Adenomatoid odontogenic tumor: A histopathologic profile of 43 cases with evidence supporting a mixed odontogenic origin

BACKGROUND

Adenomatoid Odontogenic Tumor (AOT) accounts for 3% of all odontogenic tumors. It has been classified by WHO as an odontogenic tumor of purely epithelial origin. The current study attempts to establish the origin of the tumor along with detailed histopathological and clinicoradiographic analysis of 43 cases of AOT.

MATERIAL AND METHODS

Forty-three cases were reviewed from the departmental archives for demographic data, radiographic features and histological features. Further, histopathological slides were stained with Picrosirius Red (PSR) and observed under polarised light.

RESULTS

A majority of the cases were seen in the anterior jaws (76.7%), and were less than 3 cms (76.7%) in greatest dimension. Equal number of cases were of follicular and extra-follicular location while one was peripheral. Predominantly solid histological pattern was noted in 53.5%. Varied sub-patterns were observed with most cases exhibiting solid nodules and strands of tumor cells. Few cases showed melanin pigmentation. Over a third of cases (37.2%) showed dentigerous cyst like areas and one case each showed features of ossifying fibroma and focal cemento-osseous dysplasia. Tumor droplets, hyaline rings within duct-like structures, dentinoid material and osteodentin showed reddish yellow birefringence when observed under polarised microscopy post PSR staining.

CONCLUSION

This study highlights the diverse histopathological variation of AOT with evidence to reclassify it as a mixed odontogenic tumor based on the polarising microscopic findings with PSR staining.

Upregulation of miRNA-196a and miRNA-196b correlates with Bryne's prognostic score in oral squamous cell carcinoma

BACKGROUND

microRNA(miRNA)-196a and miRNA-196b expression has been found to be dysregulated and involved in tumorigenesis and tumor progression in array of cancers through different targets. The role of these miRNAs together in clinical application is not always consistent and, its prognostic value in oral squamous cell carcinoma (OSCC) is still elusive. This study was performed to investigate the correlation of these miRNAs expression with histological grades of OSCC according to Bryne's histological grading system, to predict prognosis and to evaluate their relationship with clinico-pathological data.

METHODS

Real-time quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR) was done to evaluate the expression levels of miRNA-196a and miRNA-196b in 75 pairs of OSCC tissue matched with adjacent normal mucosa, used as a control.

RESULTS

miRNA-196a and 196b expression in OSCC was significantly higher than that in corresponding adjacent normal tissues (p > 0.001). Also, a significant differential correlation was found in between the expression levels of these two miRNAs (Pearson correlation test r = 0.676, p-value<0.0001). The increased expression of these miRNAs was more frequently observed in OSCC tissues with advanced clinical and pathological TNM stages (IVa and IVb, pIVb respectively, p-value<0.0001). Significant correlation was found between miRNA-196a upregulation and moderate prognostic score (p-value<0.0001) in comparison with good and poor prognostic score of histological grades of OSCC. Sensitivity and specificity for miRNA-196a were 95 % and 85 %, respectively (AUC = 1, 95 % CI = 0.617-0.850; p 0.001), while for miRNA-196b were 94 % and 86 %, respectively (AUC = 0.808, 95 % CI = 0.701-0.916; p0.0001).

CONCLUSIONS

These findings suggest that the increased expression of miRNA-196a and 196b may play an important role in tumor progression in OSCC. miRNA-196a might be a useful marker for predicting the clinical outcome of OSCC, especially for advanced stages. In conclusion, our data demonstrate for the first time that these miRNAs may serve as a potent prognostic marker for tumor progression. We further highlight miRNA-196a and miRNA-196b as a promising predictor of prognostic assessment in OSCC.

Critical care, maternal and neonatal outcomes of pregnant women with COVID-19 admitted to eight intensive care units during the wildtype, alpha and delta waves of the pandemic across the North West of England-a retrospective review

INTRODUCTION

Few studies have described obstetric and critical care outcomes in pregnant women with COVID-19 needing intensive care unit (ICU) admission.

MATERIAL AND METHODS

Obstetric and critical care outcomes of COVID-19 women admitted to eight ICUs from April 1, 2020 to September 15, 2021, in the North West of England were retrospectively analyzed. Women admitted to ICU were assigned to three groups: antepartum women discharged from ICU prior to delivery (antepartum ICU-discharged group), antepartum women who had expedited delivery (antepartum ICU-delivered group) and a postpartum group. Our aims were to describe maternal characteristics and assess how delivery influenced the obstetric and critical care outcomes in these women.

RESULTS

During the study period, 615 women tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of whom 62 (10.1%) needed ICU admission due to symptomatic COVID-19. Pregnancy loss (3.2%) was recorded in two women. Detailed obstetric and critical outcomes from 60 women are reported. Nine antepartum women (15%) admitted to ICU were discharged and continued their pregnancy, 13 antepartum women (21.7%) had expedited delivery by cesarean birth after ICU admission and 38 (63.3%) women were admitted to ICU during the postpartum period. Antepartum ICU-discharged women contracted the SARS-CoV-2 at an earlier median gestational age (23 weeks; p = 0.0003) and needed ICU admission at an earlier median gestational age (28 weeks, p = 0.03) compared with antepartum ICU-delivered (28 and 32 weeks) and postpartum women (35.5 and 36 weeks). Antepartum ICU-discharged women had the lowest rate of mechanical ventilation receipt (11.1%) compared with antepartum ICU-delivered women (52.3%) and postpartum women (44.3%) but the difference was not statistically significant (p = 0.13). No significant differences were observed in the frequency and severity of critical care complications in the antepartum ICU-discharged, antepartum-ICU delivered and postpartum women.

CONCLUSIONS

Of the women admitted to ICU antepartum, 40% were discharged while remaining pregnant and 60% had expedited delivery. Antepartum women who were discharged from ICU without giving birth may receive lower rates of mechanical ventilation than those who delivered in ICU or admitted postpartum; however, further studies are needed to confirm or refute this association.

"Is it time for personalised medicine for Ameloblastoma?": A hypothesis

Ameloblastoma is a benign odontogenic tumor that is locally destructive. The most common treatment option is surgery, which often results in disfigurement of the face. BRAFV600E is the common gene mutation associated with its pathogenesis. Therefore, this paper hypothesizes the use of targeted drug therapy against this mutated gene.

Lifting the lid over the pearl: A histological insight

Epithelial pearls and Keratin pearls are pathognomonic of squamous cell carcinoma. However, their histogenesis is not well understood. Only a handful of studies have been conducted in the past in this regard. This brief communication aims to understand the formation of these pearls with a few of our own experiences.

Cysticercosis: Unearthing the worm

Cysticercosis, a helminthic disease caused by T. Solium, is a major health concern in developing and underdeveloped nations of the world. If left untreated, it may lead to severe neurological and ophthalmic complications. The diagnosis of oral cysticercosis depends on the identification of the larva in the biopsied tissue. However, an accurate diagnosis can be challenging, if the larva is dead because of which it cannot be identified. In such a scenario, step by step approach to unearth the worm is discussed here.

Characterization of different parts of litchi fruit using UHPLC-QExactive Orbitrap

Litchi fruit is consumed across the globe for its high nutritional value and taste. The qualitative profiling of litchi fruit has been carried out by using ultra-high-performance liquid chromatography with QExactive high-resolution accurate mass spectrometry. Acidified water: methanol: acetonitrile (1:1:1) extracts from individual parts (skin, pulp, and seed) of matured litchi, were subjected to LC-MS analysis with electrospray ionization in full MS-ddMS2 mode as a non-target approach. The data was processed through compound discoverer software by the use of mzCloud and ChemSpider databases, for compound identification. We identified 77 compounds with protonated or deprotonated forms based on the polarity and their characteristic fragments are within ± 4 ppm mass error and retention time ± 0.1 min for parent and fragments. Hypoglycin B is the first time reported in litchi fruit along with hypoglycin A. Further, we verified the distribution of the identified components and differentiation of three different parts of litchi through principal component analysis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13197-022-05577-z.

Role of phosphatase and tensin homolog in pathogenesis of ameloblastoma: An immunohistochemical study

Background

Altered molecular signaling pathways in ameloblastoma have been identified to play a pivotal role in the mechanism of oncogenesis, differentiation, and tumor progression. Phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin pathway is one of the signaling pathways that are associated with the pathogenesis of ameloblastoma. Phosphatase and tensin homolog (PTEN) controls cell migration and proliferation. It monitors the level of the Akt and maintains cellular integrity. The present study was aimed to study the immunoexpression of PTEN in ameloblastoma to understand its role in the pathogenesis of ameloblastoma.

Materials and Methods

Twenty cases of ameloblastoma and ten cases of normal tooth germ were subjected to immunohistochemical staining against PTEN.

Results

Strong PTEN immunopositivity was seen in the tooth germs, while weak positivity was seen in the ameloblastoma. The immunoscore for PTEN was calculated by adding the percentage score and the intensity score. Seventeen cases showed the reduced PTEN expression in the epithelial component of ameloblastoma. The unpaired t-test showed a statistically significant difference in the mean PTEN immunoscore in tooth germ and ameloblastoma.

Conclusion

The study showed reduced PTEN immunoreactivity, which plays a role in the pathogenesis of ameloblastoma, through Akt pathway.

Recovery, physicochemical and functional characteristics of proteins from different meat processing wastewater streams

Recovery, physicochemical and functional characteristics of proteins recovered from different meat processing wastewater streams were revealed in the present study. Wastewaters from surimi processing (SPW) and slaughterhouses, namely fish (FSW), cattle (CSW), poultry (PSW), and goat (GSW), exhibited protein, fat, ash, moisture, and microbial load in the range of 1.28-7.04%, 0.86-2.34%, 0.02-0.80%, 89.81-97.44%, and 5.33-5.81 CFU/mL, respectively. Among the wastewaters, SPW presented slightly higher protein (7.04%), fat (2.34%), and ash (0.80%) contents (P < 0.05). Furthermore, proteins recovered from SPW (SPWP) and FSW (FSWP), CSW (CSWP), PSW (PSWP), and GSW (GSWP) presented yield, protein, fat, ash, and moisture content in the range of 55.54-76.81%, 65.86-78.22%, 7.26-11.45%, 4.58-11.75%, and 5.67-14.79%. All protein samples displayed higher essential amino acid (EAA) content with leucine (8.47-14.52 g/100 g) as a predominant amino acid. GSWP and SPWP scored the highest and lowest EAA contents, respectively. SPWP displayed myofibrillar proteins as dominant proteins, while slaughterhouses' wastewater proteins showed blood proteins as major proteins. β-Sheet is the major secondary structure presented by all protein samples. SPWP showed the highest lightness value as compared to other protein counterparts (P < 0.05). All protein samples from slaughterhouse wastewaters had the lowest protein solubility at pH 4.5. However, SPWP presented minimum solubility at pH 5.5. Among all protein samples, SPWP presented slightly higher water holding capacity and foaming property (P < 0.05), whereas FSWP displayed slightly higher emulsion property (P < 0.05). Overall, all meat processing wastewater streams served as good sources of high-quality proteins, which could be used as protein ingredients in animal feed formulation.

Recovery, physicochemical and functional characteristics of proteins from different meat processing wastewater streams

Recovery, physicochemical and functional characteristics of proteins recovered from different meat processing wastewater streams were revealed in the present study. Wastewaters from surimi processing (SPW) and slaughterhouses, namely fish (FSW), cattle (CSW), poultry (PSW), and goat (GSW), exhibited protein, fat, ash, moisture, and microbial load in the range of 1.28-7.04%, 0.86-2.34%, 0.02-0.80%, 89.81-97.44%, and 5.33-5.81 CFU/mL, respectively. Among the wastewaters, SPW presented slightly higher protein (7.04%), fat (2.34%), and ash (0.80%) contents (P < 0.05). Furthermore, proteins recovered from SPW (SPWP) and FSW (FSWP), CSW (CSWP), PSW (PSWP), and GSW (GSWP) presented yield, protein, fat, ash, and moisture content in the range of 55.54-76.81%, 65.86-78.22%, 7.26-11.45%, 4.58-11.75%, and 5.67-14.79%. All protein samples displayed higher essential amino acid (EAA) content with leucine (8.47-14.52 g/100 g) as a predominant amino acid. GSWP and SPWP scored the highest and lowest EAA contents, respectively. SPWP displayed myofibrillar proteins as dominant proteins, while slaughterhouses' wastewater proteins showed blood proteins as major proteins. β-Sheet is the major secondary structure presented by all protein samples. SPWP showed the highest lightness value as compared to other protein counterparts (P < 0.05). All protein samples from slaughterhouse wastewaters had the lowest protein solubility at pH 4.5. However, SPWP presented minimum solubility at pH 5.5. Among all protein samples, SPWP presented slightly higher water holding capacity and foaming property (P < 0.05), whereas FSWP displayed slightly higher emulsion property (P < 0.05). Overall, all meat processing wastewater streams served as good sources of high-quality proteins, which could be used as protein ingredients in animal feed formulation.

Effects of ultrasound-assisted heating on aroma profile, peptide structure, peptide molecular weight, antioxidant activities and sensory characteristics of natural fish flavouring

This study deals with the production of natural fish flavouring using ultrasound-assisted heating process. The effect of ultrasound pretreatment at different amplitudes (0, 15, 30, and 45%) on the Maillard reaction rate, antioxidant activities, flavour profile, and sensory characteristics of fish flavouring was investigated. Results showed that sonication markedly accelerated the Maillard reaction (MR) rate, as evidenced by the modification of peptide structure, a decrease in pH value, free amino acid content coupled with a rise in browning intensity. Also, ultrasound pretreatment significantly enhanced the antioxidant activities of fish flavouring (p ≤ 0.05). Moreover, sonication increased the type and content of aroma compounds significantly. Sensory analysis revealed that ultrasound pretreatment increased the fish-like and toasty aroma as well as umami and mouthfulness attributes coupled with the reduction of the bitter taste of the fish flavouring. This result was consistent with the GC-MS, electronic nose, cluster, and Partial Least Squares Regression (PLSR) analyses, which clearly showed that ultrasound pretreatment enhanced the fish-like aroma, which was associated with the increase in aldehydes, ketones, alcohols, thiophenes, pyrazine, and furans contents. Thus, it could be concluded that ultrasound pretreatment, coupled with the thermal process, could be a promising process for the production of natural fish flavouring with higher antioxidant activities.

A novel approach for extracting DNA from formalin-fixed paraffin-embedded tissue using microwave

Background

Formalin-fixed paraffin-embedded (FFPE) tissue is the gold standard procedure for tissue preservation. However, the extraction of DNA is a cumbersome procedure as the extracted DNA is fragmented because of the cross-linking effect of formalin. Hence, the aim of the present study is to extract DNA from FFPE tissues using different techniques with a specific objective of comparing the extracted DNA, both quantitatively and qualitatively.

Method

Ten samples of FFPE tissues were retrieved from the archives of the Department of Oral Pathology. Total genomic DNA was extracted by different methods which included QIAamp DNA FFPE Tissue Kit, Norgen DNA FFPE Tissue Kit, phenol-chloroform method, mineral oil-based extraction, M/10 NaOH solution method, and microwave method. A 280-base pair sequence was selected for evaluation of downstream amplification.

Results

The statistical analysis was performed using unpaired student's t-test to compare the DNA yields and quality obtained by microwave methods with other methods using SPSS software. Total genomic DNA retrieved by the microwave method was superior to other methods both qualitatively and quantitatively.

Conclusion

DNA extraction from FFPE tissues is an onerous task as irreversible bonds form between the nucleic acid during fixation which are difficult to break during DNA retrieval. Hence, the microwave method provides good total genomic DNA which gives better downstream results when compared with other methods.

Pan-Cytokeratin Positive Fibroblastic Osteosarcoma of Jaw: An Extremely Rare Entity in a Pediatric Patient

Osteosarcoma (OS) of jaws is a rare entity characterized by malignant osteoid formation and is most commonly seen in third to fourth decade of life. Here, we present a rare and intriguing case of a 14-year-old pediatric patient, who reported with a chief complaint of swelling in the left maxilla, which was rapidly increasing in size. Both cytokeratin AE1/3 and vimentin-positive spindled cells were seen arranged in storiform pattern with minimal areas of osteoid formation on histopathologic examination. The diagnosis of fibroblastic OS was confirmed by fluorescent in situ hybridization after excluding monomorphic synovial sarcoma. The patient underwent segmental resection of left maxilla and is on close follow-up. A PubMed search revealed that only 5 pediatric cases of fibroblastic OS have been published since 1991. Here, we highlight the diagnostic challenges encountered in reaching the histopathologic diagnosis.

The effect of regioisomerism on the photophysical properties of alkylated-naphthalene liquids

Novel alkylated naphthalene liquids with a correlation among the 1- and 2-regioisomeric chemical structures and their photophysical, calorimetric and rheological properties are presented.

Change the habit to change the practice: Do audits really ever change anything?

INTRODUCTION

Methicillin resistant staphylococcus aureus (MRSA) eradication by nurses and pre-op induction antibiotics are mandated for emergency surgery, where true status is unknown. We assessed adherence to local MRSA guidelines for patients undergoing emergency hip fracture surgery and employed point of decision prompts to influence clinicians' behaviour.

METHODS

We undertook a retrospective record review for all patients undergoing emergency hip fracture surgery at a UK major trauma centre over 3-months. Demographics, MRSA eradication therapy and antibiotics were recorded. Admission-to-MRSA swab result time was compared to the admit-to-operation time. Posters on induction antibiotics were placed in anaesthetic rooms, stickers on MRSA eradication therapy on nursing care bundles and standards re-audited after 6 months.

RESULTS

The case-mix was similar in both audit cycles: initial audit (n=69, mean age 76.9, range 33-94), re-audit (n=77, mean age 73.8, range 18-95). There was a small rise in adherence to eradication therapy prescription (1% vs 8%) after sticker distribution, although compliance was poor pre and post intervention. Correct antibiotic choice for MRSA unknown patients (18% vs 94%) improved significantly after poster intervention. Operations occurred at a median of 24.05h (Q1 17.6, Q3 32.3) from admission but MRSA swab results returned at a median of 48h (Q1 41.5, Q3 59.5) p=<0.0001.

CONCLUSION

Providing reminders at the points where decisions are to be made are effective. Audit interventions should be easily undertaken and will become habitual if connected in sequence to old behaviours.

Medical problems in pregnancy

The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

Medical problems in pregnancy

The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

Medical problems in pregnancy

The prevalence of medical problems in pregnancy is increasing because of a complex interplay between demographic and lifestyle factors, and developments in modern medicine. Maternal mortality and morbidity resulting from treatable medical conditions, such as venous thromboembolism, epilepsy and autoimmune disease, have not decreased in recent years. This is despite a marked decrease in overall maternal mortality. It is vital that all physicians acquire a basic knowledge and understanding of medical problems in pregnancy. This includes prepregnancy measures such as counselling and optimisation of medical therapy, as well as multidisciplinary management throughout pregnancy and the postpartum period. Prompt recognition and treatment of acute and chronic illness is of clear benefit, and most drugs and many radiological investigations may be used in pregnancy.

Symptomatic Acute Hepatitis C Infection Following a Single Episode of Unprotected Sexual Intercourse

A previously healthy 23-year-old MSM presented with jaundice, systemic upset, and rash 2 months after a single episode of unprotected sexual intercourse. Liver biochemistry was grossly deranged, with markedly elevated transaminases and hyperbilirubinaemia. Serology was positive for genotype 1a hepatitis C virus (HCV) and in the absence of other causes, acute HCV infection was suspected. He was subsequently successfully treated with pegylated interferon and ribavirin for 24 weeks and made a full clinical and biochemical recovery.

Negligence claims following non-union and malunion of long bone fractures: An analysis of 15 years of data

INTRODUCTION

Non-unions and malunions are recognised to be complications of the treatment of long bone fractures. No previous work has looked at the implications of these complications from a medicolegal perspective.

METHODS

A complete database of litigation claims in Trauma and Orthopaedic Surgery was obtained from the NHS Litigation Authority. Two separate modalities of the treatment of long bone fractures were examined i) non-union and ii) acquired deformity. The type of complaint, whether defended or not, and costs were analysed.

RESULTS

There were claims of which 97 related to non-union and 32 related to postoperative limb deformity. The total cost was £8.2 million over a 15-year period in England and Wales. Femoral and tibial non-unions were more expensive particularly if they resulted in amputation. Rotational deformity cost nearly twice as much as angulation deformities.

CONCLUSIONS

The cosmetic appearances of rotational malalignment and amputation results in higher compensation; this reinforces an outward perception of outcome as being more important than harmful effects. Notwithstanding the limitations of this database, there are clinical lessons to be gained from these litigation claims.

Does squalene alter the antioxidant potential of astaxanthin and fucoxanthinol? In vitro evidence in RAW 264.7 cells, a murine macrophage

Astaxanthin (Ax) and fucoxanthin/fucoxanthinol (FuOH) are marine xanthophylls exhibiting anti-oxidant effects. Squalene (SQ) is a triterpenoid and is a precursor of sterols. This study aimed to determine if SQ can improve the effect of Ax/FuOH on lipid peroxidation. RAW 264.7 cells were treated with different concentrations of Ax, FuOH and SQ and corresponding rate of cell survival was noted. In addition,combination groups - Ax + SQ and FuOH + SQ- were also run. Cells treated with Ax, FuOH, SQ, Ax + SQ and FuOH + SQ were stimulated with lipopolysaccharide and lipid hydroperoxides were estimated. Results showed that 5 μM Ax, 2 μM FuOH and 10 μM SQ supported cell survival. In presence of SQ, cell viability improved for higher concentrations of FuOH (5, 10 μM). Lipid hydroperoxides were supressed by Ax, FuOH, Ax + SQ and FUOH +SQ and were significantly lower in Ax + SQ, indicating the synergistic effect of Ax and SQ. To conclude, combination of Ax with SQ enhances its ability to supress lipid peroxidation while with FuOH, SQ attenuates the toxic effect at higher doses. Moreover, this is the first time that the combined effect of SQ and carotenoids has been studied and reported.

Chronic anorexia and weight loss due to extensive fibroid compression of the bowel: an unusual complication of uterine fibroids in a patient with a twin pregnancy

A 36-year-old homeless Eritrean nulliparous woman was admitted to hospital, with abdominal pain, nausea and loss of appetite. She was found to be 17 weeks pregnant with dichorionic diamniotic twins. She was cachectic and had large palpable uterine fibroids. An extensive search for infection and malignancy did not yield any significant results. She was managed with enteral nutritional support and delivered healthy twins by emergency caesarean section at 36 weeks' gestation. She re-presented 19 days postpartum, with fever and abdominal pain. Imaging revealed multiple abdominal collections and large degenerating fibroids. At laparotomy, the fibroids were found to be adherent to, compressing and enveloping large sections of bowel. The patient required a right hemicolectomy, small bowel resection and total abdominal hysterectomy. Histology confirmed an infarcted leiomyoma and the patient made a good postoperative recovery.

Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres

INTRODUCTION

This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database.

MATERIALS AND METHODS

Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation.

RESULTS

There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007.

CONCLUSIONS

Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an 'implant time-out' could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

Spatial and seasonal variations in the biofunctional lipid substances (fucoxanthin and fucosterol) of the laboratory-grown edible Japanese seaweed (Sargassum horneri Turner) cultured in the open sea

This work studied the effect of spatial and seasonal differences on the accumulation of functional lipid components in Sargassum horneri (Turner), an edible Japanese seaweed popularly called Akamoku. S. horneri obtained from Samenoura bay area of Japan was laboratory cultured to evaluate the effect of temperature on the accumulation of total lipids (TL), fucoxanthin (Fx) and fucosterol (Fs) by the alga. The laboratory cultured 3 month old S. horneri were cultured in the open sea in two different geographical locations off Usujiri and Matsushima to evaluate the monthly variations, over a year, in their TL, Fx and Fs contents. S. horneri grown off the Usujiri area accumulated the maximum TL close to 193 mg g^-1 dry weight during the coldest part of the year. Fx and Fs contributed 5.6% and 16.2% of the TL in S. horneri harvested off Usujiri in February. Further, in spite of being the same species and parent stock, S. horneri grown off the Matsushima area accumulated less TL, Fx and Fs as compared to their Usujiri counterparts. Our study clearly indicates the role of temperature and light apart from nutritional profile and depth of waters where the seaweed was grown on the accumulation of functional lipid components in S. horneri.

Biochemical and microbial characterization of Ngari and Hentaak - traditional fermented fish products of India

Ngari and hentaak are the two most preferred traditional salt-free fermented fish products of North-Eastern (NE) states of India. Chemical and microbial composition, antioxidative potential, fatty acid profile and electrophoretic pattern of protein in ngari and hentaak were studied. pH and total titratable acidity (TTA) of the products justified their stability at ambient temperature. Both ngari and hentaak showed higher contents of calcium (362.79 ± 26.89, 472.11 ± 62.7); sodium (199.66 ± 24.92, 94.0 ± 12.78); potassium (58.20 ± 7.36, 75.74 ± 6.62) and magnesium (16.056 ± 3.89, 21.125 ± 3.78) respectively. Iron, copper and zinc were found in lesser amount. DPPH (·) radical scavenging activity was close to 87 % in both the products and the ferric chloride reducing power assay was dose dependent in both the products. Both omega-3 and omega-6 fatty acids were found in ngari; whereas, only omega-3 fatty acids were observed in hentaak. Linoleic acid (11.68 %) and arachidonic acid (0.65 %) were the n-6 PUFA in ngari; while, in hentaak, it was only arachidonic acid (8.54 %). Apart from essential fatty acids, essential amino acids were also found in considerable quantity in both the products. Micrococcus sp. and Staphylococcus sp. were found to be the dominant bacterial genus in both the products; while Ngari also had lactic acid bacteria group. The nutritional properties afforded by these products justify their preference by the population.

Optimization of conditions for probiotic curd formulation by Enterococcus faecium MTCC 5695 with probiotic properties using response surface methodology

Enterococcus faecium MTCC 5695 possessing potential probiotic properties as well as enterocin producing ability was used as starter culture. Effect of time (12-24 h) and inoculum level (3-7 % v/v) on cell growth, bacteriocin production, antioxidant property, titrable acidity and pH of curd was studied by response surface methodology (RSM). The optimized conditions were 26.48 h and 2.17%v/v inoculum and the second order model validated. Co cultivation studies revealed that the formulated product had the ability to prevent growth of foodborne pathogens that affect keeping quality of the product during storage. The results indicated that application of E. faecium MTCC 5695 along with usage of optimized conditions attributed to the formation of highly consistent well set curd with bioactive and bioprotective properties. Formulated curd with potential probiotic attributes can be used as therapeutic agent for the treatment of foodborne diseases like Traveler's diarrhea and gastroenteritis which thereby help in improvement of bowel health.

Attenuated neuroprotective effect of riboflavin under UV-B irradiation via miR-203/c-Jun signaling pathway in vivo and in vitro

Background

Riboflavin (RF) or vitamin B2 is known to have neuroprotective effects. In the present study, we report the attenuation of the neuroprotective effects of RF under UV-B irradiation. Preconditioning of UV-B irradiated riboflavin (UV-B-RF) showed attenuated neuroprotective effects compared to that of RF in SH-SY5Y neuroblostoma cell line and primary cortical neurons in vitro and a rat model of cerebral ischemia in vivo.

Results

Results indicated that RF pretreatment significantly inhibited cell death and reduced LDH secretion compared to that of the UV-B-RF pretreatment in primary cortical neuron cultures subjected to oxygen glucose deprivation in vitro and cortical brain tissue subjected to ischemic injury in vivo. Further mechanistic studies using cortical neuron cultures revealed that RF treatment induced increased miR-203 expression which in turn inhibited c-Jun expression and increased neuronal cell survival. Functional assays clearly demonstrated that the UV-B-RF preconditioning failed to sustain the increased expression of miR-203 and the decreased levels of c-Jun, mediating the neuroprotective effects of RF. UV-B irradiation attenuated the neuroprotective effects of RF through modulation of the miR-203/c-Jun signaling pathway.

Conclusion

Thus, the ability of UV-B to serve as a modulator of this neuroprotective signaling pathway warrants further studies into its role as a regulator of other cytoprotective/neuroprotective signaling pathways.

Comparison of Lipase Production by Enterococcus faecium MTCC 5695 and Pediococcus acidilactici MTCC 11361 Using Fish Waste as Substrate: Optimization of Culture Conditions by Response Surface Methodology

A medium using fish waste as substrate was designed for production of lipase by Enterococcus faecium MTCC 5695 and Pediococcus acidilactici MTCC 11361. Medium components and culture conditions (fish waste protein hydrolysate (FWPH) concentration, fish waste oil (FWO) concentration, pH, temperature, and fermentation time) which affect lipase production were screened using factorial (5 factors ∗ 2 levels) design of which FWPH concentration, FWO concentration, and fermentation time showed significance (P < 0.05). The levels of these factors were optimized further by Box-Behnken design using response surface methodology (RSM). Optimized conditions were found to be 5% v/v FWO, 0.15 mg/mL FWPH and 24 h of fermentation time for MTCC 5695, and 4% v/v FWO, 0.15 mg/mL FWPH and 24 h of fermentation for MTCC 11361, which were further validated. Under optimized conditions, MTCC 5695 and MTCC 11361 showed 3.15- (543.63 to 1715 U/mL) and 2.3- (214.74 to 493 U/mL) fold increase in lipase production, respectively, as compared to unoptimized conditions.

Combined effect of enterocin and lipase from Enterococcus faecium NCIM5363 against food borne pathogens: mode of action studies

Food borne diseases have a major impact on public health whose epidemiology is rapidly changing. The whole cells of pathogens involved or their toxins/metabolites affect the human health apart from spoiling sensory properties of the food products finally affecting the food industry as well as consumer health. With pathogens developing mechanisms of antibiotic resistance, there has been an increased need to replace antibiotics as well as chemical additives with naturally occurring bacteriocins. Bacteriocins are known to act mainly against Gram-positive pathogens and with little or no effect towards Gram-negative enteric bacteria. In the present study, combination effect of lipase and bacteriocin produced by Enterococcus faecium NCIM5363, a highly lipolytic lactic acid bacterium against various food pathogens was assessed. The lipase in combination with enterocin exhibited a lethal effect against Gram-negative pathogens. Scanning electron microscopy studies carried out to ascertain the constitutive mode of action of lipase and enterocin revealed that the lipase degrades the cell wall of Gram-negative bacteria and creates a pore through which enterocin enters thereby resulting in cell death. The novelty of this work is the fact that this is the first report revealing the synergistic effect of lipase with enterocin against Gram-negative bacteria.

In vitro antioxidant and antibacterial properties of hydrolysed proteins of delimed tannery fleshings: comparison of acid hydrolysis and fermentation methods

Proteins in delimed tannery fleshings were fermentatively hydrolysed using Enterococcus faecium NCIM5335 and also hydrolysed using mild organic acids (formic acid and propionic acid). The liquor portion containing hydrolysed proteins was spray dried, in both the cases, to obtain a powder. The spray dried powder was evaluated for in vitro antioxidant activities with respect to scavenging different free radicals and antibacterial properties against nine different pathogens. Fermentation and acid hydrolysates scavenged 83 and 75.3% of 2,2-azino-bis-3-ethyl-benzthiazoline-6-sulphonic acid (ABTS) radicals, respectively, at a protein concentration of 0.25 mg. Further, fermentation hydrolysate showed higher 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity of 59% as compared to 56% scavenging by acid hydrolysate at a protein concentration of 5 mg. Acid hydrolysate exhibited lesser (82.3%) peroxy radical scavenging compared to hydrolysate from fermentation (88.2%) at a protein concentration of 10 mg. However, acid hydrolysate exhibited higher (89.2%) superoxide anion scavenging while its fermentation counterpart showed lower activity (85.4%) at 2.5 mg hydrolysate protein. Well as superoxide anion scavenging properties. All the in vitro antioxidant properties exhibited dose dependency. Fermentation hydrolysate exhibited maximum antagonistic activity against Salmonella typhi FB231, from among host of pathogens evaluated. Both the hydrolysates have potential to be ingredients in animal feeds and can help reduce oxidative stress in the animals.

Segmental fractures of the tibia treated by circular external fixation

We have carried out a retrospective review of 20 patients with segmental fractures of the tibia who had been treated by circular external fixation. We describe the heterogeneity of these fractures, their association with multiple injuries and the need for multilevel stability with the least compromise of the biology of the fracture segments. The assessment of outcome included union, complications, the measurement of the functional IOWA knee and ankle scores and the general health status (Short-form 36).

The mean time to union was 21.7 weeks (12.8 to 31), with no difference being observed between proximal and distal levels of fracture. Complications were encountered in four patients. Two had nonunion at the distal level, one a wire-related infection which required further surgery and another shortening of 15 mm with 8° of valgus which was clinically insignificant. The functional scores for the knee and ankle were good to excellent, but the physical component score of the short-form 36 was lower than the population norm. This may be explained by the presence of multiple injuries affecting the overall score.

Yield and chemical composition of fractions from fermented shrimp biowaste

Chemical composition of chitinous residue and fermentation liquor fractions, obtained from fermented shrimp biowaste, was evaluated in order to explore their potential for further utilization. Lyophilization of the liquor fraction obtained after fermentation resulted in a powder rich in both protein (30%) and carotenoids (217.18 +/- 2.89 microg/g). The yield of chitinous residue was 44% (w/w) whereas the yield of lyophilized powder was >25% (w/v). About 69% of total carotenoids were recovered by fermentation. Fermentation resulted in the removal of both protein as well as ash content from the shrimp biowaste, as indicated by approximately 92% deproteination and >76% demineralization, respectively. Post fermentation, the residue had a chitin content of >90%. The lyophilized liquor fraction had all the essential amino acids (except threonine) in quantities comparable to Food & Agriculture Organization/World Health Organization reference protein. The composition of fermentation liquor is indicative of its potential for application as an amino acid supplement in aquaculture feed formulations.

EVALUATION OF RECOVERABLE FUNCTIONAL LIPID COMPONENTS OF SEVERAL BROWN SEAWEEDS (PHAEOPHYTA) FROM JAPAN WITH SPECIAL REFERENCE TO FUCOXANTHIN AND FUCOSTEROL CONTENTS(1)

Fucoxanthin (Fx) and fucosterol (Fs) are characteristic lipid components of brown seaweeds that afford several health benefits to humans. This article describes the quantitative evaluation of lipids of 15 species of brown seaweeds with specific reference to Fx, Fs, and functional long-chain omega-6/omega-3 polyunsaturated fatty acids (PUFAs). In addition, fatty-acid composition of selected species was also accomplished in the study. Major omega-3 PUFAs in the brown seaweeds analyzed were α-linolenic acid (18:3n-3), octadecatetraenoic acid (18:4n-3), arachidonic acid (20:4n-6), and eicosapentaenoic acid (20:5n-3). Both Fx (mg · g(-1) dry weight [dwt]) and Fs (mg · g(-1) dwt) were determined to be relatively abundant in Sargassum horneri (Turner) C. Agardh (Fx, 3.7 ± 1.6; Fs, 13.4 ± 4.4) and Cystoseira hakodatensis (Yendo) Fensholt (Fx, 2.4 ± 0.9; Fs, 8.9 ± 2.0), as compared with other brown seaweed species. Studies related to seasonal variation in Fx, Fs, and total lipids of six brown algae [S. horneri, C. hakodatensis, Sargassum fusiforme (Harv.) Setch., Sargassum thunbergii (Mertens ex Roth) Kuntze, Analipus japonicus (Harv.) M. J. Wynne, and Melanosiphon intestinalis (D. A. Saunders) M. J. Wynne] indicated that these functional lipid components reached maximum during the period between January and March. The functional lipid components present in these seaweeds have the potential for application as nutraceuticals and novel functional ingredients after their recovery.

Surgical site infections following open reduction and internal fixation of ankle fractures

Background:

Ankle fracture fixation is one of the most commonly performed orthopaedic procedures. Although the results are generally favourable, complications are not uncommon, particularly in the case of surgical site infections. These have considerable impact on both postoperative morbidity and healthcare costs. Paradoxically, there is a paucity of literature studying patients who sustain them and therefore little is known about ways such occurrences can be minimised. The purpose of this study was to determine the infection rate following ankle fracture fixation and elucidate variables in their causation.

Methods:

We retrospectively reviewed 50 consecutive patients who underwent open reduction and internal fixation of an ankle fracture. The study group consisted of 26 females and 24 males with an average age of 43 (Range 16-82) years.

Results:

Problems with superficial infections were noted in seven patients and deep infections in five. Of the latter, four patients underwent further surgery including two that had their metal work removed. With use of the Fisher’s exact test we determined that only smoking and a bimalleolar fracture pattern were significant variables, having p-values of 0.02 and 0.04 respectively.

Conclusion:

We recommend that patients with ankle fractures who either have a history of smoking and/or bimalleolar injury be counselled about the potential risk of infection and its implications on their functional recovery. The ability to identify patients at risk of such problems highlights the need for caution during the perioperative period so that care strategies may be altered to facilitate recovery.

Treatment of high-energy tibial plateau fractures

Treatment of high-energy fractures of the tibial plateau requires an inordinate degree of surgical effort in order to avoid complications. Fracture reduction can be a challenge to experienced hands and the soft tissue conditions are intolerant of careless dissection. In general, it is an oversimplification to use one technique of stabilisation for such a heterogenous group (even within one classification tier). This article describes the specific attributes of Schatzker type 6 injuries (AO 41C) that enable decisionmaking algorithms to be generated and balances the merits for plate stabilisation and external fixation against injury characteristics. A detailed description is given for circular fixation in these injuries to assist those unfamiliar with the technique.