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الملخص: أهداف البحث: يرتبط عامل نخر الورم، وهو سيتوكين شحمي، ارتباطا وثيقا باضطراب تحمل الجلوكوز ومقاومة الأنسولين لدى مرضى السكري من النوع الثاني. لم يتم تحديد العلاقة بين تعدد الأشكال في جين عامل نخر الورم ومقاومة الأنسولين لدى المرضى المصابين بالسكري أو مقدمات السكري في بنجلاديش بشكل كامل حتى الآن. تم تصميم الدراسة للكشف عن ارتباط تعدد الأشكال الجيني في جين عامل نخر الورم بمقاومة الأنسولين عند مرضى فرط سكر الدم من أصل بنغلاديشي. طرق البحث: في دراستنا، تم تجنيد 106 شخصا مصابا باضطراب تحمل الجلوكوز، و100مريض سكري من النوع الثاني، و109 من الأشخاص الأصحاء من أصل بنغلاديشي لتحديد تأثير تعدد الأشكال الجيني في جين عامل نخر الورم في الموضع 308 باستخدام التفاعل السلسلي للبوليميريز ثم طريقة تعدد أشكال أطوال الشدف المقتطعة. النتائج: أظهر توزيع تكرار النمط الجيني لعامل نخر الورم -308 ضمن مجموعة التحكم ومجموعة اضطراب تحمل الجلوكوز ومجموعة مرضى السكري النوع الثاني ارتباطًا كبيرا، على الرغم من أن توزيع تكرار الأليل داخل المجموعات أظهر فرقا غير مهم إحصائيا. كما لوحظ أن نقص وظائف خلايا بيتا كان أقل بشكل ملحوظ لدى المرضى ذوي ضرب النمط الجيني. إلى جانب ذلك، تشير نتائجنا إلى أن مؤشر كتلة الجسم وحالة الإقامة للمشاركين في الدراسة كانت مرتبطة بشكل إيجابي مع تعدد الأشكال الجيني. الاستنتاجات: لذلك، يمكن استنتاج أن تعدد الأشكال الجيني في جين عامل نخر الورم في الموضع 308 قد يكون له علاقة سببية بقدرة إفراز الأنسولين المنخفضة وارتفاع مؤشر كتلة الجسم في مجموعات اضطراب تحمل الجلوكوز ومرضى السكري النوع الثاني في بنغلاديش، في حين أن نمط حياة سكان الحضر قد يكون له ارتباط مع تعدد الأشكال الجيني. Abstract: Objectives: Tumour necrosis factor (TNF)-α, an adipocytokine, is closely linked to impaired glucose tolerance (IGT) and insulin resistance (IR) in type 2 diabetes (T2D) subjects. The relationship between the polymorphisms in the TNF-α gene and IR in Bangladeshi prediabetes and T2D subjects has not yet been fully identified. This study aims to reveal the association between TNF-α gene polymorphism and IR in hyperglycaemic patients of Bangladeshi origin. Methods: In our study, 106 IGT, 100 T2D, and 109 healthy subjects of Bangladeshi origin were recruited to identify the impact of TNF-α gene polymorphism at position −308 with a G>A transition using PCR and subsequent restriction fragment length polymorphism (RFLP). Results: The −308G>A TNF-α genotype frequency distribution within the control, IGT, and T2D groups showed a significant association (χ2 = 21.077; P = 0.001), although allele frequency distribution within the groups showed a statistically non-significant difference (χ2 = 1.696; P = 0.091). β-cell functional deficiency (HOMA-B%) was observed to be significantly (P = 0.034) lower in subjects with a variant genotype. In addition, our results indicate that the study subjects’ body mass index (BMI) and residence status were positively correlated (P ≤ 0.05) with −308G>A TNF-α gene polymorphism. Conclusions: Therefore, it can be concluded that −308G>A TNF-α gene polymorphism may have a causative relationship with lower insulin secretory capacity and higher BMI in Bangladeshi IGT and T2D populations, while the urban population's lifestyle might be associated with this polymorphism.

Category: Ankle Introduction/Purpose: Ankle arthritis is a potentially debilitating disease with approximately 50,000 cases diagnosed annually. Once conservative management fails, surgical options for these patients include total ankle arthroplasty (TAA) and ankle arthrodesis. Younger, more active patients may prefer TAA as it may allow better ankle mobility compared to ankle arthrodesis. TAA has historically been performed in the inpatient setting with a one- to two-night postoperative hospital stay. Outpatient surgeries are gaining popularity due to their cost effectiveness, decreased length of hospital stay, and convenience. Therefore, it is important to evaluate the safety of specific procedures in the outpatient setting compared to the inpatient setting. This study evaluates the complication rates in inpatient vs. outpatient TAA. Methods: Our team conducted a retrospective analysis of data from 591 patients receiving inpatient and outpatient TAA from the NSQIP database. This database contains de-identified patient data and allows retrospective analyses to be performed based on data they have extracted from over 400 hospitals. Demographic information was recorded including age, sex, weight, height, and race. Thirty-day postoperative complication rates were compared between 66 outpatients and 535 inpatients. Frequencies of the following complications were analyzed: wound complications, pneumonia, hematologic complications (pulmonary embolism and deep vein thrombosis), renal failure, stroke, and return to the operating room within 30 days. The inpatient and outpatient groups were compared using chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Results: 591 total patients were identified that underwent TAA. 66 patients (11.1%) were treated as outpatients and 525 (88.8%) as inpatients. Inpatient TAA had a significantly higher mean operation time (161 min vs 148 min) and a significant difference in length of total hospital stay (2.3 days vs 1.1 days). Inpatients had higher rates of superficial incisional surgical site infection (SSI) (0.57% vs 0%), deep SSI (0.19 % vs 0%), organ/space SSI (0.19% vs 0%), pneumonia (0.38% vs 0%), and return to the operating room (0.76% to 0%). However, no significant differences were found in complication rates between inpatient and outpatient groups. There were no occurrences of acute renal failure, wound disruption, pulmonary embolism, stroke, or DVT/thrombophlebitis for inpatients or outpatients. Conclusion: We found no significant difference between inpatient vs. outpatient TAA. Incidental differences we found were that inpatients were significantly more likely to be older in age, diagnosed with diabetes, and inpatients had longer operative times. Our results suggest that inpatients are more likely, but not significantly, to have a higher occurrence of complications and return to the OR. Therefore, this study suggests that outpatient TAA is safe and may be a superior option for the correct patient population. Further investigation is warranted to verify these conclusions.

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s Neuroma is a benign enlargement of the second or third common digital branch of the medial plantar nerve. This causes a compressive neuropathy of the distal medial plantar nerve. When conservative management fails, surgery becomes the treatment of choice via either a dorsal or plantar approach to the nerve. When using a dorsal approach for a Morton Neurectomy, neuroma commonly recurs due to insufficiently resection of the medial plantar nerve. It is unclear how far the nerve can be resected and which type of retractor provides superior visualization to allow greater resection. The present cadaveric study investigates how proximally the nerve can be resected and examines both the Laminar spreader and Galpie retractor to determine which instrument facilitates maximal proximal resection of the nerve. Methods: This study involved 12 fresh-frozen below-knee cadaver specimens that underwent a dorsal approach to the medial plantar nerve with proximal resection of the nerve in both the 2nd and 3rd intermetatarsal spaces as is performed during a Morton Neurectomy. The senior surgeon made a 3 cm incision just proximal to the 2nd and 3rd webspaces, and used blunt dissection to the level of the transverse intermetatarsal ligament. The transverse intermetatarsal ligament was then transected, and either a Laminar spreader or Galpie retractor was used to improve visualization of the intermetatarsal space. The medial plantar nerve was then identified and transected, and the lengths of the distal segment of the cut nerves were measured and recorded. These values were then compared based on the retractor employed. Results: In the 2nd intermetatarsal space, the Laminar spreader allowed the nerve to be dissected an average of 2.42 cm proximal to the distal end of the 3rd metatarsal (head)compared to 1.93 cm by the Galpie retractor. Thus, use of the Laminar spreader rather than the Galpie retractor resulted in greater resection of the nerve, although this was not significant. In the 3rd intermetatarsal space, the Laminar spreader allowed the nerve to be dissected an average of 2.14 cm proximal to the distal end of the 3rd metatarsal, while the Galpie retractor allowed 1.48 cm. Thus, use of the Laminar spreader in the 3rd intermetatarsal space resulted in greater excision of the nerve than the Galpie retractor, although this was not significant. Conclusion: These results demonstrate that use of the Laminar spreader during dorsal approach to a Morton Neuroma results in superior proximal resection of the medial plantar nerve when compared to use of the Galpie retractor, thereby decreasing the risk of recurrent Morton Neuroma. Further evaluation of the available retractors is needed to support the superiority of the laminar spreader compared to the Galpie retractor.

Cystic fibrosis (CF) is the most prevalent hereditary life-threatening disease in the Caucasian population. With the improvement in clinical care, individuals with CF are living longer, and CF-related diabetes (CFRD) has emerged as a major complication. The diagnosis of CFRD is associated with shortening survival, increasing morbidity, worsening physical capacity, and body composition. Engagement in exercise training has become a prominent nonpharmacologic intervention that aims to improve fitness and clinical outcomes in individuals with CF and CFRD. This column will specifically focus on the potential benefits of resistance training and provide recommendations for children and adolescents with CF and CFRD. [ABSTRACT FROM AUTHOR]

Introduction: Sleep disturbance is common in persons with stroke and when unrecognised and untreated may hinder rehabilitation efforts and lead to poor functional outcome. It may also result in increased risk for stroke recurrence. Aim: We investigated the frequency and associated factors of sleep disturbances amongst stroke survivors. Methodology: One hundred and ten stroke survivors attending the neurology outpatient clinics of two tertiary hospitals, from February 2021 to January 2022, were interviewed after obtaining ethical approval and informed consent. We used a structured questionnaire to obtain their socio-demographic, clinical characteristics and sleep disturbances. Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Data were analysed with statistical significance set at P < 0.05. Results: Eighty (72.7%) patients were males with a mean age of 61.4 ± 11.8, slightly older than the females (30, 27.3%) with a mean age of 60.9 ± 2.9. Their median follow-up duration was 7.5 months. Majority (84, 76.4%) had ischaemic stroke, and the frequency of sleep disturbances was 37 (33.6%) consisting of insomnia (19, 17.3%), hypersomnia (10, 9.0%), sleep-disordered breathing (5, 4.5%) and sleep-related movement disorder (3, 2.7%), respectively. Using the ESS score, 22 (20.0%) had mild, 10 (9.0%) had moderate and 7 (6.4%) had severe ESS scores, respectively. Univariate analysis showed depression to be significantly associated with ESS (P = 0.006) whereas multivariate analysis revealed age and sex as significant associated factors (P = 0.008 and P = 0.009) of ESS. Conclusion: More than one-third of participants reported sleep disturbances with depression, age and gender as associated factors.

The global health exchange program between the University Teaching Hospitals (UTH) of Lusaka, Zambia and the University of Maryland, Baltimore (UMB) has been operating since 2015. As trainees and facilitators of this exchange program, we describe our experiences working in Lusaka and Baltimore, and strengths and challenges of the partnership. Since 2015, we have facilitated rotations for 71 UMB trainees, who spent four weeks on the Infectious Disease (ID) team at UTH. Since 2019 with funding from UMB, nine UTH ID trainee physicians spent up to six weeks each rotating on various ID consult services at University of Maryland Medical Center (UMMC). Challenges in global health rotations can include inadequate preparation or inappropriate expectations among high-income country trainees, low-value experiences for low- and middle-income country trainees, lack of appropriate mentorship at sites, and power imbalances in research collaborations. We try to mitigate these issues by ensuring pre-departure and on-site orientation for UMB trainees, cross-cultural mentored experiences for all trainees, and intentional sharing of authorship and credit on scientific collaborations. We present a description of our medical education collaboration as a successful model for building equitable and reciprocal collaborations between low- and middle-income countries and high-income countries, and offer suggestions for future program initiatives to enhance global health education equity among participants and organizations.

Established antiretroviral therapy (ART) programs in sub-Saharan Africa have well-defined first-and second-line therapies but no standard third-line ART regimen. The impact of third-line ART on patients with multiclass-resistant HIV in resource-limited settings has not been well characterized. We conducted a retrospective review of patients on third-line ART at the University Teaching Hospital in Lusaka, Zambia. We assessed virologic and immunologic outcomes following 6 months of third-line therapy and found among those with a documented viral load, viral suppression (≤1000 copies/ml) at 24 weeks was 95% (63/66) with a mean increase in CD4 count of 116 cells/mm 3 and viral suppression of 63% (63/100) by imputation of missing data. This study suggests that third-line therapy is clinically and virologically effective among patients with multiclass-resistance in a resource-limited setting in sub-Saharan Africa.

'n Zulu-persoon kan tot ses tipes name hê waarvan drie gruepname en drie individuele name kan wees. Uitgesonderd die amagama esilingu (“Blanke name”) het name duidelike betekenisse wat verband hou met bepaalde omstandighede of kenmerke. Die groepname is uiteraard beperk in getal en nuwe groepname ontstaan slegs met verloop van tyd. Daarenteen word individuele name (veral amagama asekhaya of “tuisname”) voortdurend deur middel van 'n verskeidenheid morfologiese moontlikhede qeskep. Dit het 'n voortdurende vernuwing ten opsigte van persoonsname tot gevolg, hoewel daar ongelukkig ook tekens van 'n verstarring in hierdie verband is. [ABSTRACT FROM PUBLISHER]

Background: Yoga interventions need fidelity monitoring to standardize the trial process and ensure adherence. We examined fidelity measures of current yoga trials and developed a fidelity assurance process in a phase III randomized clinical trial addressing chemotherapy-induced peripheral neuropathy among cancer survivors. Methods: We qualitatively analyzed the fidelity monitoring components in published clinical trials on yoga therapy for chemotherapy-induced peripheral neuropathy through a literature search in PubMed from inception to February 2023. Leveraging fidelity measures for community-based, complex interventions and yoga therapy reporting guidelines, we developed an instructor/participant-oriented fidelity checking approach in an ongoing phase III trial evaluating yoga for improving chemotherapy-induced peripheral neuropathy in cancer survivors. Two researchers independently assessed 4 of 8 video recordings of yoga instructor-led training sessions (50%) and participant-kept home practice logs using a developed fidelity checklist. Results: None of the 4 eligible yoga trials specifically have intervention fidelity measures. We prospectively incorporated yoga instructor training, virtual delivery, and participant engagement strategies in the phase III trial protocol following guidelines. All trial yoga instructors were trained under study protocol to ensure compliance and participant engagement. There was high intervention fidelity in all instructor-led virtual sessions: an average of 100% adherence to class structure and three-thirds on specific skills. Assessment of participant adherence to the established home yoga protocol was 63%. Conclusion: Yoga trials for chemotherapy-induced peripheral neuropathy need adequate fidelity measures. Our study provides a feasible fidelity-monitoring approach to ensure trial intervention delivery and protocol adherence by instructors and participants in oncological settings.

Background: Understanding patient perceptions of care coordination in primary care can help improve responsiveness to patients' needs, outcomes, and quality of care., Purpose: The purpose of this study was to explore patient experiences and perceptions of care coordination in primary care., Method: Interviews with 13 patients from 10 clinics were conducted and analyzed using directed content analysis., Results: Three primary themes arose: care coordinators provide a gateway to accessing needed care; patients needed and valued the support and trusted advice of their care coordinators; and patients valued care coordinators' help with navigating, engaging, and educating them about their care., Conclusions: Understanding what patients value in care delivery can help frame a vision for a more responsive approach in delivering primary care, as well as create a pathway to quality improvement, moving toward a truly patient-centered focus in primary care., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Care coordination is important for patients with complex needs; yet, little is known about the factors impacting implementation from the care coordinator perspective., Purpose: To understand how care coordination implementation differs across clinics and what care coordinators perceive as barriers and facilitators of effective coordination., Methods: Nineteen care coordinators from primary care clinics in Minnesota participated in interviews about their perceptions of care coordination. A team of analysts coded interviews using inductive thematic analysis., Results: Four major themes emerged: variety in care coordination implementation; importance of social needs; necessity for leader buy-in; and importance of communication skills., Conclusions: Described differences in care coordination implementation were often logistical, but the implications of these differences were foundational to care coordinator perceived effectiveness., Competing Interests: All authors are employed by organizations who received support through the PCORI award disclosed earlier or received support from the award directly. There are no additional potential conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Bushen Tiansui Formula (BSTSF) is a traditional formulation of Chinese medicine that has been used to treat Alzheimer's disease (AD) for decades; however, the underlying mechanisms by which this formula achieves such therapeutic effects have yet to be elucidated. Prupose: To investigate the neuroprotective mechanisms of BSTSF against AD by analyzing metabolite profiles in the hippocampus and cortex of AD rats. Methods: The rat models of AD were established by the injection of Aβ 25-35 . The Morris water maze (MWM) test was performed to evaluate the effect of BSTSF treatment on cognitive dysfunction. Hematoxylin and eosin (HE) staining was used to assess the effect of BSTSF on typical AD pathologies. Underlying mechanisms were investigated using LC-MS/MS-based untargeted metabolomics analysis of the cerebral cortex and hippocampus. Results: BSTSF significantly improved memory deficits and the typical histopathological changes of AD rats. Untargeted metabolomics analysis showed that 145 and 184 endogenous metabolites in the cerebral cortex and hippocampus, respectively, were significantly different in the BSTSF group when compared with the AD group. The differential metabolites in the cerebral cortex were primarily involved in cysteine and methionine metabolism, while those in the hippocampus were mainly involved in d-Glutamine and d-glutamate metabolism. Conclusion: In the present study, we confirmed the neuroprotective effects of BSTSF treatment against AD using a rat model. Our findings indicate that the BSTSF-mediated protective effects were associated with amelioration of metabolic disorders in the hippocampus and cerebral cortex., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Tan, Cheng, Zhang, Huang, Hui, Zhu, Liu, Zhao, Liu and Peng.)

Regulatory T cells (Treg) are an integral component of the adaptive immune system that negatively affect antitumor immunity. Here, we investigated the role of the E3 ubiquitin ligase casitas B-lineage lymphoma-b (Cbl-b) in establishing CD8+ T-cell resistance to Treg-mediated suppression to enhance antitumor immunity. Transcriptomic analyses suggested that Cbl-b regulates pathways associated with cytokine signaling and cellular proliferation. We showed that the hypersecretion of IFNγ by Cbl-b-deficient CD8+ T cells selectively attenuated CD8+ T-cell suppression by Tregs. Although IFNγ production by Cbl-b-deficient T cells contributed to phenotypic alterations in Tregs, the cytokine did not attenuate the suppressive function of Tregs. Instead, IFNγ had a profound effect on CD8+ T cells by directly upregulating interferon-stimulated genes and modulating T-cell activation. In murine models of adoptive T-cell therapy, Cbl-b-deficient T cells elicited superior antitumor immune response. Furthermore, Cbl-b-deficient CD8+ T cells were less susceptible to suppression by Tregs in the tumor through the effects of IFNγ. Collectively, this study demonstrates that the hypersecretion of IFNγ serves as a key mechanism by which Cbl-b-deficient CD8+ T cells are rendered resistant to Tregs. See related Spotlight by Wolf and Baier, p. 370., (©2022 The Authors; Published by the American Association for Cancer Research.)

Bioremediation itself is considered to be a cost effective soil clean-up technique and preferred over invasive physical and chemical treatments. Besides increasing efficiency, application of genetic engineering has led to reduction in the time duration required to achieve remediation, overcoming the so called 'Achilles heel' of Bioremediation. Omics technologies, namely genomics, transcriptomics, proteomics, and metabolomics, are being employed extensively to gain insights at genetic level. A wise synchronised application of these approaches can help scrutinize complex metabolic pathways, and molecular changes in response to heavy metal stress, and also its fate i.e., uptake, transport, sequestration and detoxification. In the present review, an account of some latest achievements made in the field is presented., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Osteoarthritis (OA) is a chronic, progressive disease involving the degeneration of cartilage and joint tissue, resulting in pain and disability. Bilateral total knee arthroplasty (TKA) is is an effective intervention that improves quality of life, reduces pain and increases functional capability. This study was performed to compare the functional outcomes between staged and simultaneous total knee arthroplasty. This prospective interventional study was carried out in Arthroscopic and Arthroplasty unit of BSMMU, Dhaka from January 2017 to December 2018. A total of 60 OA patients underwent TKA were included in this study. Thirty patients underwent simultaneous TKA procedure and 30 patients underwent staged TKA procedures performed with 1-6 months between stages were included. Pre-operative and post operative data were collected. Data were analyzed using SPSS 12.0. Numerical data were analyzed using unpaired t test and categorical data were analyzed using Chi-Square test. A value of p<0.05 was considered statistically significant. Mean age of the study subjects was 60.47±10.13 years in staged group and 59.30±9.90 years in simultaneous group. Male to female ratio was 1:1.5 in staged group and 1:2 in simultaneous group. Mean BMI of the study subjects was 30.70±4.91kg/m² in staged group and 30.06±4.79kg/m² in simultaneous group (p>0.05). In both groups, maximum study subjects were housewife (33.3% vs. 33.3%). In staged group 13.3% and 16.7% in simultaneous group were heavy worker; 20.0% in staged group and 16.7% in simultaneous group were medium worker (p>0.05). Pain, motion, stability and function were significantly changed after surgery comparing before surgery.Infection was observed in 10.0% cases in both groups. Stiffness was observed in 10.0% cases in staged group but in 6.7% cases in simultaneous group. Even final outcome showed better in simultaneous procedure, there was no significant difference between two procedures. The outcome of both simultaneous andstaged procedure of bilateral total knee replacement in Advanced Osteoarthritis is similar.

Lumbar decompressive laminectomy for spinal stenosis can be performed using a less-invasive, unilateral approach with subperiosteal dissection and decompression by undermining the lamina from the ipsilateral to the contralateral side. A unilateral approach to bilateral decompression can be supplemented with interspinous instrumentation and facet fusion, a combined procedure that has not been studied before. The less-invasive technique appears to be as effective for lumbar stenosis as the traditional lumbar laminectomy. It also causes less blood loss and reduced operating time, and so may benefit patients who are elderly, medically frail, or with multiple comorbidities.  Fifteen patients (eight females, seven males) underwent outpatient surgery by the author (HA) using this technique. These patients complained of progressive lower back pain associated with radicular pain exacerbated by prolonged standing or walking with improvement in flexed position of the lumbar spine with decreased walking distance ability. A one-level less-invasive lumbar laminectomy and foraminotomy with facet fusion and interspinous fixation were performed for spinal stenosis in conjunction with a Grade I degenerative spondylolisthesis. These patients all had a single-level facet fusion with bone graft material and local autograft. The approximate surgical time for each patient was between 50 and 80 minutes. The visual analog scale for pain (VAS) score decreased significantly after surgery; patients presented with preoperative VAS scores of 5-10/10 (mean 8.33/10). Postoperative VAS scores were 0-6/10 (mean 2/10), yielding a mean VAS improvement of 76% following surgery. Future analysis should be performed for evaluation of sustained VAS score, Oswestry Disability Index (ODI), Form 36 Health Survey Questionnaire (SF 36), and the Zurich Claudication Questionnaire (ZCQ)., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Aliabadi et al.)

Background: Providing care and nurturance to a child with bipolar disorder (BPAD) is a challenging task for parents, especially mothers. In Indian contexts, mothers are the primary caregivers of ailing children and they have to keep intrafamily situation stable, which makes their role more stressful., Objectives: The objective of the study was to assess maternal stress and coping in mothers of adolescents with BPAD., Materials and Methods: This study was a comparative one and carried out on sixty mothers of adolescents; of which thirty were adolescents with BPAD, and the remaining thirty were the mothers of normal adolescents. The participants were selected purposively as per the mothers' age and education level, and the socioeconomic status of the families they belong to. Sociodemographic and clinical data sheet, Parenting Stress Index/Short Form (PSI/SF), and Brief COPE were applied on the mothers for data collection., Results: Mothers' of the BPAD adolescents reported higher scores in the both PSI/SF and Brief COPE., Conclusion: Mothers of the adolescents with BPAD tend to perceive high level of stress and they also use maladaptive coping more in dealing with stressful situations., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Psychiatry.)

This study investigates the impact of Glomus mosseae on heavy metal(loid) (HM) uptake efficiency of pea ( Pisum sativum L.) plants along with physiological and biochemical parameters. Plants were grown in soil spiked with HMs (Pb and As: 50 and 100 mg kg -1 ; Cd: 25 and 50 mg kg -1 ) and a multi-metal(loid) (Mm: Pb + Cd + As) combination, inoculated/non-inoculated with G. mosseae . A dose-dependent increase in HM accumulation was observed in plants upon harvest at 60 days. Plant growth, concentration of photosynthetic pigments, total nitrogen, and carbohydrates reduced, whereas enzymatic [catalase (CAT), superoxide dismutase (SOD), and ascorbate peroxidase (APX)] and non-enzymatic (proline and total phenolics) antioxidants increased upon HM stress. Inoculation with G. mosseae led to an increase in plant growth, concentration of photosynthetic pigments, carbohydrate, nitrogen, and defence antioxidants (whereas proline decreased) which was statistically significant ( p  ≤ 0.05). This symbiosis can be applied for onsite remediation of Pb and Cd contaminated soil by virtue of accumulation efficiency and adaptive response of pea plants inoculated with G. mosseae . Since the amount of HMs in edible parts exceeded the maximum permissible limits recommended by FAO/WHO, pea must not be cultivated in HM-contaminated soil for agricultural purpose due to associated toxicity. Novelty statement   To our knowledge, phytoremediation potential of Pea in synchronization with Glomus mosseae has not been evaluated previously. This study highlights:  • Pea-AMF symbiosis can be applied for Pb and/or Cd phytoremediation.  • Target Hazard Quotient >1 for Pb, Cd and As; caution to food chain exposure required.  • Nonenzymatic (proline, TPC) and enzymatic (CAT, SOD, APX) antioxidants play a key role in ROS detoxification.

While exome sequencing (ES) is commonly the final diagnostic step in clinical genetics, it may miss diagnoses. To clarify the limitations of ES, we investigated the diagnostic yield of genetic tests beyond ES in our Undiagnosed Diseases Network (UDN) participants. We reviewed the yield of additional genetic testing including genome sequencing (GS), copy number variant (CNV), noncoding variant (NCV), repeat expansion (RE), or methylation testing in UDN cases with nondiagnostic ES results. Overall, 36/54 (67%) of total diagnoses were based on clinical findings and coding variants found by ES and 3/54 (6%) were based on clinical findings only. The remaining 15/54 (28%) required testing beyond ES. Of these, 7/15 (47%) had NCV, 6/15 (40%) CNV, and 2/15 (13%) had a RE or a DNA methylation disorder. Thus 18/54 (33%) of diagnoses were not solved exclusively by ES. Several methods were needed to detect and/or confirm the functional effects of the variants missed by ES, and in some cases by GS. These results indicate that tests to detect elusive variants should be considered after nondiagnostic preliminary steps. Further studies are needed to determine the cost-effectiveness of tests beyond ES that provide diagnoses and insights to possible treatment., (© 2020 Wiley Periodicals, Inc.)

A pot study was conducted to assess the phytoremediation potential of Spinach plants along with their physiological and biochemical response when grown in soil contaminated with heavy metal(loid)s (HMs). Plants were grown under different doses of Pb, Cd and As; and their metal(loid) accumulation efficiency was studied upon harvest; expressed in terms of bioabsorption coefficient (BAC), bioconcentration factor (BCF) and translocation factor (TF). Results showed significant (p ≤ 0.05) difference in physiological and biochemical mechanisms of plants as detected through decrease in concentration of cellular constituents (pigments, carbohydrates, total nitrogen content); and increase in antioxidants (both enzymatic and non-enzymatic). Despite of accumulating high amount of HMs in tissues, no visible signs of toxicity were seen; and hence the efficient survival and defense mechanism shown by spinach plants conclude that they are a viable option to be used for phytoremediation of sites contaminated with Cd and Pb. Since the content of Cd and Pb in edible part was higher than safe limits prescribed by USEPA, the present investigation also highlights the ecological hazards that may result upon cultivation of spinach in contaminated soil for agricultural purpose; or its accidental exposure to food chain when grown for phytoremediation., (Copyright © 2019 Elsevier Inc. All rights reserved.)