Mitochondrial complex I activity in microglia sustains neuroinflammation

Sustained smouldering, or low-grade activation, of myeloid cells is a common hallmark of several chronic neurological diseases, including multiple sclerosis1. Distinct metabolic and mitochondrial features guide the activation and the diverse functional states of myeloid cells2. However, how these metabolic features act to perpetuate inflammation of the central nervous system is unclear. Here, using a multiomics approach, we identify a molecular signature that sustains the activation of microglia through mitochondrial complex I activity driving reverse electron transport and the production of reactive oxygen species. Mechanistically, blocking complex I in pro-inflammatory microglia protects the central nervous system against neurotoxic damage and improves functional outcomes in an animal disease model in vivo. Complex I activity in microglia is a potential therapeutic target to foster neuroprotection in chronic inflammatory disorders of the central nervous system3.

Is the atmospheric boundary layer altitude or the strong thermal inversions that control the vertical extent of aerosols?

It is well known that the atmospheric boundary layer (ABL) plays a significant role in controlling the variability of atmospheric constituents such as aerosols and trace-gases. Hence, significant diurnal and seasonal variation in these will be observed as the ABL altitude does. However, on several occasions, high aerosol concentration in the lidar measurements is observed even above the ABL altitude. This raised a question that up to what extent ABL altitude acts as a capping layer for these pollutants? From the detailed analysis carried out using long-term (2010-2018) lidar observations and simultaneous radiosonde profiles obtained from Gadanki, India, we show that 'there exist thermal inversions (TI), which are stronger than the ABL inversions, that fully control the vertical extent'. The detailed characteristics of TI (inversion strength (IS) and inversion depth (ID)) are also obtained. The results revealed that aerosol concentrations below the TI altitude increases with IS (ID) up to 3-4 K (300-400 m) during winter whereas in pre-monsoon it increases up to 2-3 K (100-200 m). Thus, IS of up to 2-4 K is required to fully trap the aerosol concentrations and this TI coincide with the ABL inversions for 51.7% only, particularly during the winter and pre-monsoon seasons. This analysis is further extended to different geographical locations of India using the aerosol profiles obtained from CALIPSO and a network of 23 radiosonde stations. The observed results provided further evidence that the vertical distribution of aerosols is restricted to the maximum extent by the TI but not the ABL altitude. These observations lead us to propose a hypothesis that 'trapping of aerosols fully occurs up to particular IS and ID only and the ABL altitude is not the deciding factor most of the time for capping the aerosol vertical distribution'. These findings will greatly help in modeling the diffusion and transport of air pollutants in the lower troposphere.

P–686 <span>safety & efficacy of the combination therapy of inositols, antioxidants and vitamins in polycystic ovarian syndrome (PCOS): A multicentric, retrospective observational study (Trazer study)</span>

Study question

Does combinations therapy of insulin sensitizing agents, antioxidants and vitamins are safe and efficacious in PCOS patients.

Summary answer

Combination therapy of inositols, antioxidants and vitamins is safe and effective non-hormonal treatment option to manage PCOS.

What is known already

Monotherapy of insulin sensitising agents, antioxidants and vitamins is beneficial in the treatment of PCOS. Nutritional supplement containing inositols, N-acetylcysteine (NAC), lycopene, chromium picolinate, vitamin D3, biotin and folic acid treatment resulted in a significant improvement in menstrual cyclicity, acne and hirsutism. But there is no evidence pertaining to the hormonal parameters and ovarian morphology. Therefore, the present investigation was planned to evaluate the effects of combination therapy of inositols, antioxidants and vitamins on sign and symptoms, metabolic and hormonal parameters in women with PCOS.

Study design, size, duration

Multicentric, retrospective, observational cohort study was planned for the first time at thirty-six fertility clinics in different states of India from April 2019 to November 2020. Both lean and obese patients (16–39 years; n = 180) with confirmed diagnosis of PCOS as per the Rotterdam/ESHRE criteria were included in study.

Participants/materials, setting, methods

Patients were received a combination therapy of insulin sensitizers, antioxidants and vitamins in a marketed formulation (Trazer F ForteTM) twice daily as a tablet for 3 months and thereafter ovulation induction was done using letrozole (2.5–5 mg). Primary outcomes were improvements in signs of PCOS (menstrual cyclicity or ovulation restoration, acne and hirsutism), body weight, body mass index, waist circumference, ovarian cysts, pregnancy rate and hormonal balance. Secondary outcome was the evaluation of side effects.

Main results and the role of chance

Combination therapy of Trazer F ForteTM containing insulin sensitising agents (inositols, NAC and chromium), antioxidants (NAC and lycopene), and vitamins (vitamin D, biotin and folic acid) showed significant improvement in menstrual cyclicity by 54.3% and 88.2% in obese PCOS cases, and 48.7% and 79.5% in lean PCOS cases after 3- and 6-month of intervention respectively. Significant improvement was observed in acne, hirsutism and ovarian cysts post-intervention in both obese and lean PCOS women. After successful completion of the treatment, significant corrections were observed in metabolic (fasting glucose, fasting insulin and HOMA-IR) and hormonal profile (free testosterone, LH:FSH ratio, AMH and progesterone) in obese as well as lean PCOS cases. The clinical pregnancy rate was 16.2% and 34.1% in obese women, and 9.9% and 22.1% in lean cases after 3- and 6-month of intervention respectively.

Limitations, reasons for caution

Prevalent of PCOS is different in different population in India with diverse ethnic background. Hence, community-based intervention studies on larger population are needed to assess the efficacy and safety of such combinations amongst different age groups of women with PCOS.

Wider implications of the findings: Since, PCOS is a multifactorial disorder, combined use of inositols, antioxidants and vitamins can be used as a promising and clinically relevant non-hormonal treatment option for the management of PCOS.

Trial registration number

NA

Physiologic Specialization and Genetic Differentiation of Puccinia triticina Causing Leaf Rust of Wheat on the Indian Subcontinent During 2016 to 2019

Wheat is the second most cultivated cereal crop in the world and is an important crop in India. Leaf (brown) rust, caused by Puccinia triticina, was the most prevalent among the three rusts found in all the wheat-growing areas of India, Bhutan, and Nepal during 2016 to 2019. Leaf rust samples from wheat crops in these countries were pathotyped using the wheat differential genotypes and binomial Indian system of nomenclature. To facilitate international communication, each pathotype identified was also tested using the North American differentials. A total of 33 pathotypes were identified from 1,086 samples, including three new pathotypes: 61R47 (162-5 = KHTPM) and 93R49 (49 = NHKTN) from India and 93R57 (20-1 = NHKTN) from Nepal. Two pathotypes, 121R60-1 (77-9/52 = MHTKL) and 121R63-1 (77-5 = THTTM), accounted for 79.46% of the population. Virulence on Lr19 was identified in 0.27% of the samples from Nepal only. The proportion of pathotype 121R60-1 (77-9 = MHTKL) increased to 57.55% during these years. Virulence was not observed on Lr9, Lr24, Lr25, Lr28, Lr32, Lr39, Lr45, and Lr47 in the population of the Indian subcontinent. Eighteen polymorphic simple sequence repeat (SSR) primer pairs tested on the isolates amplified 48 alleles with an average of 2.66 alleles per primer pair. Based on SSR genotyping, these pathotypes could be grouped into two clades with another two subclades each. Many of the Lr genes present in Indian wheat germplasm (Lr1, Lr3a, Lr10, Lr11, Lr14a, Lr15, Lr16, Lr17, Lr20, Lr23, and Lr26) were ineffective for a majority of pathotypes. Most of these varieties possessed a high degree of leaf rust resistance. The field resistance of wheat varieties could be attributed to the interaction of genes, unknown resistance, or adult plant resistance.

Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study

OBJECTIVE

COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown.

MATERIALS AND METHODS

Online cross-sectional survey was conducted between April 2020 and May 2020.

RESULTS

114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing.

CONCLUSIONS

The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.

Phase-wise analysis of the COVID-19 lockdown impact on aerosol, radiation and trace gases and associated chemistry in a tropical rural environment

Phase-wise variations in different aerosol (BC, AOD, PM₁, PM_2.5 and PM₁₀), radiation (direct and diffused) and trace gases (NO, NO₂, CO, O₃, SO₂, CO₂ and CH₄) and their associated chemistry during the COVID-19 lockdown have been investigated over a tropical rural site Gadanki (13.5° N, 79.2° E), India. Unlike most of the other reported studies on COVID-19 lockdown, this study provides variations over a unique tropical rural environment located at a scientifically strategic location in the Southern Indian peninsula. Striking differences in the time series and diurnal variability have been observed in different phases of the lockdown. The levels of most species that are primarily emitted from anthropogenic activities reduced significantly during the lockdown which also impacted the levels and diurnal variability of secondary species like O₃. When compared with the same periods in 2019, short-lived trace gas species such as NO, NO₂, SO₂ which have direct anthropogenic emission influence have shown the reduction over 50%, whereas species like CO and O₃ which have direct as well as indirect impacts of anthropogenic emissions have shown reductions up to 10%. Long-lived species (CO₂ and CH₄) have shown negligible difference (<1%). BC and AOD have shown reductions over 20%. Particulate Matter (1, 2.5 and 10) reductions have been in the range of 40 to 50% when compared to the pre-lockdown period. The changes in shortwave downward radiation at the surface, diffuse component due to the scattering and diffuse fraction have been +2.2%, -4.1% and -2.4%, respectively, in comparison with 2019. In contrast with the studies over urban environments, air quality category over the rural environment remained same during the lockdown despite reduction in pollutants level. All the variations observed for different species and their associated chemistry provides an excellent demonstration of rural atmospheric chemistry and its intrinsic links with the precursor concentrations and dynamics.

Plant-based stearidonic acid as sustainable source of omega-3 fatty acid with functional outcomes on human health

Dietary omega-3 long chain polyunsaturated fatty acids (n-3 LC-PUFA) like eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) are known to be potent biological regulators with therapeutic and preventive effects on human health. Many global health organizations have recommended consuming marine based omega-3 sources for neonatal brain development and reducing the risk of various chronic diseases. However, due to concerns regarding the origin, sustainable supply and safety of the marine sources, alternative n-3 PUFA sources are being explored. Recently, plant-based omega-3 sources are gaining much importance because of their sustainable supply and dietary acceptance. α-linolenic acid (ALA, 18:3n-3) rich seed oils are the major omega-3 fatty acid source available for human consumption. But, efficiency of conversion of ALA to n-3 LC-PUFAs in humans is limited due to a rate-limiting step in the n-3 pathway catalyzed by Δ6-desaturase. Botanical stearidonic acid (SDA, 18:4n-3) rich oils are emerging as a sustainable omega-3 source with efficient conversion rate to n-3 LC-PUFA especially to EPA, as it bypasses the Δ6-desaturase rate limiting step. Several recent studies have identified the major plant sources of SDA and explored its potential health benefits and preventive roles in inflammation, cardiovascular disease (CVD) and cancer. This systematic review summarizes the current state of knowledge on the sources, nutraceutical roles, food-based applications and the future perspectives of botanical SDA.

Impact of trainee involvement in esophagectomy on clinical outcomes: a narrative systematic review of the literature

Changes in the structure of surgical training have affected trainees' operative experience. Performing an esophagectomy is being increasingly viewed as a complex technical skill attained after completion of the routine training pathway. This systematic review aimed to identify all studies analyzing the impact of trainee involvement in esophagectomy on clinical outcomes. A search of the major reference databases (Cochrane Library, MEDLINE, EMBASE) was performed with no time limits up to the date of the search (November 2017). Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and study quality assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Four studies that included a total of 42 trainees and 16 consultants were identified, which assessed trainee involvement in open esophagogastric resectional surgery. A total of 1109 patients underwent upper gastrointestinal procedures, of whom 904 patients underwent an esophagectomy. Preoperative characteristics, histology, neoadjuvant treatment, and overall length of hospital stay were comparable between groups. One study found higher rates of anastomotic leaks in procedures primarily performed by trainees as compared to consultants (P < 0.01)-this did not affect overall morbidity or survival; however, overall anastomotic leak rates from the published data were 10.4% (trainee) versus 6.3% (trainer) (P = 0.10). A meta-analysis could not be performed due to the heterogeneity of data. The median MINORS score for the included studies was 13 (range 11-15). This study demonstrates that training can be achieved with excellent results in high-volume centers. This has important implications on the consent process and training delivered, as patients wish to be aware of the risks involved with surgery and can be reassured that appropriately supervised trainee involvement will not adversely affect outcomes.

Trainee performance in radical gastrectomy and its effect on outcomes

Background

This study aimed to determine whether trainee involvement in D2 gastrectomies was associated with adverse outcomes.

Methods

Data from a prospectively created database of consecutive patients undergoing open D2 total (TG) or subtotal (STG) gastrectomy with curative intent between January 2009 and January 2014 were reviewed. Short‐ and long‐term clinical outcomes were compared in patients operated on by consultants and those treated by trainees under consultant supervision.

Results

A total of 272 D2 open gastrectomies were performed, 123 (45·2 per cent) by trainees. There was no significant difference between consultants and trainees in median duration of surgery (TG: 240 (range 102–505) versus 240 (170–375) min respectively, P = 0·452; STG: 225 (150–580) versus 212 (125–380) min, P = 0·192), number of resected nodes (TG: 30 (13–101) versus 30 (11–102), P = 0·681; STG: 26 (5–103) versus 25 (1–63), P = 0·171), length of hospital stay (TG: 15 (7–78) versus 15 (8–65) days, P = 0·981; STG: 10 (6–197) versus 14 (7–85) days, P = 0·242), overall morbidity (TG: 44 versus 49 per cent, P = 0·314; STG: 34 versus 25 per cent, P = 0·113) or mortality (TG: 4 versus 2 per cent; P = 0·293). No difference in predicted 5‐year overall survival was noted between the two cohorts (TG: 68 per cent for consultants versus 77 per cent for trainees, P = 0·254; STG: 70 versus 75 per cent respectively, P = 0·512). The trainee cohort had lower median blood loss for both TG (360 (range 90–1200) ml versus 600 (70–2350) ml for consultants; P = 0·042) and STG (235 (50–1000) versus 360 (50–3000) ml respectively; P = 0·053).

Conclusion

Clinical outcomes were not compromised by supervised trainee involvement in D2 open gastrectomy.

An empirical method for source apportionment of black carbon aerosol: Results from Aethalometer observations at five different locations in India

Black carbon (BC) aerosol emitted in incomplete combustion processes is known for causing warming in the climate system also poses serious health issues. Identification of the sources of BC is essential for the development of mitigation strategies to regulate their effects in changing climate. Among different observational and analytical techniques currently available, source apportionment methods based on optical measurements are relatively simple. For example, 'Aethalometer model' was developed based on Aethalometer observations. However, there are a few limitations with this model arising from assumption of wavelength and angstrom exponent pairs. We have developed an empirical method which also relies on Aethalometer observations named as 'Two alpha method' which assumes angstrom exponent from fossil fuel as 1 and estimates bio-mass fraction and angstrom exponent for bio-mass burning. This method has been applied to Aethalometer observations from five different locations (rural, semi-urban and urban) over Indian sub-continent to quantify sources of BC. Fossil fuel is found to be the major source of BC (∼70%) irrespective of the location. Collocated measurements of Carbon Monoxide (CO) over rural site correlated well with derived bio-mass fraction. Results from this study demonstrated the capabilities of empirical method and shall provide spatio-temporal variability in sources of BC if applied to more locations.

Unravelling a stearidonic acid-rich triacylglycerol biosynthetic pathway in the developing seeds of Buglossoides arvensis: A transcriptomic landscape

Buglossoides arvensis is an emerging oilseed crop that is rich in stearidonic acid (SDA) and has several potential applications in human health and nutrition. The molecular basis of SDA biosynthesis in this plant remains unknown due to lack of genomic information. To unravel key genes involved in SDA-rich triacylglycerol (TAG) biosynthesis, we performed transcriptome sequencing of pooled mRNA from five different developmental stages of B. arvensis seeds using Illumina NextSeq platform. De novo transcriptome assembly generated 102,888 clustered transcripts from 39.83 million high-quality reads. Of these, 62.1% and 55.54% of transcripts were functionally annotated using Uniprot-Viridiplantae and KOG databases, respectively. A total of 10,021 SSR-containing sequences were identified using the MISA tool. Deep mining of transcriptome assembly using in silico tools led to the identification of genes involved in fatty acid and TAG biosynthesis. Expression profiling of 17 key transcripts involved in fatty acid desaturation and TAG biosynthesis showed expression patterns specific to the development stage that positively correlated with polyunsaturated fatty acid accumulation in the developing seeds. This first comprehensive transcriptome analysis provides the basis for future research on understanding molecular mechanisms of SDA-rich TAG accumulation in B. arvensis and aids in biotechnological production of SDA in other oilseed crops.

Dissection of genomic features and variations of three pathotypes of Puccinia striiformis through whole genome sequencing

Stripe rust of wheat, caused by Puccinia striiformis f. sp. tritici, is one of the important diseases of wheat. We used NGS technologies to generate a draft genome sequence of two highly virulent (46S 119 and 31) and a least virulent (K) pathotypes of P. striiformis from the Indian subcontinent. We generated ~24,000-32,000 sequence contigs (N50;7.4-9.2 kb), which accounted for ~86X-105X sequence depth coverage with an estimated genome size of these pathotypes ranging from 66.2-70.2 Mb. A genome-wide analysis revealed that pathotype 46S 119 might be highly evolved among the three pathotypes in terms of year of detection and prevalence. SNP analysis revealed that ~47% of the gene sets are affected by nonsynonymous mutations. The extracellular secreted (ES) proteins presumably are well conserved among the three pathotypes, and perhaps purifying selection has an important role in differentiating pathotype 46S 119 from pathotypes K and 31. In the present study, we decoded the genomes of three pathotypes, with 81% of the total annotated genes being successfully assigned functional roles. Besides the identification of secretory genes, genes essential for pathogen-host interactions shall prove this study as a huge genomic resource for the management of this disease using host resistance.

Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases

A comprehensive germplasm evaluation study of wheat accessions conserved in the Indian National Genebank was conducted to identify sources of rust and spot blotch resistance. Genebank accessions comprising three species of wheat-Triticum aestivum, T. durum and T. dicoccum were screened sequentially at multiple disease hotspots, during the 2011-14 crop seasons, carrying only resistant accessions to the next step of evaluation. Wheat accessions which were found to be resistant in the field were then assayed for seedling resistance and profiled using molecular markers. In the primary evaluation, 19,460 accessions were screened at Wellington (Tamil Nadu), a hotspot for wheat rusts. We identified 4925 accessions to be resistant and these were further evaluated at Gurdaspur (Punjab), a hotspot for stripe rust and at Cooch Behar (West Bengal), a hotspot for spot blotch. The second round evaluation identified 498 accessions potentially resistant to multiple rusts and 868 accessions potentially resistant to spot blotch. Evaluation of rust resistant accessions for seedling resistance against seven virulent pathotypes of three rusts under artificial epiphytotic conditions identified 137 accessions potentially resistant to multiple rusts. Molecular analysis to identify different combinations of genetic loci imparting resistance to leaf rust, stem rust, stripe rust and spot blotch using linked molecular markers, identified 45 wheat accessions containing known resistance genes against all three rusts as well as a QTL for spot blotch resistance. The resistant germplasm accessions, particularly against stripe rust, identified in this study can be excellent potential candidates to be employed for breeding resistance into the background of high yielding wheat cultivars through conventional or molecular breeding approaches, and are expected to contribute toward food security at national and global levels.

Draft Genome of the Wheat Rust Pathogen (Puccinia triticina) Unravels Genome-Wide Structural Variations during Evolution

Leaf rust is one of the most important diseases of wheat and is caused by Puccinia triticina, a highly variable rust pathogen prevalent worldwide. Decoding the genome of this pathogen will help in unraveling the molecular basis of its evolution and in the identification of genes responsible for its various biological functions. We generated high quality draft genome sequences (approximately 100- 106 Mb) of two races of P. triticina; the variable and virulent Race77 and the old, avirulent Race106. The genomes of races 77 and 106 had 33X and 27X coverage, respectively. We predicted 27678 and 26384 genes, with average lengths of 1,129 and 1,086 bases in races 77 and 106, respectively and found that the genomes consisted of 37.49% and 39.99% repetitive sequences. Genome wide comparative analysis revealed that Race77 differs substantially from Race106 with regard to segmental duplication (SD), repeat element, and SNP/InDel characteristics. Comparative analyses showed that Race 77 is a recent, highly variable and adapted Race compared with Race106. Further sequence analyses of 13 additional pathotypes of Race77 clearly differentiated the recent, active and virulent, from the older pathotypes. Average densities of 2.4 SNPs and 0.32 InDels per kb were obtained for all P. triticina pathotypes. Secretome analysis demonstrated that Race77 has more virulence factors than Race 106, which may be responsible for the greater degree of adaptation of this pathogen. We also found that genes under greater selection pressure were conserved in the genomes of both races, and may affect functions crucial for the higher levels of virulence factors in Race77. This study provides insights into the genome structure, genome organization, molecular basis of variation, and pathogenicity of P. triticina The genome sequence data generated in this study have been submitted to public domain databases and will be an important resource for comparative genomics studies of the more than 4000 existing Puccinia species.

In vitro propagation of Rudraksha (Elaeocarpus sphaericus (Gaertn.) K. Schum): a biotechnological approach for conservation

The species Elaeocarpus sphaericus (Rudraksha) is a religious, medicinally important threatened tree of India. An efficient micropropagation protocol has been developed from nodal explants of this plant species collected from north-east India for large scale production of planting material at favourable sites within the country. Best shoot initiation occurred in MS medium supplemented with 2.2μM BA+2.2μM Kn in combination. Addition of Casein Hydrolysate (CH) (100mg/L) increased the shoot number. Microshoots excised and subcultured in 2.0μM BA further enhanced growth and multiplication. The shoot cultures were maintained in this concentration for 2years with subculturing at 6weeks interval. MS medium containing 5.0μM NAA was most effective for rooting. Successfully acclimatized plants (80%) showed normal growth under suitable habitat conditions.

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

SETTINGS

Three tuberculosis (TB) treatment centres under the Fiji National Tuberculosis Programme.

OBJECTIVES

To determine the prevalence of diabetes mellitus (DM) among TB patients for the period 2010-2012, and to evaluate sputum smear conversion and anti-tuberculosis treatment outcomes, comparing patients with and without DM.

DESIGN

A retrospective descriptive study using routinely collected data from the TB register and in-patient folders.

RESULTS

Of 577 TB patients identified, information on DM was available for 567 (98%), of whom 68 (12%) had DM. Smear status at 2 months was available for 254 (82%) patients with sputum smear-positive pulmonary TB. The sputum smear conversion rate (from positive to negative) was equivalent in TB patients with and without DM (78% vs. 80%, P = 0.66). Anti-tuberculosis treatment outcome information was available for 462 patients; the difference in outcome comparing successfully treated patients with those unsuccessfully treated was not statistically significant (91% in TB patients with DM vs. 84% in TB patients without DM, P = 0.06).

CONCLUSION

DM is common among TB patients in Fiji. Sputum smear conversion rates were not different in TB patients with and without DM; no difference in treatment success between the two groups was observed.

Incidentalomas during imaging for primary hyperparathyroidism--incidence and clinical outcomes

Background

Imaging for pre-operative localisation of parathyroid glands in primary hyperparathyroidism is now routine. This has led to the detection of incidental lesions (incidentalomas) in other organs, the nature of which is not well characterised.

The aim of this study was to determine the incidence, characteristics and outcomes in patients who had incidental findings on parathyroid imaging.

Methods

Records of patients who underwent imaging for primary hyperparathyroidism over 2 years were reviewed to identify incidental lesions detected on parathyroid imaging. Patients with persistent or renal hyperparathyroidism were excluded. Details on the management of detected incidentalomas were obtained from patient records.

Results

Incidentalomas were identified in 17 of 170 patients (10 %) undergoing parathyroid imaging. Incidentalomas included thyroid (n = 11), breast (n = 3), lateral compartment of the neck (n = 1), lung (n = 1) and clavicle (n = 1). However, no disease of clinical significance needing treatment was detected on further investigation.

Conclusions

Although a significant proportion of patients undergoing parathyroid imaging had incidental lesions detected, these seem to be of little clinical significance. The morbidity and cost of further interventions on these incidentalomas need to be weighed against the benefits of routine imaging in improving outcomes of first-time surgery in patients with primary hyperparathyroidism.

Zwitterionic Amphiphilic Homopolymer Assemblies

Zwitterionic amphiphilic homopolymers can be conveniently prepared in one-pot using activated ester-based polymer precursors. We show that these zwitterionic polymers can (i) spontaneously self-assemble to form micelle-like and inverse micelle-like assemblies depending on the solvent environment; (ii) act as hydrophilic and hydrophobic nanocontainers in apolar and polar solvents respectively; (iii) undergo pH-responsive surface charge and size variations; (iv) exhibit least cytotoxicity compared to structurally analogous amphiphilic homopolymers.

Transformations of the macromolecular landscape at mitochondria during DNA-damage-induced apoptotic cell death

Apoptosis is a dynamic process regulated by mitochondrion critical for cellular respiration and survival. Execution of apoptosis is mediated by multiple protein signaling events at mitochondria. Initiation and progression of apoptosis require numerous apoptogenic factors that are either released from or sequestered in mitochondria, which may transform the biomolecular makeup of the organelle. In this communication, using Raman microspectroscopy, we demonstrate that transformation in biomolecular composition of mitochondrion may be used as apoptosis marker in an individual cell. For the first time, we show that significant changes occur in the concentrations of RNA, DNA, protein, and lipid constituents of mitochondria during apoptosis. The structural analysis of proteins on mitochondria demonstrated a decrease in α-helix secondary structure content, and an increase in the levels of random coils and β-sheets on mitochondria. This may represent an additional hallmark of apoptosis. Strikingly, we observed nearly identical changes in macromolecular content of mitochondria both in the presence and absence of a key proapoptotic protein, Bax (Bcl-2-associated X protein). Increased DNA level in mitochondria corresponded with higher mitochondrial DNA (mtDNA), cellular reactive oxygen species (ROS), and mitochondrial ROS production. Upregulation of polymerase-γ (POLG), mitochondrial helicase Twinkle, and mitochondrial transcription factor A (Tfam) in response to DNA damage correlated with increased mtDNA and RNA synthesis. Elevated activity of oxidative phosphorylation complexes supports functional mitochondrial respiration during apoptosis. Thus, we define previously unknown dynamic correlation of macromolecular structure of mitochondria and apoptosis progression in the presence and absence of Bax protein. These findings open up a new approach for monitoring physiological status of cells by non invasive single-cell method.

Phenology of plants in relation to ambient environment in a subalpine forest of Uttarakhand, western Himalaya

Observations on phenology of some representative trees, shrubs, under-shrubs and herbs in a subalpine forest of Uttarakhand, western Himalaya were recorded. With the commencement of favorable growth season in April, occurrence of leaf fall was indicatory growth phenomenon in Quercus semecarpifolia, Q. floribunda and Abies spectabilis. However, active vegetative growth in herbaceous species starts onward April and fruit maturation and seed dehiscence are completed from mid of September to October. In general, vegetative growth and reproductive stages in majority of the studied species seems to be dependent on adequate moisture content and also flowering and fruiting in subalpine plants correlate ambient temperature.

Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit

BACKGROUND

Post-thyroidectomy hypocalcaemia is a common complication with significant short and long term morbidity. The aim of this study was to determine the incidence and predictors of post-thyroidectomy hypocalcaemia (as defined by a corrected calcium <2.1 mmol/l) in a tertiary endocrine surgical unit.

METHODS

A total of 238 consecutive patients who underwent completion or bilateral thyroid surgery between 2008 and 2011 were included in this retrospective study. Clinical and biochemical data were obtained from electronic and hard copy medical records.

RESULTS

The incidence of post-thyroidectomy hypocalcaemia on first postoperative day (POD1) was 29.0%. There was variation in the incidence of hypocalcaemia depending on the timing of measurement on the first postoperative day. At six months following surgery, 5.5% of patients were on calcium and/or vitamin D supplementation. Factors associated with post-thyroidectomy hypocalcaemia were lower preoperative corrected calcium (p=0.005) and parathyroid gland (PTG) auto-transplant (p=0.001). Other clinical factors such as central lymph node dissection, inadvertent PTG excision, ethnicity, preoperative diagnosis and Lugol's iodine were not associated with post-thyroidectomy hypocalcaemia.

CONCLUSION

The incidence of post-thyroidectomy hypocalcaemia was underestimated by 6% when only POD1 measurements were considered. The timing of measurement on POD1 has an impact on the incidence of post-thyroidectomy hypocalcaemia. Auto-transplantation and lower preoperative calcium were associated with post-thyroidectomy hypocalcaemia.

Spatial distribution and regeneration of Quercus semecarpifolia and Quercus floribunda in a subalpine forest of western Himalaya, India

Studies were conducted on population status and regeneration of Quercus semecarpifolia and Quercus floribunda in a subalpine forest of western Himalaya. Saplings of Q. semecarpifolia belonging to the 51-100 cm size class and those of Q. floribunda belonging to the 101-150 cm size class were well represented in studied subalpine forests. Comparable seedling emergence and establishment of both species, either in the habitat dominated by same or different species seems to be an adaptational strategy of these species in subalpine forests. Seedling to tree ratio for Q. semecarpifolia was higher in the stand dominated by Q. floribunda, while comparable pattern was observed for Q. floribunda in the stand dominated by Q. semecarpifolia. Establishment of higher percent of seedlings of one species in the habitats dominated by another species of Quercus appears to indicate an oligarchic nature of oaks in subalpine forests. This study describes regeneration strategies, and spatial distribution of these species in a subalpine forest of Uttarakhand.

Early results of the Acclaim total elbow replacement in patients with primary osteoarthritis

This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged ≥ 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4).

Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved.

This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged ≥ 65 years with primary osteoarthritis of the elbow.

Phase II study of vincristine sulfate liposomes injection in patients with metastatic uveal melanoma

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Background: Preclinical and clinical studies showed that liposomal encapsulation of vincristine sulfate (VCR) results in increased drug circulation time and accumulation of VCR at the tumor site. Marqibo has been administered safely at 2.25 mg/m2, a dose exceeding that typically employed for VCR ( dose capped at 2 mg), with tolerable clinical toxicities consistent with VCR. Of the 27 previously treated patients with metastatic melanoma in the Marqibo pharmacokinetic studies, 3 patients had a tumor response, including one patient with uveal melanoma metastatic to the lung that experienced a complete response. Methods: Patients with metastatic uveal melanoma with no more than one prior systemic therapy were enrolled. Patients with controlled brain metastases were allowed. Marqibo (2.25 mg/m2 by 1-hour intravenous infusion, no dose capping) was administered every 14 days until tumor progression. Responses were assessed every 6 weeks using the Response Evaluation Criteria in Solid Tumors (RECIST). Toxicity was assessed at least as frequently as before each dose. Results: Preliminary data is available for 22 enrolled patients (73% female). Median age was 65 years (range 38–79), 23% were previously treated with systemic chemotherapy, 86% had liver metastasis and 96% had M1c disease. Baseline serum LDH levels were elevated in 73% and were more than 2 × ULN in 37% of the patients. Twenty-one patients were evaluable for response; one patient discontinued the treatment after a single dose of therapy for toxicity without tumor progression. No patients died of drug toxicity while on the study. Twelve patients (57%) had stable disease. Estimated median survival is 6.4 months. Fourteen patients are alive, 2 for more than 12 months. Treatment related side effects were mostly grade 1 or 2; peripheral neuropathy was the only grade 3 toxicity, seen in 18% of the patients. The hematologic toxicities were minor; no neutropenia or thrombocytopenia was seen. Conclusions: Marqibo is well tolerated as single agent therapy in patients with advanced stage IV uveal melanoma. Its impact on the progression-free and overall survival of these critically ill patients will be presented.

No significant financial relationships to disclose.

Association of ADH2 and ALDH2 Gene Polymorphisms with Alcohol Dependence: A Pilot Study from India

Background:

Functional polymorphism in ADH2 and ALDH2 genes are considered most important among several genetic determinants of alcohol dependence (AD), a complex disorder.

Aims:

There is no report on the widely studied Arg47His and Glu487Lys polymorphisms from Indian alcohol dependent population. We, for the first time, report allelic and genotypic frequencies of Arg47His and Glu487Lys SNPs in North Indian alcohol dependent subjects.

Methods:

A total of n=174 alcohol dependent males, recruited using DSM IV criteria, were genotyped using PCR-RFLP method.

Results:

Data obtained from genetic analysis was correlated with clinical parameters using T test or Mann Whitney's U test. ADH2 gene polymorphism was found to be largely monomorphic with minor allele frequency (ADH2*2) < 0.001. For the ALDH2 Glu487Lys SNP, genotypic frequencies were 0.73 (2*1/*1), 0.16 (2*1/*2) and 0.11 (2*2/*2), with minor allele frequency (ALDH2*2) = 0.19. Various clinical parameters were found to be significantly associated with ALDH2 polymorphism.

Conclusions:

The highlight of the study is a clear association of ALDH2 gene polymorphism with delayed onset and shorter duration of alcohol consumption among ALDH2*2/*2 individuals. Our finding bolsters the protection conferring property of the ALDH2*2 allele of Glu487Lys SNP of ALDH2 gene.