did not influence the odds of season-ending surgery., Conclusion: The 2021 and 2022 NFL seasons of our analysis demonstrated a higher incidence rate of injuries on artificial turf surfaces compared with natural grass surfaces. In addition, the odds of injury requiring season-ending surgery were found to be significantly higher on artificial turf compared with natural grass., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: N.K.P. has received education payments from Evolution Surgical. B.T.F. has received education payments from Evolution Surgical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study., (© The Author(s) 2024.)

The inhibitory action of Schiff base complexes of 3d metals against the urease enzyme is well explored in the scientific community. However, the ability of such complexes in mimicking active metallobiosites of urease enzymes, possessing ureolytic behavior, still remains unexplored. With this aim firstly, two Zn(II)-complexes (PPR-HMB-Zn and PZ-HMB-Zn) have been developed from two different Schiff base ligands (HL1 = 2-(( E )-(2-(piperidin-1-yl)ethylimino)methyl)-5-methylphenol and HL2 = 2-(( E )-(2-(piperizin-1-yl)ethylimino)methyl)-5-methylphenol) and structurally characterized using single crystal XRD. The hydrolytic enzymatic activity of both complexes was demonstrated by the gradual increase in the absorption maxima at 425 nm for the formation of the p -nitrophenolate ion from catalytic hydrolysis mediated by the Zn(II) complexes with a disodium salt of p -nitrophenyl phosphate as a model substrate. Associated kinetic parameters, pH dependency and a relevant hydrolysis mechanism have also been explored. After confirming the hydrolytic ability, the complexes were exploited to mimic the hydrolytic activity of Jack bean urease that catalytically hydrolyses urea into ammonia and CO 2 . The change in the pH of the solution owing to the formation of ammonia under the complex catalysed hydrolytic action of urea has been monitored spectrophotometrically using the pH dependent structural change of phenol red. The amount of ammonia has been quantified using the Nessler's reagent spectrophotometric method. The ureolytic reaction mechanism has been investigated using density functional theory (DFT) calculations using the B3LYP and TPSSH methods for the systematic calculation of the interaction energy. In contrast to PZ-HMB-Zn, PPR-HMB-Zn functions more effectively as a catalyst due to the existence of a lattice-occluded water molecule in its crystal structure and the protonation of the non-terminal N to attract urea by H-bonding, which was further confirmed by AIM analysis.

Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Polyisoprene (PI) melts have been studied, with most reports focusing on systems with high 1,4-cis content. In contrast, 1,4-trans PI homopolymers or random copolymers have seldom been examined, despite a handful of investigations suggesting a distinct dynamic behavior. Herein, we employ all-atom simulations to investigate the effect of chemical architecture on the dynamics of cis and trans-PI homopolymers, as well as copolymers. We examine the thermodynamic, conformational, and structural properties of the polymers and validate the performance of the models. We probe chain dynamics, revealing that cis-PI presents accelerated translation and reorientation modes relative to trans as recorded by the mean square displacement of the chain center-of-mass as well as by the characteristic times of the lower modes in a Rouse analysis. Interestingly, progressing to higher modes, we observe a reversal with trans units exhibiting faster dynamics. This was further confirmed by calculations of local carbon-hydrogen vector reorientation dynamics, which offer a microscopic view of segmental mobility. To obtain insight into the simulation trajectories, we evaluate the intermediate incoherent scattering function that supports a temperature-dependent crossover in relative mobility that extends over separations beyond the Kuhn-length level. Finally, we analyzed the role of non-Gaussian displacements, which demonstrate that cis-PI exhibits increased heterogeneity in dynamics over short-timescales in contrast to trans-PI, where deviations persist over times extending to terminal dynamics. Our all-atom simulations provide a fundamental understanding of PI dynamics and the impact of microstructure while providing important data for the design and optimization of PI-based materials., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

Background: Transcatheter aortic valve replacement (TAVR) is an alternative therapeutic modality to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS). In the current analysis, we compare the characteristics and outcomes of AVR procedures in patients <60 years of age., Methods: We queried the Nationwide Readmissions Database for all AVR hospitalizations in patients 18-59 years of age between January 2012 and December 2017. We performed a propensity score matching analysis (1:1) and compared baseline characteristics, procedural complications, and outcomes between TAVR and SAVR patients., Results: A total of 72,356 hospitalizations for AVR were identified in patients <60 years of age. Compared to their SAVR counterparts, TAVR patients were older (52.5 ± 7.6) vs. 48.8 ± 9.6, p < 0.001), more likely to be women (37.9% vs. 28.0%, p < 0.001), and have history of prior radiation (8.3% vs. 0.7%, p < 0.001). After propensity score matching, TAVR patients had lower procedural complications, but a similar mortality rate compared to SAVR patients (2.9% vs. 3.0%, p = 0.77). TAVR was associated with a shorter length of hospital stay [4 [2-9] vs. 6 [5-11], p < 0.001), but no significant difference in the 30-day readmission rate was noted (16.2% vs. 16.8%, p-value = 0.49)., Conclusion: Our study demonstrates favorable short-term outcomes in younger patients undergoing TAVR, which improved over time. Further investigation of long-term outcomes in TAVR performed younger patients is warranted to draw a comprehensive picture of TAVR safety and efficacy in low-risk patients., Competing Interests: Declaration of competing interest The authors report no conflict of interest in relation to this submission., (Published by Elsevier Inc.)

Introduction: There is paucity of data on the outcomes of hospitalization for bicuspid aortic valve (BAV)-related aortopathies., Methods: We queried the NIS database (2012-2016) for hospitalizations for elective thoracic aortic repair or acute aortic syndrome (AAS) among those with BAV versus trileaflet aortic valve (TAV)., Results: Our analysis yielded 38,010 hospitalizations for elective aortic repair, of whom 34.4% had BAV, as well as 81,875 hospitalizations for thoracic AAS, of whom 1.1% had BAV. Hospitalizations for BAV were younger and had fewer comorbidities compared with their TAV counterparts. The number of hospitalizations for BAV during the observational period was unchanged. After propensity matching, elective aortic repair for BAV was associated with lower mortality (0.5% versus 1.7%, odds ratio = 0.28; 95% CI 1.5-0.50, p < 0.001), use of mechanical circulatory support, acute stroke, and shorter length of hospital stay compared with TAV. After propensity matching, AAS among those with BAV had a greater incidence of bleeding events, blood transfusion, cardiac tamponade, ventricular arrhythmias, and a longer length of hospital stay compared with TAV. Among those with BAV, predictors of lower mortality if undergoing elective aortic repair included larger hospitals and teaching hospitals. Predictors of higher mortality in patients with AAS included heart failure, chronic kidney disease, and coronary artery disease., Conclusion: Data from a national database showed no change in the number of hospitalizations for BAV-related aortopathy, with relatively lower incidence of AAS. Compared with TAV, elective aortic repair for BAV is associated with lower mortality, while BAV-related AAS is associated with higher in-hospital complications., (© 2021. The Author(s).)

Background: Segond fractures (avulsion fractures of the proximal lateral tibia) are highly associated with anterior cruciate ligament (ACL) tears in adult patients. This large case series of pediatric Segond fractures describes the associated intra-articular knee injuries to determine if these fractures have a high incidence of ACL tears or its equivalent injury in young patients., Methods: Institutional review board approved retrospective study at a tertiary children's hospital of patients under 19 years who were diagnosed with a Segond fracture between 2009 and 2019 was conducted. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected., Results: Fifty-three patients (44 males and 9 females) with median age 15.4 (11.8 to 19) years with Segond fractures of the proximal tibia on radiographic imaging were included. Diagnosis of associated injuries was established based on clinical examination, radiology report, and arthroscopic findings. Median Segond fracture size was 2.0×9.0 mm measured on standard anteroposterior knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/53 (92.5%) patients. Associated injuries included ACL tears (39 patients, 73.6%), tibial spine fractures (9, 17.0%), and other injuries (5, 9.4%). 37/53 (69.8%) patients had meniscal injury. Three (5.7%) patients sustained multiligament injuries. All associated injuries were confirmed by either MRI/computerized tomography or direct operative examination. Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. There was a statistically significant difference (P=0.013) in age, patients with tibial spine fractures (median 13.6 y) being younger than those with ACL tears (median 15.4 y). 12/53 (22.6%) had associated articular cartilaginous injuries, 3 of which were treated surgically. Overall, 81.1% of patients were treated operatively for associated intra-articular injuries., Conclusions: This large case series of Pediatric Segond fractures suggests a high association with intra-articular injuries, specifically, ACL tears and its equivalent injury, that is, tibial spine fractures, the later more common in the younger patient population. An MRI is recommended in patients with a Segond fracture for characterizing the exact intra-articular injury to help plan the appropriate management., Level of Evidence: Level IV-prognostic., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and their families across 6 locations in the US. This article provides a perspective on how, despite coronavirus disease 2019-related school closures, Brighter Bites pivoted rapidly to collaborate with medical and public health institutions to improve health and food literacy among their families. Through these partnerships, Brighter Bites was able to rapidly provide accurate, evidence-based information related to coronavirus disease 2019 and other social needs, including food, housing, transportation, and access to health care, to help fill a needed gap in vulnerable communities., (Copyright © 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background There is a paucity of data on the trends and outcomes of reoperative coronary artery bypass graft (CABG) surgery during the current decade in the United States. Methods and Results We queried the National Inpatient Sample database (2002-2016) for all hospitalizations with isolated CABG procedure. We reported the temporal trends and outcomes of reoperative CABG versus primary CABG procedures. The main outcome was in-hospital mortality. Among 3 212 768 hospitalizations with CABG, 46 820 (1.5%) had reoperative CABG. Over the 15-year study period, there were no changes in the proportion of reoperative CABG (1.8% in 2002 versus 2.2% in 2016, P tren =0.08), and the related in-hospital mortality (3.7% in 2002 versus 2.7% in 2016, P trend =0.97). Reoperative CABG was performed in patients with increasingly higher risk profile. Compared with primary CABG, hospitalizations for reoperative CABG were associated with higher in-hospital mortality (3.2% versus 1.9%, P <0.001), cardiac arrest, cardiogenic shock, vascular complications, and respiratory complications. Among hospitalizations for reoperative CABG, the predictors of higher mortality included history of heart failure and chronic kidney disease. Conclusions In this 15-year nationwide analysis, reoperative CABG procedures were increasingly performed in patients with higher risk profile. In-hospital mortality rates were relatively low and did not change during the examined period. Compared with primary CABG, reoperative CABG is associated with higher in-hospital mortality.

Objectives: Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG)., Methods: A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017. The full cohort of DNC and CC recipients, as well as propensity score-matched pairs, was compared regarding preoperative risk variables and outcomes., Results: The DNC and CC groups showed no significant differences in mean cardiopulmonary bypass time (53.09 vs 52.10 min, P = 0.206) or aortic cross-clamp time (32.82 vs 33.28 min, P = 0.967). The groups also showed no difference in operative mortality (2.1% vs 2.5%, P = 0.734); however, DNC use resulted in lower rates of overall infections (1.7% vs 4.3%, P = 0.024), total sternal infections (0.9% vs 3.2%, P = 0.023), postoperative atrial fibrillation (23.8% vs 30.7%, P = 0.023) and postoperative ventricular tachycardia (0.5% vs 3.4%, P = 0.002). A propensity-matching analysis (n = 335 pairs) showed similar statistically significant decreases with DNC., Conclusions: In this large cohort of CABG patients, DNC was shown as a safe alternative to CC and was associated with lower postoperative dysrhythmia and infection rates. These findings show that DNC is safe and effective in patients whose operative interventions may require only single-dosing cardioplegia; its use in longer cases should be further explored given its low complication rate., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The final year of cardiothoracic surgery residency is an exciting time for most trainees because it marks the culmination of many years of hard work and dedication. However, it is not uncommon for trainees to also experience some degree of anxiety or uncertainty, particularly when it comes to understanding the necessary steps and finer details involved in seeking out and securing that much anticipated and well-deserved first job. This article explores the philosophy, strategy, and etiquette essential to navigating the various stages of one's initial job search, providing valuable information and perspective to those hoping to find a position that is best suited to one's skill set, needs, and long-term career goals., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

A non-faradaic label-free cortisol biosensor was demonstrated using MoS 2 nanosheets integrated into a nanoporous flexible electrode system. Low volume (1-5 μL) sensing was achieved through use of a novel sensor stack design comprised of vertically aligned metal electrodes confining semi-conductive MoS 2 nanosheets. The MoS 2 nanosheets were surface functionalized with cortisol antibodies towards developing an affinity biosensor specific to the physiological relevant range of cortisol (8.16 to 141.7 ng/mL) in perspired human sweat. Sensing was achieved by measuring impedance changes associated with cortisol binding along the MoS 2 nanosheet interface using electrochemical impedance spectroscopy. The sensor demonstrated a dynamic range from 1-500 ng/mL with a limit of detection of 1 ng/mL. A specificity study was conducted using a metabolite expressed in human sweat, Ethyl Glucuronide. Continuous dosing studies were performed during which the sensor was able to discriminate between four cortisol concentration ranges (0.5, 5, 50, 500 ng/mL) for a 3+ hour duration. Translatability of the sensor was shown with a portable form factor device, demonstrating a comparable dynamic range and limit of detection for the sensor. The device demonstrated a R 2 correlation value of 0.998 when comparing measurements to the reported impedance values of the benchtop instrumentation.

Objectives: Percutaneous mitral repair with the MitraClip system (Abbott Vascular, Santa Clara, Calif) has been available in trials since 2006 and is currently approved for patients with degenerative mitral valve disease at prohibitive risk for surgery. There has been concern that novel transcatheter approaches may detract from mitral valve surgical volumes. We sought to evaluate the influence of our MitraClip program on our surgical mitral valve volumes and outcomes., Methods: All patients referred for MitraClip underwent evaluation by a multidisciplinary team. Patients were screened for surgical candidacy and suitable valve anatomy for transcatheter repair. The fate of patients referred for MitraClip as well as the overall surgical mitral volumes and outcomes were evaluated., Results: From July 2007 to December 2014, 468 patients were referred for the MitraClip procedure at our institution. Of these, 156 patients (33.3%) received a MitraClip (including 45 implanted by surgeons), whereas 82 patients (17.5%) underwent surgical interventions. During this timeframe, the volume of isolated mitral valve operations increased from 50 procedures in 2007 to 93 in 2014 (80% increase; R(2) = 0.89). Importantly, operative mortality for all patients undergoing isolated mitral surgery from 2008 to 2014 was 2.6%, with an observed to expected ratio of 0.64., Conclusions: The availability of MitraClip resulted in an increase in our mitral valve referrals. Despite seeing an increase in higher risk referrals, operative mortality for mitral surgery remained excellent. Multidisciplinary evaluation, including input from experienced mitral surgeons, is necessary to have a successful percutaneous and surgical mitral valve program., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Transradial access may be advantageous for patients with end-stage liver disease (ESLD) who need to undergo left heart catheterization (LHC). We aimed to assess the safety of transradial cardiac catheterization in patients listed for orthotopic liver transplantation., Methods: This is a retrospective analysis of consecutive adult patients with the diagnosis of ESLD, who underwent LHC via transradial access as part of a pre-operative liver transplantation evaluation. All the patients also underwent right heart catheterization (RHC) via brachial or femoral vein. The primary outcome measure was procedure-related major bleeding. Secondary outcomes included access site minor bleeding, in-hospital mortality, radial access failure, and acute kidney injury., Results: A total of 82 consecutive patients with ESLD, who underwent LHC via transradial access, were enrolled in the study. All patients also underwent RHC (n = 45 via brachial and n = 37 via femoral vein). The median age was 59 (54, 67) years old, and 58% were male. History of coronary artery disease or heart failure was present in 17% of patients. The median MELD score was 19 (13, 24.5), baseline hemoglobin was 10.5 mg/dL (9.4, 11.8), INR was 1.4 (1.2, 1.8) and platelets were 74,000 (53,000, 117,000)/mm(3) . The most common etiology of liver failure was viral hepatitis (51%), followed by alcoholic cirrhosis (24%) and non-alcoholic steatohepatitis (21%). Angiographically significant coronary artery disease was present in 17 (21%) patients. Major bleeding and acute kidney injury each occurred in two patients (2.4%). There were no instances of vascular complications. There were no deaths attributable to complications from cardiac catheterization., Conclusion: Upper extremity right and left heart catheterization appears to be a safe method to evaluate coronary anatomy and hemodynamics in a severely ill population of patients with ESLD awaiting transplant., (Copyright © 2013 Wiley Periodicals, Inc.)