Staphylococcus aureus dry-surface biofilms are more resistant to heat treatment than traditional hydrated biofilms

BACKGROUND

The importance of biofilms to clinical practice is being increasingly realized. Biofilm tolerance to antibiotics is well described but limited work has been conducted on the efficacy of heat disinfection and sterilization against biofilms.

AIM

To test the susceptibility of planktonic, hydrated biofilm and dry-surface biofilm forms of Staphylococcus aureus, to dry-heat and wet-heat treatments.

METHODS

S. aureus was grown as both hydrated biofilm and dry-surface biofilm in the CDC biofilm generator. Biofilm was subjected to a range of temperatures in a hot-air oven (dry heat), water bath or autoclave (wet heat).

FINDINGS

Dry-surface biofilms remained culture positive even when treated with the harshest dry-heat condition of 100°C for 60min. Following autoclaving samples were culture negative but 62-74% of bacteria in dry-surface biofilms remained alive as demonstrated by live/dead staining and confocal microscopy. Dry-surface biofilms subjected to autoclaving at 121°C for up to 30min recovered and released planktonic cells. Recovery did not occur following autoclaving for longer or at 134°C, at least during the time-period tested. Hydrated biofilm recovered following dry-heat treatment up to 100°C for 10min but failed to recover following autoclaving despite the presence of 43-60% live cells as demonstrated by live/dead staining.

CONCLUSION

S. aureus dry-surface biofilms are less susceptible to killing by dry heat and steam autoclaving than hydrated biofilms, which are less susceptible to heat treatment than planktonic suspensions.

One-Pot Synthesis of Carbon Nanodots in an Organic Medium with Aggregation-Induced Emission Enhancement (AIEE): A Rationale for "Enzyme-Free" Detection of Cholesterol

Addressing the limitations associated with the detection of cholesterol, we present a one-pot synthesis of a carbon nanodot (CD) in an organic medium (CD_org) from a novel bile acid hydrazone-based organogel. Interestingly, CD_org possesses the aggregation-induced emission enhancement (AIEE) phenomenon, which rationally aids in the "enzyme-free" detection of cholesterol through a fluorescence turn-on mechanism. On dilution of the THF/water mixture of CD_org with its poor solvent (water), a 9.8-fold enhancement in its photoluminescence (PL) emission is witnessed. Such an enhancement in PL emission is credited to the occurrence of molecular restrictions due to the formation of nanoaggregates of CD_org, thereby initiating a radiative pathway for exciton decay. Excitingly on adding cholesterol to CD_org, we observed a similar enhancement in its PL emission without the use of any cholesterol oxidase (ChO _x ) enzyme. The limit of detection and limit of quantification of cholesterol is found to be as low as 1.09 and 3.64 μM, respectively. Hence, this contribution highlights the enzyme-free fluorescence turn-on detection of cholesterol by a novel CD rationally designed to extend its applicability in an organic medium, where it is still considered a major restraint.

Chiral carbon dots and their effect on the optical properties of photosensitizers

In this work, we have successfully prepared intrinsically chiral carbon dots from chiral precursors. We have also demonstrated that the chirality of these carbon dots can affect the optical properties of photosensitizer molecules like azobenzene.

Incidence and clinical characteristics of transfusion-associated circulatory overload using an active surveillance algorithm

BACKGROUND

The concordance of haemovigilance criteria developed for surveillance of transfusion-associated circulatory overload (TACO) with its clinical diagnosis has not been assessed. In a pilot study to evaluate an electronic screening algorithm, we sought to examine TACO incidence and application of haemovigilance criteria in patients with post-transfusion pulmonary oedema.

STUDY DESIGN AND METHODS

From June to September 2014, all transfused adult inpatients at four academic hospitals were screened with an algorithm identifying chest radiographs ordered within 12 h of blood component release. Patients with post-transfusion pulmonary oedema underwent case adjudication by an expert panel. TACO incidence was calculated, and clinical characteristics were compared with other causes of post-transfusion pulmonary oedema.

RESULTS

Among 4932 transfused patients, there were 3412 algorithm alerts, 50 cases of TACO and 47 other causes of pulmonary oedema. TACO incidence was 1 case per 100 patients transfused. TACO classification based on two sets of haemovigilance criteria (National Healthcare Safety Network and proposed revised International Society for Blood Transfusion) was concordant with expert panel diagnosis in 57% and 54% of reviewed cases, respectively. Although the majority of clinical parameters did not differentiate expert panel adjudicated TACO from other cases, improved oxygenation within 24 h of transfusion did (P = 0·01).

CONCLUSIONS

The incidence of TACO was similar to that observed in prior studies utilizing active surveillance. Case classification by haemovigilance criteria was frequently discordant with clinical diagnoses of TACO in patients with post-transfusion pulmonary oedema. Improvements in oxygenation within 24 h of transfusion merit further evaluation in the diagnosis of TACO.

Carbon-Dot-Coated Alginate Beads as a Smart Stimuli-Responsive Drug Delivery System

In this work, we report a smart stimuli-responsive drug delivery system (DDS) that can release drug depending upon the amount of pathogen (MRSA) present in the target. A greater amount of MRSA in the system will lead to more release of drug and vice versa. Carbon-dot-coated novel alginate beads (CA-CD) exhibiting superior stability was successfully used as smart drug delivery vehicle. Garlic extract (GE), which contains allicin, was taken as model drug system to demonstrate the phenomena. It was observed that GE loading was 19 and 78% with CA and CA-CD, respectively. CA-CD-GE shows pH-dependent controlled drug release, which results in increased therapeutic efficiency. CA-CD-GE is not only stimuli responsive but also a controlled drug release system as it releases drug according to the pathogen concentration (MRSA). All the three factors viz. drug release, MRSA concentration and pH of the medium are interdependent as when the cell divides, it produces secondary metabolites that lead to the decrease in pH of the medium. The drop in the pH value triggers drug release from the beads. And the effect of the drug is reflected by the MRSA cell death. Hence, we demonstrate a smart stimuli responsive DDS. However, such DDS will be useful in cases where increased amount of pathogen in the system will lead to reduction in pH.

Chitosan-Iron Oxide Coated Graphene Oxide Nanocomposite Hydrogel: A Robust and Soft Antimicrobial Biofilm

We report a robust biofilm with antimicrobial properties fabricated from chitosan-iron oxide coated graphene oxide nanocomposite hydrogel. For the first time, the coprecipitation method was used for the successful synthesis of iron oxide coated graphene oxide (GIO) nanomaterial. After this, films were fabricated by the gel-casting technique aided by the self-healing ability of the chitosan hydrogel network system. Both the nanomaterial and the nanocomposite films were characterized by techniques such as scanning electron microscopy, FT-IR spectroscopy, X-ray diffraction, and vibrating sample magnetometry. Measurements of the thermodynamic stability and mechanical properties of the films indictaed a significant improvement in their thermal and mechanical properties. Moreover, the stress-strain profile indicated the tough nature of the nanocomposite hydrogel films. These improvements, therefore, indicated an effective interaction and good compatibility of the GIO nanomaterial with the chitosan hydrogel matrix. In addition, it was also possible to fabricate films with tunable surface properties such as hydrophobicity simply by varying the loading percentage of GIO nanomaterial in the hydrogel matrix. Fascinatingly, the chitosan-iron oxide coated graphene oxide nanocomposite hydrogel films displayed significant antimicrobial activities against both Gram-positive and Gram-negative bacterial strains, such as methicillin-resistant Staphylococcus aureus, Staphylococcus aureus, and Escherichia coli, and also against the opportunistic dermatophyte Candida albicans. The antimicrobial activities of the films were tested by agar diffusion assay and antimicrobial testing based on direct contact. A comparison of the antimicrobial activity of the chitosan-GIO nanocomposite hydrogel films with those of individual chitosan-graphene oxide and chitosan-iron oxide nanocomposite films demonstrated a higher antimicrobial activity for the former in both types of tests. In vitro hemolysis potentiality tests and MTT assays of the nanocomposite films indicated a noncytotoxic nature of the films, which conveyed the possibility of potential applications of these soft and tough films in biomedical as well as in the food industry.

A sulphonated carbon dot-chitosan hybrid hydrogel nanocomposite as an efficient ion-exchange film for Ca2+ and Mg2+ removal

We have developed a hybrid hydrogel nanocomposite film via conjugation of oxidised carbon dots synthesized from 11-mercaptoundecanoic acid with chitosan. The potential applicability of the film was then successfully tested for the removal of Ca2+ and Mg2+ ions from solution.

Functionalized graphene oxide quantum dot-PVA hydrogel: a colorimetric sensor for Fe²⁺, Co²⁺ and Cu²⁺ ions

Functionalized graphene oxide quantum dots (GOQDs)-poly(vinyl alcohol) (PVA) hybrid hydrogels were prepared using a simple, facile and cost-effective strategy. GOQDs bearing different surface functional groups were introduced as the cross-linking agent into the PVA matrix thereby resulting in gelation. The four different types of hybrid hydrogels were prepared using graphene oxide, reduced graphene oxide, ester functionalized graphene oxide and amine functionalized GOQDs as cross-linking agents. It was observed that the hybrid hydrogel prepared with amine functionalized GOQDs was the most stable. The potential applicability of using this solid sensing platform has been subsequently explored in an easy, simple, effective and sensitive method for optical detection of M(2+) (Fe(2+), Co(2+) and Cu(2+)) in aqueous media involving colorimetric detection. Amine functionalized GOQDs-PVA hybrid hydrogel when put into the corresponding solution of Fe(2+), Co(2+) and Cu(2+) renders brown, orange and blue coloration respectively of the solution detecting the presence of Fe(2+), Co(2+) and Cu(2+) ions in the solution. The minimum detection limit observed was 1 × 10(-7) M using UV-visible spectroscopy. Further, the applicability of the sensing material was also tested for a mixture of co-existing ions in solution to demonstrate the practical applicability of the system. Insight into the probable mechanistic pathway involved in the detection process is also being discussed.

Ethylene diamine mediated cobalt nanoparticle studded graphene oxide quantum dots with tunable photoluminescence properties

The present study demonstrates ethylene diamine mediated in situ synthesis of cobalt oxide nanoparticles (Co₃O₄NPs) studded on graphene oxide quantum dots (GOQDs) showing reversible on/off fluorescence switching.

Paper carbon dot based fluorescence sensor for distinction of organic and inorganic sulphur in analytes

In this work a paper carbon dot (PCDs) based fluorescence sensor was developed which can distinguish between the organic and inorganic sulphur in analytes.

Amino acid appended cholic acid–azobenzene dyad: an effective & smart phase selective gelator for aromatic solvents

A series of amino acid appended cholic acid–azobenzene dyads have been synthesized and studied for their phase selective gelation behavior, which was further explored for water purification and oil spill remediation.

Carbon dots rooted agarose hydrogel hybrid platform for optical detection and separation of heavy metal ions

A robust solid sensing platform for an on-site operational and accurate detection of heavy metal is still a challenge. We introduce chitosan based carbon dots rooted agarose hydrogel film as a hybrid solid sensing platform for detection of heavy metal ions. The fabrication of the solid sensing platform is centered on simple electrostatic interaction between the NH3+ group present in the carbon dots and the OH- groups present in agarose. Simply on dipping the hydrogel film strip into the heavy metal ion solution, in particular Cr6+, Cu2+, Fe3+, Pb2+, Mn2+, the strip displays a color change, viz., Cr6+→yellow, Cu2+→blue, Fe3+→brown, Pb2+→white, Mn2+→tan brown. The optical detection limit of the respective metal ion is found to be 1 pM for Cr6+, 0.5 μM for Cu2+, and 0.5 nM for Fe3+, Pb2+, and Mn2+ by studying the changes in UV-visible reflectance spectrum of the hydrogel film. Moreover, the hydrogel film finds applicability as an efficient filtration membrane for separation of these quintet heavy metal ions. The strategic fundamental feature of this sensing platform is the successful capability of chitosan to form colored chelates with transition metals. This proficient hybrid hydrogel solid sensing platform is thus the most suitable to employ as an on-site operational, portable, cheap colorimetric-optical detector of heavy metal ion with potential skill in their separation. Details of the possible mechanistic insight into the colorimetric detection and ion separation are also discussed.

Property relationship of alginate and alginate–carbon dot nanocomposites with bivalent and trivalent cross-linker ions

Biocompatible alginate and alginate–carbon dot nanocomposites with superior properties and good mechanical properties.

Magnetic alginate–Fe3O4 hydrogel fiber capable of ciprofloxacin hydrochloride adsorption/separation in aqueous solution

Magnetic alginate–Fe₃O₄ hydrogel fibers were successfully prepared and used as adsorption/separation of ciprofloxacin hydrochloride using a simple laboratory micropipette, employing the basic principle of the wet spinning technique.

Fragmentation of supported gold nanoparticles@agarose film by thiols and the role of their synergy in efficient catalysis

A non-conventional fragmentation of supported gold nanoparticles@agarose film by thiols through a prompt electron transfer is demonstrated. The film also shows catalysis of p-nitrophenol reduction in only ∼20 to 30 s.

β-Cyclodextrin and calix[4]arene-25,26,27,28-tetrol capped carbon dots for selective and sensitive detection of fluoride

In this work we have designed a novel system based on carbon dots prepared from chitosan gel capped with β-cyclodextrin and calix[4]arene-25,26,27,28-tetrol for sensitive and selective detection of fluoride ions in aqueous media. Fluorescent carbon dots prepared from chitosan gel when capped with β-cyclodextrin and calix[4]arene-25,26,27,28-tetrol results in quenching of its fluorescence intensity. Introduction of F(-) ions to carbon dots capped with β-cyclodextrin and calix[4]arene-25,26,27,28-tetrol system results in enhancement and restoration of fluorescence intensity leading to detection of F(-) ion. Minimum detection limit was determined to be ∼6.6 μM. The detection is selective as with other halide ions i.e. Cl(-), Br(-) and I(-) and hydroxyl ion (OH(-)), there is observed decrease of fluorescence intensity. A possible mechanism to justify the observation is also discussed in the paper.

Green chitosan-carbon dots nanocomposite hydrogel film with superior properties

In this work we report novel chitosan-carbon dots nanocomposite hydrogel films. A new green source "tea" was used as precursor for carbon dots (CDs). The electrostatic interaction of positive charge on chitosan and negative charge on CDs prepared from tea was used for the successful preparation of a stable and robust chitosan-carbon dots nanocomposite hydrogel film. The hydrogel films were characterized by UV-visible spectroscopy, X-ray diffraction (XRD), Fourier transformed infra-red spectroscopy (FTIR), scanning electron microscope (SEM), fluorescent microscopy, thermogravimetric analysis (TGA) and contact angle analysis. It was observed that chitosan-carbon dots hydrogel films are soft but tough with superior UV-visible blocking, swelling, thermal and mechanical properties in comparison to chitosan hydrogel film. Moreover chitosan-carbon dots films are more water repellent (hydrophobic) as indicated by their high contact angle values. Thus, fabrication of such green soft but tough biocompatible chitosan-carbon dots nanocomposite hydrogel films offers tremendous bio-medical and industrial applications.

In-situ and ex-situ chitosan-silver nanoparticle composite: comparison of storage/release and catalytic properties

In this work storage of silver nanoparticles (Ag NPs) in chitosan gel and its subsequent release for catalytic reduction processes is investigated. The generation of small sized metal nanoparticles which acts as catalyst is prerequisite to progress of a catalytic reaction. We show that Ag NPs extracted from chitosan gel are less than 5 nm so very effective in catalysis. Chitosan-Ag nanocomposite gels were prepared from two different approaches. The first approach involves in-situ incorporation of Ag nanoparticles into the reaction mixture while preparing the chitosan hydrogel and termed as chitosan-Ag-in-situ (CH-Ag-I) nanocomposite gel. And, in second approach already prepared chitosan hydrogel was placed in Ag NPs solutions, resulting in adsorption of Ag NPs and thus forming chitosan-Ag-ex-situ (CH-Ag-E) nanocomposite gel. The prepared gels were characterized by UV-Visible spectroscopy, Fourier transformed infra-red spectroscopy (FTIR), Thermogravimetric analysis (TGA) and Scanning electron microscopy (SEM). Swelling studies showed that the CH-Ag-E exhibits efficient water absorption property compared to that of CH-Ag-I. In addition to efficient swelling properties the CH-Ag-E can also act as store house of Ag NPs that can be used to catalyze the reduction of 4-Nitrophenol (4-NP) to 4-Aminophenol (4-AP) as Ag NPs of this composite can be easily extracted just by treating with sodium borohydride which is not possible in case of CH-Ag-I. The rate of the reaction increases upto 10 fold when CH-Ag-E nanocomposite gel is used as catalyst in comparison to CH-Ag-I. The reduction reaction catalyzed by such Ag NPs follow zero order kinetics and dependent on the size of the Ag NPs loaded in the gel (CH-Ag-E) as well as on the amount of the gel used. We found that smaller is the size of the loaded Ag NPs in CH-Ag-E, more effective it is in catalyzing the reduction reaction. The CH-Ag-E gel also showed reusability with efficient catalysis.

Novel carbon dot coated alginate beads with superior stability, swelling and pH responsive drug delivery

Novel carbon dot coated alginate beads (CA-CD) exhibiting superior stability and swelling properties have been successfully prepared. CA-CD show exceptional stability in ambient condition and are stable at room atmosphere and temperature even after 60 days. Moreover, CA-CD show excessive swelling in comparison to calcium alginate (CA) beads. The beads were characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), scanning electron microscopy (SEM) and optical microscopy. The CA and CA-CD beads were investigated for their use as pH dependent sustained drug delivery vehicles taking tetracycline (TC) and tetracycline associated with β-cyclodextrin (β-TC) as model drug systems. It was observed that TC loading was 35% and 77% with CA and CA-CD, respectively. Tetracycline associated with β-cyclodextrin (β-TC) shows 48% loading for CA and much greater loading (as high as 90%) for CA-CD. At pH 1, CA-CD and CA beads show maximum drug release with TC cumulative release of 70% and 37% at 96 h, respectively. However, the delivery rates at pH 1 were slower in case of tetracycline associated with β-cyclodextrin (β-TC) loading showing 61% release for CA-CD and 22% for CA after 96 h. Thus, CA-CD can be suitably used as an effective drug delivery vehicle with maximum release obtained at pH 1 emphasizing its use in the gastrointestinal tract where pH is low. Also, the use of β-cyclodextrin with the drug as an inclusion complex renders the CA and CA-CD beads useful for slow and long-term drug administration.

Evaluation of ophthalmic manifestations in patients with intracranial tumours

The present study was done to observe the ophthalmic manifestations in patients with intracranial tumor. This was a prospective, purposive, consecutive, observational study conducted in patients with radiologically proven intracranial tumors in the department of Ophthalmology with collaboration of Department of Neuro-surgery of Bangabandhu Sheikh Mujib Medical University from January 2006 to December 2010. All cases had tissue histopathology confirmation post-operatively. The most common type of intracranial tumor was pituitary adenoma (58.04%), followed by craniopharyngioma (20.53%), posterior fossa tumour (12.50%) [medulloblestoma, ependymoma], meningioma (8.04%) [sphenoidalwing meningioma, petroclavel meningioma, oligodendroglioma] and others (0.89%) [nasopharyngial carcinoma, esthesio - astrocytoma]. Common neuro-ophthalmological findings were visual blur (91.07%), visual field defect (71.42%), optic disc changes (50%), pupillary light reaction defect (48.21%) and colour vision defect (46.42%). The study shows, pituitary adenoma is the most common tumor that impairs the visual pathway structures followed by craniopharyngioma, posterior fossa tumour & meningioma. Furthermore, decreased visual acuity, visual field defect, abnormal optic discs, relative afferent pupillary defect and ophthalmoplegia etc. are the common neuro-ophthalmic features that should be carefully examined for early detection of intracranial tumors.

The impact of cerebral embolization during infant cardiac surgery on neurodevelopmental outcomes at intermediate follow-up

Cerebral embolization during pediatric cardiac surgery may be an underappreciated source of subsequent neurodevelopmental impairment. Transcranial Doppler ultrasound is a neuromonitoring tool that can provide intraoperative surveillance for cerebral embolization. We hypothesized that increased cerebral embolic signals detected during infant cardiac surgery would be associated with worse neurodevelopmental outcomes at follow-up. A study group of 24 children who underwent infant cardiac surgery with transcranial Doppler detection of cerebral embolic signals returned at intermediate follow-up for standardized neurodevelopmental assessment. The children were evaluated using two neurocognitive tests and the parents completed two questionnaires regarding observed behavior. Statistical analysis assessed for correlation between the number of cerebral embolic signals at surgery and the results of the neurodevelopmental assessment. Of the 67 test parameters analyzed, five showed a significant association with the number of embolic signals, yet, all in the contrary direction of the clinical hypothesis, likely representing a Type I error. Thus, in this small cohort of patients, the number of cerebral embolic signals detected during infant cardiac surgery was not shown to be associated with worse neurodevelopmental outcomes at intermediate follow-up. A larger study is probably necessary to ascertain the potential influence of cerebral embolic signals on eventual neurologic outcomes in children. The clinical relevance of cerebral embolic signals during pediatric cardiac surgery remains undetermined and deserves further investigation.

Influence of body mass index on low back pain

Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. We conducted a clinic based cross-sectional study in the city of Dhaka and Chittagong during the period of January 2009 to December 2011. Participants (n=357) were interviewed and examined through a structured questionnaire after a non purposive sampling to explore the influence of body mass index (BMI) on LBP. BMI was assessed by the equation weight (Kg)/hight² (m²) and LBP was assessed by modified visual analogue scale. Association between LBP and BMI was tested by Chi-square test. Among 357 patients the incidence of LBP was common in the age group between 40-59 years and it was 172(48.17%) followed by 60-79, 20-39 and ≥80 years group with 21.29%, 17.65% and 12.89% respectively. Female presented more with LBP, i.e. 196(54.91%) than the male 161(45.09%). The more study population was found to have BMI within normal range, i.e. 167(46.78%). This was followed by overweight group which amounted 137(38.37%) while the obese group was the least, i.e. 53(14.85%). Maximum study population presented with severe LBP which amounted 140(39.22%) while others presented with moderate and mild LBP and amounting 118(33.05%) and 99(27.73%) respectively. Among the normal BMI group most patient presented with mild pain (n=82) followed by moderate (n=55) and severe (n=30) pain. Participants with overweight presents with severe pain mostly (n=58) but obese participants presented with severe low back pain (n=25). Statistically the association of LBP with BMI was found to be highly significant (p<0.0001). In this study, 137(46.78%) participants of normal BMI presented with LBP but majorities (n=82) presented with mild LBP and overweight and obese participants mostly presented with severe LBP. On the basis of these findings, careful evaluation of risk factors and deliberate assessment of the therapeutic as well as preventive measure for the management of patient of LBP is highly recommended.

A primary spinal hydatid cyst

Hydatid disease occurs in humans as a result of faeco-oral contamination. Spinal hydatid cyst is a rare entity and a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. Neural compression is common in vertebral hydatidosis where prognosis is always considered as very poor. Difficulty in management due to recurrence of this rare entity makes it a challenging disease to eradicate entirely. Efficacy of use of anthelminthic even after complete surgical removal is yet to be established. We are reporting diagnosis and management of a case of primary extradural and paraspinal hydatid cyst (HC) in an otherwise healthy patient who did not show any other evidence of systemic hydatid disease. The diagnosis was recognized preoperatively by magnetic resonance imaging (MRI) and confirmed postoperatively by histopathology. Surgical removal of the cysts/lesions was followed by anti-helminthic medication and recovery was satisfactory until the patient had recurrence after one year. The patient underwent surgery for the second time and was given anti-helminthic again for a longer period and was recurrence free for the next one year.

Anterior cervical discectomy and fusion without instrumentation for cervical spondylosis

This prospective study included 50 patients receiving anterior cervical discectomy and fusion (ACDF) was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study period was 1st July 2006 to 30th June 2010. This study was done to see the functional outcome of surgery in relation to duration of symptoms and age of the patient. The clinical information and relevant imaging of 50 consecutive patients, 41 male and 9 female, was reviewed at 1 year after surgery. All surgery was performed at no more than 2 contiguous levels, by one surgeon. After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. All surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months. In 50 patients, there were 4 pseudarthroses (8%). Only 4% of the 50 patients had pain related to the donor site. The functional outcome was excellent to good (87.5%) when duration of symptoms less than 1 year and outcome was excellent to good (85.29%) when the age less than 50 years. These results tend to confirm published reports of most expected outcome related to young age and short duration of symptoms. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication. ACDF is a safe, cheap and effective procedure for cervical spondylosis. In this series no major operative complications have occurred. No extra expenditure for plate and screw in this procedure.

Large calcified subdural empyema

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

Patterned organosilane monolayers as lyophobic-lyophilic guiding templates in surface self-assembly: monolayer self-assembly versus wetting-driven self-assembly

Monolayer self-assembly (MSA) was discovered owing to the spectacular liquid repellency (lyophobicity) characteristic of typical self-assembling monolayers of long tail amphiphiles, which facilitates a straightforward visualization of the MSA process without the need of any sophisticated analytical equipment. It is this remarkable property that allows precise control of the self-assembly of discrete, well-defined monolayers, and it was the alternation of lyophobicity and lyophilicity (liquid affinity) in a system of monolayer-forming bifunctional organosilanes that allowed the extension of the principle of MSA to the layer-by-layer self-assembly of planed multilayers. On this basis, the possibility of generating at will patterned monolayer surfaces with lyophobic and lyophilic regions paves the way to the engineering of molecular templates for site-defined deposition of materials on a surface via either precise MSA or wetting-driven self-assembly (WDSA), namely, the selective retention of a liquid repelled by the lyophobic regions of the pattern on its lyophilic sites. Highly ordered organosilane monolayer and thicker layer-by-layer assembled structures are shown to be ideally suited for this purpose. Examples are given of novel WDSA and MSA processes, such as guided deposition by WDSA on lyophobic-lyophilic monolayer and bilayer template patterns at elevated temperatures, from melts and solutions that solidify upon cooling to the ambient temperature, and the possible extension of constructive nanolithography to thicker layer-by-layer assembled films, which paves the way to three-dimensional (3D) template patterns made of readily available monofunctional n-alkyl silanes only. It is further shown how WDSA may contribute to MSA on nanoscale template features as well as how combined MSA and WDSA modes of surface assembly may lead to composite surface architectures exhibiting rather surprising new properties. Finally, a critical evaluation is offered of the scope, advantages, and limitations of MSA and WDSA in the bottom-up fabrication of surface structures on variable length scales from nano to macro.

Contact electrochemical replication of hydrophilic-hydrophobic monolayer patterns

Contact electrochemical replication (CER) is a novel pattern replication methodology advanced in this laboratory that offers the unprecedented capability of direct one-step reproduction of monolayer surface patterns consisting of hydrophilic domains surrounded by a hydrophobic monolayer background (hydrophilic @ hydrophobic monolayer patterns), regardless of how the initial "master" pattern was created. CER is based on the direct electrochemical transfer of information, through aqueous electrolyte bridges acting as an information transfer medium, between two organosilane monolayers self-assembled on smooth silicon wafer surfaces. Upon the application of an appropriate voltage bias between a patterned monolayer/silicon specimen playing the role of "stamp" and a monolayer/silicon specimen playing the role of "target", the hydrophilic features of the stamp are copied onto the hydrophobic surface of the target. It is shown that this electrochemical printing process may be implemented under a variety of experimental configurations conducive to the formation of nanometric electrolyte bridges between stamp and target; however, using plain liquid water for this purpose is, in general, not satisfactory because of the high surface tension, volatility, and incompressibility of water. High-fidelity replication of monolayer patterns with variable size of hydrophilic features was achieved by replacing water with a sponge-like hydrogel that is nonvolatile, compressible, and binds specifically to the hydrophilic features of such patterns. Since any copy resulting from the CER process can equally perform as stamp in a subsequent CER step, this methodology offers the rather unique option of multiple parallel reproduction of an initially fabricated master pattern.

Wetting driven self-assembly as a new approach to template-guided fabrication of metal nanopatterns

Wetting driven self-assembly (WDSA) of appropriate materials in their liquid state on organic monolayer nanopatterns consisting of wettable (lyophilic) surface features surrounded by a nonwettable (lyophobic) monolayer background is shown to provide the basis of a versatile new approach to template-guided fabrication of metal nanopatterns. Monolayer nanopatterns with planned distributions of lyophilic/lyophobic surface regions are conveniently generated by constructive nanolithography upon local electrochemical oxidation of the top -CH3 groups of a highly ordered OTS (n-octadecyltrichlorosilane) monolayer self-assembled on silicon to -COOH (Adv. Mater. 2000, 12, 725-731). Retraction of such a patterned monolayer from a liquid that does not wet its nonpolar -CH3 surface (lyophobic) results in selective, site-defined immobilization of nanosized volumes of the liquid on the locally generated polar -COOH groups (lyophilic). Examples are given of WDSA of organic materials that offer further options for post-assembly chemical processing, such as nonvolatile low-melting olefins, acids, or thiols, the former being in situ reacted to generate polar functions like -COOH or -SH. Loading surface patterns created in this manner with silver or gold ions followed by further chemical processing results in elemental metal nanoparticles generated within the ion-binding organic material, which thus functions as a guiding template for planned metal deposition at predefined surface sites. WDSA is particularly versatile, as any nonvolatile material with appropriate melting temperature and surface wetting characteristics or solubility in a liquid displaying such properties may in principle be utilized to fabricate potentially useful surface nanostructures.

Approach to a case of autonomic peripheral neuropathy

Autonomic neuropathy is the term used to describe autonomic disturbances resulting from diseases of the peripheral autonomic nervous system. This is a group of disorders in which the small, lightly myelinated and unmyelinated autonomic nerve fibers are selectively targeted. Most often, autonomic neuropathies occur in conjunction with a somatic neuropathy (i.e. with motor weakness and/or sensory loss), but they can occur in isolation. Causes of autonomic neuropathies are immune-mediated, paraneoplastic, infectious, toxic and drug-induced, hereditary, nutritional and idiopathic. Amongst all, diabetes mellitus is the most common cause. Autonomic features, which involve the cardiovascular, gastrointestinal, urogenital, sudomotor, and pupillomotor systems, occur in varying combination in these disorders. Orthostatic hypotension is often the first recognized and most disabling symptom. Noninvasive, well-validated clinical tests of autonomic functions along with a host of laboratory tests are of immense value to diagnose the presence and to demonstrate the distribution of autonomic failure. Treatment aims to treat specific cause of the autonomic neuropathy (if possible) and to control symptoms of autonomic dysfunction. Present review attempts to outline clinical approach to a case of autonomic peripheral neuropathy.

Cytokine response in children undergoing surgery for congenital heart disease

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) induces a complex inflammatory response that may cause multiorgan dysfunction. The objective of this study was to measure postoperative cytokine production and correlate the magnitude of this response with intraoperative variables and postoperative outcomes. Serum samples from 20 children (median age, 15 months) undergoing cardiac surgery with CPB were obtained preoperatively and on postoperative days (POD) 1-3. Serum levels of interleukin (IL)-6, IL-8, and IL-10 increased significantly on POD 1 (p < 0.01) vs pre-op values to 271 +/- 68, 44 +/- 9, 7.5 +/- 0.8 pg/ml, respectively, whereas serum IL-1beta, IL-12, and tumor neurosis factor -alpha were not significantly changed. The serum IL-6 and IL-8 levels correlated positively (p < 0.01) with the degree of postoperative medical intervention as measured by the Therapeutic Interventional Scoring System and indicated a greater need for inotropic support (p = 0.057). A negative correlation (p < 0.01) between IL-6, IL-8, and mixed venous oxygen saturation suggested compromised cardiopulmonary function. Patients with single ventricle anatomy had the highest levels of IL-6 and IL-8 (629 +/- 131 and 70 +/- 17 pg/ml, respectively), with a mean CPB time of 106 +/- 23 minutes. Thus, the proinflammatory response after surgery with CPB was associated with postoperative morbidity with increased need for medical intervention.

Solid-state storage of Ag nanoparticles in anion exchange resin beads and their recovery

This paper reports the idea and describes a method of reversible storage and recovery of silver nanoparticles (NPs) in anion exchange resin beads based on the principle of ion exchange. We also report that similar exchange of NPs was not possible with cation exchange resins. The Ag NPs were stored by simple exchange of anions of the resins, which were activated with OH- and NO3- ions. FTIR spectroscopic measurements support that the Ag NPs were exchanged with NO3- ions in the resins. The so-stored NPs could be regenerated by addition of NaBH4 solution to the resins. These NPs were recovered and subsequently utilized for catalytic reduction of an organic dye (eosin). Powder X-ray diffraction (XRD) pattern indicated storage of the NPs in the form of various oxides of silver in the resin, with the peak value of intensity corresponding to XRD of the NPs not changing with time. Scanning electron microscopic measurements show that the NPs in the beads were stable for over a month without the formation of any apparent agglomeration.

Vitamin B12 deficiency: a clinical and electrophysiological profile

OBJECTIVE

The present study was conducted to evaluate the clinical and electrophysiological profile of vitamin B12 deficiency syndrome and whether a correlation exists between the disease process and the various electrophysiological parameters.

METHODS

40 patients with vitamin B12 deficiency neurological syndromes with low serum vitamin B12 and high homocysteine levels were subjected to a detailed motor and sensory nerve conduction studies and pattern reversal VER (P100), SSEP (P37) after stimulation of the posterior tibial nerve and median nerve (N 20) were obtained bilaterally. MR cervical spine was done in all the patients and MR brain in those who presented with neuro-psychiatric symptoms. The patients were followed up at three months, six months and one year after treatment.

RESULTS

On the basis of clinico-electrophysiological profile, 31 patients had myeloneuropathy, 5 isolated myelopathy, 4 isolated neuropathy. Four of the patients with myeloneuropathy, had concomitant dementia. MR imaging revealed abnormality in 12.5% of cases. Prolongation of P37 latency was observed in 39 (97.5%) patients, N 20 latency in 22 (55%), and P100 latency in 19 (47.5%) patients. Peripheral neuropathy was seen in 18 patients; optic neuropathy in 8; and combination of peripheral and optic neuropathy in 9 patients. The peripheral neuropathy was axonal in 19, and demyelinating in 6 patients. There was a significant correlation of the duration of the disease with N 20 latency (P < 0.04). Serum vitamin B12 level correlated well with the latencies of P37 (P < 0.005) and sural SNAP (P < 0.006). On treatment, normalization of P100, MRI signal, N 20 and partial recovery of P37 latencies was seen at 6 months, 9 months and one year respectively.

CONCLUSION

Differential recovery of central and peripheral syndromes was seen. This correlated with the underlying demyelinating and axonal processes, which was well reflected by the electrophysiological studies, and has an important bearing on the outcome.

Photocatalytic polypyrrole-TiO2-nanoparticles composite thin film generated at the air-water interface

Herein, we report a new method of generation of TiO(2) nanoparticles (NPs) incorporated thin films of polypyrrole (PPy) at the air-water interface. Aqueous TiO(2) NPs when treated with H(2)O(2) and left in a chamber of pyrrole vapor resulted in the formation of a film at the interface, in addition to bulk precipitate. Spectroscopic, X-ray diffraction, and electron microscopic measurements establish the formation of a thin film of PPy with the incorporation of TiO(2) NPs. The TiO(2)-containing PPy films when transferred onto glass substrates were able to photo catalyze the decomposition of aqueous organic dyes: methyl orange and methylene blue. Further, these films could also photo catalyze the oxidation of iodide to triiodide ions in aqueous potassium iodide solution. We find that the PPy-TiO(2) composite films catalyze the reactions in the presence of light more efficiently than a suspension of TiO(2) NPs.

A polyaniline-containing filter paper that acts as a sensor, acid, base, and endpoint indicator and also filters acids and bases

In this paper we report a new idea for synthesizing polyaniline in an ordinary filter paper. The synthesis was carried out by a process in which aqueous acidic aniline solution and the oxidizing agent H(2)O(2) was added to the paper drop by drop and in sequence. Uniform polymerization could be obtained with the addition of reagents in either sequence. The polymer formation led to a green coloration of the paper. Formation of the emeraldine salt of polyaniline was confirmed by UV-vis and FTIR spectroscopy. Scanning electron microscopic measurements were made for surface characterization of the polymer formed in the paper. The same paper was used as a sensor for ammonia in vapor and in solution, for acid and base as well as endpoint indication, and also to filter acids and bases. We found that, using the polymer-containing paper, ammonia concentrations in a solution as low as 14 ppm could be measured.

Are multiple acute small subcortical infarctions caused by embolic mechanisms?

OBJECTIVE

To seek evidence of potential embolic sources or other stroke mechanisms in patients who, on chance observation, had several apparently recent small subcortical infarcts on diffusion weighted magnetic resonance imaging (DWI).

METHODS

Patients presenting with stroke and multiple hyperintense subcortical infarcts visible on DWI were identified prospectively. Detailed clinical and radiological assessments were done independently and blinded to each other.

RESULTS

Of 10 patients with multiple hyperintense subcortical infarcts on DWI, a definite embolic source was identified in only one. Most patients were hypertensive and smoked. The DWI appearance suggested that the subcortical lesions had occurred within several weeks rather than at exactly the same time. Most patients also had significant white matter hyperintensities and four had microhaemorrhages.

CONCLUSIONS

Embolic sources were not identified in most patients but they did have systemic vascular risk factors and brain imaging features of "small vessel disease." A more generalised intrinsic process affecting many small cerebral vessels contemporaneously could explain multiple acute small subcortical infarcts. White matter hyperintensities, microhaemorrhages, and multiple small subcortical infarcts may share a common pathophysiological mechanism such as a diffuse cerebral microvascular abnormality which requires further exploration.

Brachial plexopathy: a clinical and electrophysiological study

BACKGROUND

A retrospective study to evaluate the clinical and electrophysiological profile of brachial plexus lesions in a tertiary care center of India.

METHODS

Thirty eight patients with brachial plexopathy (idiopathic or traumatic) with detailed electrophysiological studies were sampled. This included detailed motor and sensory nerve conduction studies of the conventional median, ulnar and radial nerves of the upper limbs, CMAP from deltoid, biceps and triceps on stimulating the ERB's point, needle EMG in the appropriate muscles and paraspinal muscles. The electrophysiological studies were performed on both sides irrespective of the clinical involvement and were recorded within 1.61 +/- 2.89 months in idiopathic group and 2.11 +/- 2.65 months in traumatic plexopathy group. The severity of involvement was assessed on MRC scale. ADL scale was used to assess the disability at presentation and subsequent follow up.

RESULTS

12 patients (11 male and 01 female) had idiopathic brachial plexopathy and 26 patients (all male) had traumatic brachial plexopathy. In the idiopathic group the lesion was localized to upper trunk in 58.3% of patients and middle trunk (posterior cord) in 41.66% and none had lower trunk or diffuse involvement. 25% had bilateral involvement. Two patients (16.6%) with idiopathic plexitis had recurrence involving the opposite side during the follow up. In the traumatic group the lesion was localized to the upper trunk in 11.53%, middle trunk (posterior cord) in 57.69% and 30.76% of patients had diffuse involvement. All the patients in traumatic plexopathy group had severe disability while in idiopathic group 91.66% had severe disability and 8.33% had moderate disability. Low amplitude CMAP and F wave abnormality were seen in 16.6% of patients in idiopathic group. On needle EMG 83.3% had fasciculation or fibrillations while none had paraspinal EMG abnormality. In traumatic group low to absent CMAP was seen in 69.2% and 76.92% had F wave abnormality. SNAPs were not recordable in 53.8%. On Needle EMG all the patients showed fasciculation or fibrillations and only 6 (23.0%) had paraspinal muscle fibrillations. Root avulsion could be documented in only four of these cases on MR imaging.

CONCLUSIONS

Recovery in the traumatic group correlated well with the electrophysiological abnormalities while no such correlation was evident in the idiopathic group.

Spreading and recoil of a surfactant-containing water drop on glass-supported alcohol films

In this paper we report the experimental observation of spreading and recoil of surfactant-containing water drops on various alcohol films supported on glass slides. The time evolution of spreading and recoil behavior was recorded by placing a web camera above the drop. We observed that the drop spread the fastest on CH3OH, followed by C2H5OH, and the slowest on i-PrOH. On the other hand, the recoil behavior was just the opposite. The drop recoiled the slowest on CH3OH and fastest on i-PrOH, while it recoiled in an intermediate time on C2H5OH. In addition, concentration of surfactant in the drop played a prominent role in the spreading and recoil time of the drop, with higher surfactant concentration making the drop spread and recoil faster. The time evolution of spreading velocity of the drop on different alcohol films at various surfactant concentrations occurred with a Gaussian distribution and the peak velocity was reached earliest on CH3OH followed by C2H5OH, while on i-PrOH it took the longest time. The recoil behavior was similar. The variation of velocity as a function of radius exhibited oscillatory behavior, indicating the existence of an interfacial phenomenon. We also report the observation that spreading of the drop occurred without observable fingering instability. Further, we observed by Fourier transform infrared (FTIR) spectroscopic measurements that the drop had mixed with the alcohol films as it spread. Miscibility of the alcohol in the film with the drop, alcohol evaporation cooling-induced temperature gradient, and Marangoni effect probably play important roles in the spreading and recoil behavior of the drop.

Macroscopic and mesoscopic patterns observed in thin films formed due to polymerization of aniline at the air-water interface

We report two-dimensional mesoscopic and macroscopic patterns observed in thin films formed due to polymerization of aniline at the air-water interface. The polymerization at the interface was coupled to a reaction in the bulk medium that was either an iron (ferroin)-catalyzed Belousov-Zhabotinsky (BZ) reaction or another reaction condition where the ferroin component of BZ reaction was replaced by FeSO(4) or Mohr's salt [(NH(4))(2)SO(4).FeSO(4).6H(2)O]. Also, a simple mixture of KBrO(3) and KBr in aqueous acidic solution produced patterned polymers at the interface, observed with aniline introduced from both the vapor phase and the bulk phase (by dissolving in H(2)SO(4)). Observation under an optical microscope revealed that the macroscopic patterns consisted of mesoscopic patterns of various geometrical shapes. In one case, regular circular mesoscopic patterned polymer growth was observed when the reaction was carried out in the presence of 2.02 mM sodium dodecyl sulfate. On the other hand, when the film was grown in an ultrasonicator bath there were no observable mesoscopic or macroscopic patterns in the film.