Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients

INTRODUCTION

Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups.

MATERIALS AND METHODS

We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT.

RESULTS

Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01).

CONCLUSION

Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate.

LEVEL OF EVIDENCE

IV.

Hypoxia Informed RBE-Weighted Beam Orientation Optimization for Intensity Modulated Proton Therapy Using [18F]-FMISO-PET Estimation of pO2

PURPOSE/OBJECTIVE(S)

Variable relative biological effectiveness (RBE) models have previously informed proton therapy dose optimization algorithms, but few models have incorporated hypoxia's increase on radioresistance. Here, we obtain voxel-based estimation of partial oxygen pressure to weigh RBE values in a single biologically informed beam orientation optimization (BOO) algorithm.

MATERIALS/METHODS

Four brain cancer patients with [18F]-FMISO-PET/CT images were selected from an HCP database. Oxygen values were derived from tracer uptake using a non-linear least squares curve fitting. RBE dose was then weighted using oxygen enhancement ratios (OER) for each structure and substituted into the dose fidelity term of our BOO algorithm. The nonlinear optimization problem was solved using a split-Bregman approach, with FISTA as the solver. This method (HypRBE) was compared dose fidelity terms using the Rorvik RBE model (RegRBE), without OER. Tumor homogeneity index (HI), Dmax, and D95% were evaluated along with worst-case statistics after normalization to normal tissue isotoxicity.

RESULTS

Compared to RegRBE, HypRBE increased tumor [HI, Dmax, D95%] on average by [0.5%, 2.0%, 2.5%] and improved worst-case tumor [HI, Dmax, D95%] by [5.3%, 16.2%, 9.6%]. HypRBE shows an increase in therapeutic ratio, and is notably robust against uncertainty scenarios.

CONCLUSION

We have developed an optimization algorithm whose dose fidelity term is weighted by hypoxia informed RBE values. We have shown that HypRBE selects beams that are better suited to protect low RBE, well-oxygenated normal tissue while maintaining high dose to high RBE, hypoxic tumor cells.

Impact of COVID-19 on Guillain-Barre Syndrome in India: A Multicenter Ambispective Cohort Study

Introduction/Aims

Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain-Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year.

Methods

A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143).

Results

Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases).

Discussion

Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Reconstruction of Massive Segmental Distal Femoral Metaphyseal Bone Defects After Open Injury: A Study of 20 Patients Managed with Intercalary Gamma-Irradiated Structural Allografts and Autologous Cancellous Grafts

BACKGROUND

Our aim was to examine the outcome of gamma-irradiated intercalary structural allografts combined with autologous cancellous grafts in treating large metaphyseal bone defects of the distal femur following open injuries.

METHODS

We prospectively included 20 consecutive patients with large metaphyseal bone defects of >4 cm located in the region of the distal femur following open injuries treated between 2010 and 2018, with a mean follow-up of 2 years (range, 2 to 10 years). Of these patients,18 were men and 2 were women. The mean age was 39 years (range, 22 to 72 years). The mean length of the bone defects was 10.1 cm (range, 5.5 to 14.5 cm), and all were in the metaphysis of the distal femur. The surgical technique included initial early debridement and external fixation followed by reconstruction of the bone defect using structural allograft combined with autologous cancellous bone graft harvested from the iliac crest and locking plate fixation. Definitive fixation was performed at an average period of 22.5 days (range, 3 to 84 days) after injury. Osseous union, rate of infection, complications, need for secondary procedures, and functional outcome using the Lower Extremity Functional Scale (LEFS) at the final follow-up were assessed.

RESULTS

After excluding 1 patient who was lost to follow-up, 19 patients with complete follow-up were available for analysis. Of those, 13 patients (68%) achieved complete union at both ends of the allograft with host bone without any further intervention. Three patients (16%) developed aseptic nonunion of the proximal end of the allograft requiring 1 additional procedure each to achieve union. Four patients (21%) developed a deep surgical site infection. Of those, 1 elderly patient required above-the-knee amputation following uncontrolled diabetes and infection. A second patient required 2 additional procedures, and a third patient needed 4 additional procedures to achieve union. The fourth patient developed infection after achieving union, and the infection subsided after debridement and implant removal. The mean LEFS score for all 19 patients was 55 (range, 41 to 75).

CONCLUSIONS

Use of allograft was a reasonable single-stage alternative solution for massive distal femoral bone defects, which united without additional surgery in two-thirds of the patients and without limb-length discrepancy.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of oral mucosal biopsies done using scalpel and diode lasers: A vivo study

Background:

As dental lasers are becoming more popular in the branch of oral medicine for its various advantages and applications, this study was carried out to evaluate better mode of obtaining oral biopsies which is a common and inevitable procedure for providing final diagnosis in majority of conditions.

Methodology:

In this study, a total of 60 patients who required biopsy for final diagnosis of oral mucosal lesions as part of diagnosis in department of Oral Medicine were selected, out of which 30 were subjected to scalpel biopsies and 30 patients were subjected to diode laser biopsies. A 980 nm Zolar plus diode laser was used for the study. Out of 30 patients who were subjected to laser biopsies, 3W continuous mode settings were used for 15 patients and 3W pulsed mode was used for 15 patients. The specimens were sent to Department of Oral Pathology for histopathological evaluation to provide the final diagnosis. The time taken for each patient, volume of local anesthesia, during operative, postoperative pain scale, and co-relation of provisional and final diagnosis was noted for comparison purpose and the pathologist comments, peripheral tissue damage and artifact's for each slide were noted.

Results:

The study results showed the postoperative pain was comparatively less in diodlaser than scalpel, the lasers were patient friendly as the heammorage was negligible when compared to scalpel and suturing was not required. The pulsed mode in diode laser was advantageous over continuous mode when amount of thermal damage and postoperative pain score was compared.

Conclusion:

The results showed that oral biopsies can be made better using diode lasers, by having thorough knowledge on the device.

Disseminated pulmonary mucormycosis with concomitant tuberculosis infection in a diabetic patient

Patients with diabetes are often susceptible to various opportunistic infections such as tuberculosis and mucormycosis. However, the occurrence of both these infections simultaneously is rare. We present one such case of pulmonary tuberculosis with disseminated pulmonary mucormycosis in a patient with diabetes, which was successfully managed.

H-FABP: A beacon of hope for prediabetic heart disease

Background:

Prediabetes is increasingly being studied in the context of its association with cardiovascular disease (CVD). Besides raised HbA1c and sugar levels, the major underlying defect seems to be insulin resistance (IR). Subclinical atherosclerosis, measured by high sensitivity C reactive protein (hsCRP) and carotid artery intima media thickness (CIMT) underlies the pathogenesis of CVD in prediabetes. Heart-type fatty acid binding protein (H-FABP), a novel cardiac biomarker also might have a role in predictin prediabetic heart disease.

Aims:

The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with the atherosclerotic markers, hsCRP and CIMT.

Setting and Design:

50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum F & PPBS, (HbA1c), fasting insulin levels were measured in cases and controls. Serum H-FABP was measured in both cases and controls. All cases and controls were subjected to bilateral CIMT measurements and Serum hsCRP levels. The values were compared between both the groups and subjected to appropriate statistical analysis.

Statistical Analysis Used:

Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected then non parametric test was used. Quantitative variables were compared using Independent t test/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-Square test/Fisher's Exact test. Spearman rank correlation coefficient was used to find out the correlation of various parameters with each other. Univariate linear regression was used to find out the cause and effect relationship between various parameters. A p <0.05 was considered statistically significant. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0.

Results:

The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). Mean CIMT was found to be higher in prediabetics (0.59 ± 0.11 mm ) compared to controls (0.45 ± 0.07mm) (p<0.0001). Serum hsCRP levels were also statistically higher in prediabetics (5.75± 4.16 mg/l) then that of controls (1.86± 1.67 mg/l) (p <0.0001). The correlations of the two variables, hsCRP and CIMT with H-FABP were both strongly positive (r = 0.687) & (r = 0.779) respectively [both cases (p < 0.0001)].

Conclusion:

The novel cardiac biomarker H-FAPB might be a good predictor of cardiovascular risks in prediabetics.

Evaluation of airflow characteristics before and after septoplasty in unilateral cleft patients with a deviated nasal septum: a computational fluid dynamics study

The aim of this study was to evaluate changes in airflow characteristics before and after septoplasty in unilateral cleft lip and palate (UCLP) patients using computational fluid dynamics (CFD) models. The study was designed as a prospective cohort study involving pre- and postoperative computed tomography data from 12 UCLP patients with a deviated nasal septum who underwent septoplasty. CFD analysis of nasal airflow was conducted to study changes in velocity, pressure, volume, nasal resistance, and wall shear stress of the nasal domain before and after surgery. The study results demonstrated a statistically significant difference in pressure drop after septoplasty: median 116.10Pa (interquartile range (IQR) 749.02Pa) preoperative compared with 43.39Pa (IQR 349.01Pa) postoperative (P= 0.004). Maximum wall shear stress was found to be approximately three times lower after septoplasty: median 6.15 Pa (IQR 1908.62 Pa) preoperative versus median 2.51 Pa (IQR 540.06 Pa) postoperative (P=0.002). Changes in nasal resistance were also found to be statistically significant: median 460.59 Pa·s/l (IQR 1946.99 Pa·s/l) preoperative versus median 166.61 Pa·s/l (IQR 694.08 Pa·s/l) postoperative (P=0.04). These values demonstrate significant changes in flow dynamics after surgery indicative of a more uniform airflow pattern and stabilization of the nasal mucosa.

Serum Heart Type Fatty Acid Binding Protein Levels in Prediabetes-An Invaluable Cardiovascular Biomarker

BACKGROUND

The pathophysiological effects of diabetes on the heart and the rest of the cardiovascular system begins much earlier in its precedent stage of prediabetes and one major underlying defect is insulin resistance. Heart-type fatty acid binding protein (H-FABP) is a recently studied molecule inherent to the cardiac myocytes found to rise in both coronary and non-coronary heart diseases. The utility of the molecule in prediabetes and its relationship with insulin resistance is being studied.

OBJECTIVE

The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with Homeostatic model assessment - insulin resistance (HOMA-IR).

METHODS

50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum fasting and postprandial blood sugars, glycosylated hemoglobin (HbA1c), fasting insulin levels were measured in cases and controls. HOMA-IR index was calculated from fasting glucose and insulin values. Serum H-FABP was measured in both cases and controls using Immunoturbidimetric method with anti- H-FABP coated latex reagent kits. The values were compared between both the groups.

RESULTS

The mean serum fasting insulin level among cases was 12.22mIU/ml and that of the control group was 5.37mIU/ml (p value <0.0001). HOMA- IR mean values were 3.31 ± 1.56 and 1.16 ± 0.44 in cases and controls respectively (p- <0.001). The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). The correlation between the two variables, HOMA-IR and H-FABP was also found to be strongly positive (r=0.675). Linear regression analysis showed that for 1 unit increase in HOMA-IR, H-FABP increased by 1.095 and for 1 unit increase in Fasting insulin, H-FABP increased by 0.038.

CONCLUSION

Prediabetics have a higher risk of cardiovascular morbidity when compared to normoglycemics with insulin resistance being the single most important contributor. Serum H-FABP levels are elevated in prediabetes representing a marker of subclinical cardiovascular disease (CVD).

Molecular structure interpretation, spectroscopic (FT-IR, FT-Raman), electronic solvation (UV-Vis, HOMO-LUMO and NLO) properties and biological evaluation of (2E)-3-(biphenyl-4-yl)-1-(4-bromophenyl)prop-2-en-1-one: Experimental and computational modeling approach

In this present work, a molecule (2E)-3-(biphenyl-4-yl)-1-(4-bromophenyl) prop-2-en-1-one (3BPO) was synthesized and the structure has been characterized by using spectroscopic techniques. The most stable conformational structure of title compound has been calculated using HF-6-31G(d,p) basis set. DFT method were used through B3LYP/6-311++G(d,p) basis set to optimize the structure of the title compound. The geometrical parameters, vibrational wavenumbers and electronic properties have also been performed. The electronic properties for HOMO-LUMO, UV-Vis and MEP maps were contemplated by IEFPCM model with various solvation impacts which depends on TD-DFT ((M062X for UV and B3LYP for HOMO-LUMO, MEP)/6-311++G(d,p)) strategies. The NLO activity of title compound has been examined by solvation DFT/B3LYP technique with 6-311++G(d,p) premise set. Mean while, lone pair of donor-acceptor interactions and H bond donor/acceptor surface has been obtained by which a charge transfer mechanism can be explained. Molecular docking has been explored to comprehend the coupling transportation of the examined ligand with human folate receptor alpha in complex with folic corrosive protein (4LRH).

Spectroscopic, chemical reactivity, molecular docking investigation and QSAR analyses of (2E)‑1‑(3‑bromo‑2‑thienyl)‑3‑(2,5‑dimethoxyphenyl)prop‑2‑en‑1‑one

Chalcone derivative of (2E)‑1‑(3‑bromo‑2‑thienyl)‑3‑(2,5‑dimethoxyphenyl) prop‑2‑en‑1‑one (BTD) molecule has been deliberated for spectroscopic properties experimentally and theoretically. The title compound was characterized by FT-IR, FT-Raman and UV-Vis analyses. The structural activity and vibrational wavenumbers were calculated by a DFT method. The Natural Bond Orbital (NBO) analysis which reveals the hyper conjugative interactions of the present molecule has been performed. Meanwhile, the Chemical reactivity of Condensed Fukui function, MEP and HOMO-LUMO energies of the molecule were also analyzed. Furthermore, Multiwfn 3.3.9 program has been utilized to study MEP and the electron excitation analysis. Docking studies which play a significant role in determining the endothelial nitric oxide synthase inhibition activity of the present compound have also been carried out to predict the binding energy and inhibition constant of the title compound. In addition, drug resemblance parameters have also considered by QSAR study in which the comparison of chemical parameters of chalcone drugs of title molecule has been done.

Neuropathy in Prediabetics: Is Oxidative Stress to Contribute?

OBJECTIVE

To assess the association of oxidative stress and serum vitamin D levels in sensory neuropathy in prediabetes.

METHODS

Serum and urine levels of 8-OHdG (a marker of oxidative stress) and serum levels of vitamin D were compared in prediabetic patient having sensory neuropathy to those who did not have sensory neuropathy as determined by VPTs measured by Digital Biothesiometer and MNSI (Michigan Neuropathy Screening Instrument).

RESULT

A total of 60 prediabetic cases between 35 years to 60 years were included in this study. Among all the prediabetic subjects, 43.3 % subjects had neuropathy according to VPTs measured by Biothesiometer. T-test analysis suggested that serum levels of 8-OHdG were significantly higher in subjects with neuropathy than subjects without neuropathy (1006.58 ± 511.8 vs 688.6 ± 607.3, p value = 0.035). Urinary levels of 8-OHdG were also significantly higher in subjects with neuropathy than subjects without neuropathy (699.35 ± 419.5 vs 474.57 ± 402.5, p-value = 0.04). No such significant difference however was present in serum levels of vitamin D between neuropathic and non-neuropathic prediabetics (20.13 ± 18.44 vs 16.96 ± 11.72, p value = 0.419. VPTs were found to have statistically significant positive correlation with serum 8-OHdG {, Pearson Correlation Coefficient= 0.317(R), 0.307(L); p-value=0.014(R),0.017(L)} and urine 8-OHdG levels{Pearson Correlation Coefficient= 0.288(R), 0.255(L); p-value=0.026(R), 0.049(L),}. According to MNSI physical assessment score (> or = 2), 38.3 % subjects (23 subjects) had neuropathy. MNSI score is positively correlated with serum 8-OHdG (Pearson Correlation Coefficient = 0.308; p-value = 0.017). Correlation with urine 8-OHdG was not statistically significant (Pearson Correlation Coefficient= 0.687; p value = 0.06). Correlations of MNSI scores {Pearson Correlation Coefficient=0.14, p-value=0.287} and VPTs{Pearson Correlation Coefficient= 0.058(R), 0.189(L); p-value=0.660(R), 0.148(L)} with serum vitamin D levels were not statistically significant.

CONCLUSION

Oxidative stress, as confirmed by the biomarker, 8-OHdG, has a important role in the development of this sensory neuropathy.

Pamidronate-encapsulated electrospun polycaprolactone as a potential bone regenerative scaffold

This study explores the potential of electrospun polycaprolactone scaffolds for the controlled delivery of pamidronate disodium pentahydrate, an amino-bisphosphonate drug used for the treatment of osteoporosis. Major drawbacks associated with oral bisphosphonate therapy are its poor bioavailability and gastrointestinal side-effects. Herein, we used polycaprolactone, a well-known Food and Drug Administration–approved biomaterial, as the delivering vehicle for pamidronate disodium pentahydrate. Scaffolds based on polycaprolactone with three different formulations (1, 3, and 5 wt%) of pamidronate disodium pentahydrate were fabricated by electrospinning, and a comparative study was carried out to evaluate the effect of pamidronate disodium pentahydrate on physico-mechanical and biological properties of polycaprolactone. The observations from Fourier-transform infrared spectra and thermogravimetric analysis confirmed the successful incorporation of pamidronate disodium pentahydrate into polycaprolactone scaffolds. The study also revealed that pamidronate disodium pentahydrate–loaded scaffolds exhibited improved hydrophilicity as well as superior mechanical properties as depicted by the contact angle measurements and mechanical property evaluation. In vitro drug release studies of pamidronate disodium pentahydrate–loaded scaffolds in phosphate buffer saline at 37°C showed that all the scaffolds exhibited controlled release of pamidronate disodium pentahydrate. In vitro degradation studies further revealed that pamidronate disodium pentahydrate incorporated polycaprolactone scaffolds degraded faster as depicted by the fiber rupture and drop in mechanical properties. In vitro cell culture studies using human osteosarcoma cell lines demonstrated that pamidronate disodium pentahydrate–loaded polycaprolactone scaffolds were cytocompatible. The human osteosarcoma cells had favorable interaction with the scaffolds, and the viability of adhered cells was depicted by the fluorescein diacetate/propidium iodide staining. MTT assay further revealed enhanced cell viability on PCL/PDS3 scaffolds. Our findings bespeak that the pamidronate disodium pentahydrate–encapsulated electrospun polycaprolactone scaffolds have the potential to serve as a promising drug delivery vehicle for osteoporotic bone defect repair.

A Novel Ceramide from the Indian Marine Sponge Fasciospongia Cavernosa

A new ceramide 1, has been isolated along with a known compound 3,6-diacetoxy-cholest-7-en-3β,5α,6β-triol (2) from a marine sponge Fasciospongia cavernosa collected off the Mandapam coast in the Gulf of Manner, India. The structures of 1 and 2 were determined by spectroscopic analysis.

Unusual Terpenoid Constituents of the Soft Coral Sinularia dissecta

Chemical examination of the soft coral Sinularia dissecta furnished six known terpenoids, along with a new sequiter-penoid seco-africanane (1) and a new norcembrane diterpene (2)

Hybrid polycaprolactone/polyethylene oxide scaffolds with tunable fiber surface morphology, improved hydrophilicity and biodegradability for bone tissue engineering applications

In the present study, we attempt to modify Polycaprolactone (PCL) by blending it with a water soluble polymer Polyethyleneoxide (PEO) having two different molecular weights (Mv ~1,00,000 and 6,00,000) using electrospinning technique. The effect of PEO molecular weight and blend ratio on fiber morphology, porosity, surface wettability, static and dynamic mechanical properties of PCL was investigated. In vitro degradation studies in phosphate buffer saline (PBS) at 37 °C demonstrated formation of pores on fiber surface especially in blend scaffolds with 50:50 ratios. In vitro studies using human osteoblast sarcoma (hOS) cell lines on blend scaffolds showed improved cellular response with good cell adhesion, viability and proliferation. The study revealed that incorporation of PEO on PCL scaffolds complemented the properties of PCL and facilitated fabrication of scaffolds with improved hydrophilicity, mechanical property and tunable degradation profile with better cell viability which makes it an ideal candidate for bone tissue engineering applications.

Biomimetic approaches with smart interfaces for bone regeneration

A 'smart tissue interface' is a host tissue-biomaterial interface capable of triggering favourable biochemical events inspired by stimuli responsive mechanisms. In other words, biomaterial surface is instrumental in dictating the interface functionality. This review aims to investigate the fundamental and favourable requirements of a 'smart tissue interface' that can positively influence the degree of healing and promote bone tissue regeneration. A biomaterial surface when interacts synergistically with the dynamic extracellular matrix, the healing process become accelerated through development of a smart interface. The interface functionality relies equally on bound functional groups and conjugated molecules belonging to the biomaterial and the biological milieu it interacts with. The essential conditions for such a special biomimetic environment are discussed. We highlight the impending prospects of smart interfaces and trying to relate the design approaches as well as critical factors that determine species-specific functionality with special reference to bone tissue regeneration.

Incidence of Onchocerca gibsoni in subcutaneous nodules of cross bred Jersey cows: case report

Onchocerca gibsoni subcutaneous nodules in four cross bred Jersey cows aged 5-6 years brought for post mortem with calcified and caseated skin nodules in the lateral flank region is reported. Examination and dissection of these nodules revealed that they were "worm nests" of Onchocerca sp. of filarid nematodes. The worm nests were carefully dissected and filarid worms were extracted out. Multiple numbers of worms were recovered from each nodule ranging from 15 to 20. Female worms were found inside the worm nests and were found to be filled with microfilariae. The nodules weighed 2-3 g. Based on the morphological features the worms were identified as O. gibsoni.

Occurrence of Knemidokoptes mutans and Laminosioptes cysticola in backyard poultry in India

Birds reared in backyard poultry farming system are more prone to parasitic infestation resulting in economic losses to rural community. The present study reports occurrence of Knemidokoptes mutans and Laminosioptes cysticola mites in a male Aseel bird. Clinical signs observed in the affected bird include hyperkeratosis with whitish film layer on shank and hock region of legs. Focal areas of sloughing of skin with oozing of blood were also observed on the back and on the legs. Examination of skin scrapings from the affected sites revealed different developmental stages of Knemidokoptes mutans and Laminosioptes cysticola mites. This paper reports occurrence of L. cysticola for the first time from India. The bird was treated with ivermectin injection through intramuscular route.

Ganga hospital open injury score in management of open injuries

INTRODUCTION

Open injuries of the limbs offer challenges in management as there are still many grey zones in decision making regarding salvage, timing and type of reconstruction. As a result, there is still an unacceptable rate of secondary amputations which lead to tremendous waste of resources and psychological devastation of the patient and his family. Gustilo Anderson's classification was a major milestone in grading the severity of injury but however suffers from the disadvantages of imprecise definition, a poor interobserver correlation, inability to address the issue of salvage and inclusion of a wide spectrum of injuries in Type IIIb category. Numerous scores such as Mangled Extremity Severity Score, the Predictive Salvage Index, the Limb Salvage Index, Hannover Fracture Scale-97 etc have been proposed but all have the disadvantage of retrospective evaluation, inadequate sample sizes and poor sensitivity and specificity to amputation, especially in IIIb injuries.

METHODS

The Ganga Hospital Open Injury Score (GHOIS) was proposed in 2004 and is designed to specifically address the outcome in IIIb injuries of the tibia without vascular deficit. It evaluates the severity of injury to the three components of the limb--the skin, the bone and the musculotendinous structures separately on a grade from 0 to 5. Seven comorbid factors which influence the treatment and the outcome are included in the score with two marks each. The application of the total score and the individual tissue scores in management of IIIB injuries is discussed.

RESULTS

The total score was shown to predict salvage when the value was 14 or less; amputation when the score was 17 and more. A grey zone of 15 and 16 is provided where the decision making had to be made on a case to case basis. The additional value of GHOIS was its ability to guide the timing and type of reconstruction. A skin score of more than 3 always required a flap and hence it indicated the need for an orthoplastic approach from the index procedure. Bone score of 4 and 5 will require complex reconstruction procedures like bone transport, extensive bone grafting or free fibular graft. Regarding the timing of reconstruction, injuries with a score of 9 or less indicated a low violence trauma and were amenable for early soft tissue reconstruction whereas injuries with a score of 10 or more indicated high violence injuries where a staged reconstruction policy must be followed.

CONCLUSIONS

Ganga Hospital Open Injury Score was found to be highly useful in decision making regarding salvage in IIIB injuries. The individual tissue scores were also useful to provide guidance regarding the timing and type of bone and soft tissue reconstruction.

CD40 signaling drives B lymphocytes into an intermediate memory-like state, poised between naïve and plasma cells

Immunological memory comprising of antigen-specific B and T cells contributes to the acquisition of long-term resistance to pathogens. Interactions between CD40 on B cells and CD40L on T cells are responsible for several aspects of acquired immune responses including generation of memory B cells. In order to gain insights into events leading to memory B cell formation, we analyzed the genome-wide expression profile of murine naive B cells stimulated in the presence of anti-CD40. We have identified over 8,000 genes whose expression is altered minimally 1.5-fold at least at one time point over a 3-day time course. The array analysis indicates that changes in expression level of maximum number of these genes occur within 24 h of anti-CD40 treatment. In parallel, we have studied the events following CD40 ligation by examining the expression of known regulators of naive B cell to plasma cell transition, including Pax5 and BLIMP1. The expression profile of these regulatory genes indicates firstly, that CD40 signaling activates naïve B cells to a phenotype that is intermediate between the naive and plasma cell stages of the B cell differentiation. Secondly, the major known regulator of plasma cell differentiation, BLIMP1, gets irreversibly downregulated upon anti-CD40 treatment. Additionally, our data reveal that CD40 signaling mediated BLIMP1 downregulation occurs by non-Pax5/non-Bcl6 dependent mechanisms, indicating novel mechanisms at work that add to the complexity of understanding of B cell master regulatory molecules like BLIMP1 and Pax5.

Nanohydroxyapatite incorporated electrospun polycaprolactone/polycaprolactone-polyethyleneglycol-polycaprolactone blend scaffold for bone tissue engineering applications

The present work is a comparative evaluation of physical and biological properties of electrospun biodegradable fibrous scaffolds based on polycaprolactone (PCL) and its blend with polycaprolactone-polyethyleneglycol-polycaprolactone (CEC) with and without nanohydroxyapatite (nHAP) particles. The fiber morphology, porosity, surface wettability, and mechanical properties of electrospun PCL were distinctly influenced by the presence of both copolymer CEC and nHAP. The degradation in hydrolytic media affected both morphological and mechanical properties of the scaffolds and the tensile strength decreased by 58% for PCL, 83% for PCL/CEC, 36% for PCL/nHAP and 75% for PCL/CEC/nHAP in 90 days of PBS ageing. MTT assay using mouse fibroblast L929 cells proved all the scaffolds to be non-cytotoxic. An overall enhanced performance was shown by PCL/CEC/nHAP scaffold in cell viability (LPH) and proliferation (Picogreen). Simultaneously, ELF assay of ALP activity (bone marker) confirmed the presence of osteogenic-induced Rabbit adipose-derived mesenchymal stem cells (ADMSCs) on all the scaffolds. In comparison, the results reveal the potential of the cytocompatible PCL/CEC/nHAP scaffold for the fabrication of living bony constructs for tissue engineering applications.