A tissue-engineered model of the blood-tumor barrier during metastatic breast cancer

Metastatic brain cancer has poor prognosis due to challenges in both detection and treatment. One contributor to poor prognosis is the blood-brain barrier (BBB), which severely limits the transport of therapeutic agents to intracranial tumors. During the development of brain metastases from primary breast cancer, the BBB is modified and is termed the 'blood-tumor barrier' (BTB). A better understanding of the differences between the BBB and BTB across cancer types and stages may assist in identifying new therapeutic targets. Here, we utilize a tissue-engineered microvessel model with induced pluripotent stem cell (iPSC)-derived brain microvascular endothelial-like cells (iBMECs) and surrounded by human breast metastatic cancer spheroids with brain tropism. We directly compare BBB and BTB in vitro microvessels to unravel both physical and chemical interactions occurring during perivascular cancer growth. We determine the dynamics of vascular co-option by cancer cells, modes of vascular degeneration, and quantify the endothelial barrier to antibody transport. Additionally, using bulk RNA sequencing, ELISA of microvessel perfusates, and related functional assays, we probe early brain endothelial changes in the presence of cancer cells. We find that immune cell adhesion and endothelial turnover are elevated within the metastatic BTB, and that macrophages exert a unique influence on BTB identity. Our model provides a novel three-dimensional system to study mechanisms of cancer-vascular-immune interactions and drug delivery occurring within the BTB.

Towards automated check-worthy sentence detection using Gated Recurrent Unit

People are exposed to a lot of information daily, which is a mix of facts, opinions, and false claims. The rate at which information is created and spread has necessitated an automated fact-checking mechanism. In this work, we focus on the first step of the fact-checking system, which is to identify whether a given sentence is factual. We propose a glove embedding-based gated recurrent unit pipeline for check-worthy sentence detection, referred to as G2CW framework. It detects whether a given sentence has check-worthy content in it or not; furthermore, if it has check-worthy content, whether it is important or not, from a fact-checking perspective. We evaluate our proposed framework on two datasets: a standard ClaimBuster dataset commonly used by the research community for this problem and a self-curated IndianClaim dataset. Our G2CW framework outperforms prior work with 0.92 as F1-score. Furthermore, our G2CW framework, when trained on the ClaimBuster dataset, performs the best on the IndianClaims dataset.

Three-dimensional microenvironment regulates gene expression, function, and tight junction dynamics of iPSC-derived blood-brain barrier microvessels

The blood-brain barrier (BBB) plays a pivotal role in brain health and disease. In the BBB, brain microvascular endothelial cells (BMECs) are connected by tight junctions which regulate paracellular transport, and express specialized transporter systems which regulate transcellular transport. However, existing in vitro models of the BBB display variable accuracy across a wide range of characteristics including gene/protein expression and barrier function. Here, we use an isogenic family of fluorescently-labeled iPSC-derived BMEC-like cells (iBMECs) and brain pericyte-like cells (iPCs) within two-dimensional confluent monolayers (2D) and three-dimensional (3D) tissue-engineered microvessels to explore how 3D microenvironment regulates gene expression and function of the in vitro BBB. We show that 3D microenvironment (shear stress, cell-ECM interactions, and cylindrical geometry) increases BBB phenotype and endothelial identity, and alters angiogenic and cytokine responses in synergy with pericyte co-culture. Tissue-engineered microvessels incorporating junction-labeled iBMECs enable study of the real-time dynamics of tight junctions during homeostasis and in response to physical and chemical perturbations.

Urine Specific Gravity Measurement for Fluid Balance in Neonates on Intravenous Fluids in a Neonatal Intensive Care Unit: An Open Label Randomized Controlled Trial

BACKGROUND

Urine specific gravity reflects hydration status and correlates well with urine osmolality.

OBJECTIVE

To compare intravenous fluid therapy guided with and without inclusion of urine specific gravity to the standard parameters for maintaining postnatal weight loss within permissible limits in neonates admitted to the intensive care unit.

METHODS

An open-label randomized controlled trial was conducted, including neonates requiring intravenous fluids for ≥72 hours, randomized into the study (urine specific gravity guided fluids) and control arms. The outcomes of the study were to determine proportion of neonates with weight loss within permissible limits, mean percentage weight loss and number of days to reach maximum weight loss.

RESULTS

80 preterm and term neonates (40 in each arm) were enrolled. A comparable proportion of neonates had weight loss within permissible limits in study arm and in control arms [39 (97.5%) vs 36 (90%); P=0.165]. The (mean (SD) percentage weight loss was significantly less in the study arm compared to control arm [All neonates: 7.2(2.6) vs 9.3(3.5); P=0.004); preterm neonates: 7.7 (2.8) vs 11 (3.9); P=0.008)]. Preterm neonates in the study arm attained nadir weight significantly earlier than in the controls (P=0.03) and attained complete enteral feeding earlier. Urine specific gravity showed a moderate negative correlation with the percentage weight loss.

CONCLUSION

Using urine specific gravity to regulate intravenous fluids in neonates resulted in a significant reduction in postnatal weight loss, especially in preterm neonates.

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.

Effects of acute and chronic oxidative stress on the blood-brain barrier in 2D and 3D in vitro models

Oxidative stress is a shared pathology of neurodegenerative disease and brain injuries, and is derived from perturbations to normal cell processes by aging or environmental factors such as UV exposure and air pollution. As oxidative cues are often present in systemic circulation, the blood-brain barrier (BBB) plays a key role in mediating the effect of these cues on brain dysfunction. Therefore, oxidative damage and disruption of the BBB is an emergent focus of neurodegenerative disease etiology and progression. We assessed barrier dysfunction in response to chronic and acute oxidative stress in 2D and 3D in vitro models of the BBB with human iPSC-derived brain microvascular endothelial-like cells (iBMECs). We first established doses of hydrogen peroxide to induce chronic damage (modeling aging and neurodegenerative disease) and acute damage (modeling the response to traumatic brain injury) by assessing barrier function via transendothelial electrical resistance in 2D iBMEC monolayers and permeability and monolayer integrity in 3D tissue-engineered iBMEC microvessels. Following application of these chronic and acute doses in our in vitro models, we found local, discrete structural changes were the most prevalent responses (rather than global barrier loss). Additionally, we validated unique functional changes in response to oxidative stress, including dysfunctional cell turnover dynamics and immune cell adhesion that were consistent with changes in gene expression.

Effects of a combination of xylanase, amylase and protease, and probiotics on major nutrients including amino acids and non-starch polysaccharides utilization in broilers fed different level of fibers

This study evaluated the effects of a combination of xylanase, amylase, and protease (XAP), with probiotics (3 Bacillus spp.) supplementation on apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of nutrients in Cobb 500 broilers from 0 to 21 d. A completely randomized 2 × 4 factorial design (2 levels of fiber; 4 types of supplements) with 8 replicate cages (6 birds/cage) was used. Each low and high-fiber diet contained 500 FTU/kg Buttiauxella sp. phytase and was supplemented with: (a) none (control), (b) XAP (2,000 U xylanase + 200 U amylase + 4,000 U protease/kg diet), (c) probiotics (75,000 CFU/g of Bacillus spp.), or (d) XAP + probiotics. High fiber decreased (P < 0.05) nitrogen-corrected apparent metabolizable energy (AMEn), AID of all amino acids (AA), AID and ATTD of dry matter (DM), crude protein (CP), starch, and gross energy (GE). High fiber increased (P < 0.01) the flow of total non-starch polysaccharides (NSP) in both ileum and total tract. The XAP + probiotics increased (P < 0.01) AMEn as well as AID and ATTD of DM, CP, GE, starch, while alone, XAP yielded similar improvement except for DM compared with control. The supplemental XAP alone improved (P < 0.01) the digestibility of most of the AAs compared with control. Moreover, XAP + probiotics increased (P < 0.05) AID of all AA except arginine and serine compared with control. A fiber × supplements interaction (P < 0.05) was found for AID of histidine and threonine, and their digestibility in high-fiber diet was improved to a level comparable to low-fiber diet by XAP + probiotics. The flow of NSP in XAP group was 5 to 6% lower than in control while NSP flow in XAP + probiotic group was further 4% lower than that of XAP group (P < 0.01). The results infer that the combination of XAP and probiotics can effectively optimize the nutrient digestibility in broilers fed both low and high-fiber diets.

Changes in middle ear transmission characteristics secondary to altered bone remodelling

Alteration in the process of bone remodelling results in conditions like osteopenia and osteoporosis in which the bones become susceptible to fracture. The functioning of middle ear bones in such individuals were assessed in this study and it was found that the middle ear bones are equally susceptible to micro-fractures and can cause reduction in the transmission of sound energy.

INTRODUCTION

Alteration in the process of bone remodelling or increase in the number of osteoclasts cells as it occurs in osteoporosis and osteopenia are likely to affect the middle ear bones in the same way it affects the skeletal bones. Whether these micro-structural changes occurring at the level of the middle ear secondary to altered bone remodelling cause any significant impairment in its functioning is not explored. Thus, the present study aimed at assessing the different aspects of middle ear functioning in individuals with reduced BMD.

METHODS

The study included 25 normal, 39 osteopenic and 40 osteoporotic participants. The participants underwent pure-tone audiometry, otoscopic examination, conventional immittance evaluation using a 226 Hz probe tone, multi-component and multi-frequency tympanometry and acoustic reflex threshold testing. None of the participants had any current or previous history of middle ear effusion.

RESULTS

A significantly higher proportion of participants in the clinical group had hearing loss compared to the normal group. The clinical group participants also had reduced middle ear resonance frequency, elevated static compliance values and elevated or absent acoustic reflexes compared to the normal participants. There was no difference among the three groups for the proportion of participants having conductive hearing loss.

CONCLUSIONS

There is a detrimental impact of reduction in bone mineral density on middle ear transmission characteristics which may go unnoticed initially. Treatment of osteoporosis may potentially mitigate hearing loss from middle ear fractures due to reduced bone mineral density. Absence of significant air-bone gap with the presence of reduced middle ear resonance frequency may be early signs of reduced BMD.

Effect of in ovo injection of raffinose on growth performance and gut health parameters of broiler chicken

The effects of in ovo injection of raffinose (RFO) as a prebiotic on growth performance, relative weight of proventriculus, gizzard, drumstick and breast muscles, and ileum mucosa morphology were examined in Cobb 500 broilers. A total of 240 fertilized eggs were divided into 4 groups: a non-injected with intact shell and 3 levels of RFO solution (1.5, 3.0, and 4.5 mg in 0.2 mL of an aqueous diluents). The RFO solution was injected into the air sac on d 12 of incubation. In total 144 birds were fed a standard diet and management and sacrificed at d 21 post hatch for collection of samples. Total RNA was extracted from the small intestine, and RT-qPCR was performed to quantify mRNA levels of marker genes of immune cells. Injection of RFO had no significant effect (P > 0.05) on d one body weight of chicks. On d 21, the relative weight of the proventriculus, drumstick, breast, and gizzard was not affected (P > 0.05) by RFO. On hatch d, the villus height increased linearly (P < 0.01) with an increasing dose of RFO. Also, an increasing dose of RFO increased the villus height and villus height:crypt depth ratio (P < 0.05) but did not affect the crypt depth on d 21. The expression levels of CD3 and chB6, which are T cell and B cell marker genes, respectively, were significantly enhanced by high dose RFO (4.5 mg). In conclusion, although an increasing dose of RFO in ovo injection did not significantly influence growth performance or slaughter yield of broilers, RFO has the potential of enhancing ileum mucosa morphology and improving immunity in the small intestine, which are indicators of improved gut health.

Physico-chemical properties of purified fiber affect their in vitro fermentation characteristics and are linked to in vivo characteristics in pigs

Fermentation characteristics of purified fiber differing in physico-chemical properties were investigated using an in vitro model. Fermentation characteristics and short-chain fatty acid (SCFA) profile differed (P < 0.001) among the fiber sources. Solubility and viscosity of fibers were correlated to in vitro fermentation kinetics, total gas production, and SCFA profile.

Carcinoma of the Tongue in Renal Transplant Recipients: An Unusual Spectrum of De novo Malignancy at a Tertiary Care Center in India Over a Period of 26 Years

Renal transplant recipients are at a higher risk of malignancy. We report our experience and the critical differences in the presentation of malignancy in kidney transplant patients performed at our tertiary care center and followed up over the period of 1990–2015. A total of 338 live donor transplants performed in 332 patients were analyzed. Induction immunosuppression was used in 22 cases with interleukin-2 (IL-2) receptor antibody. Overall 299 patients were continued on calcineurin inhibitor (CNI)-based triple drug immunosuppression, 33 were off CNI with 13 of them receiving sirolimus additionally. A total of 16 malignancies including post transplant lymphoproliferative disease (5), oral cancer (5), lung cancer (2), hepatobiliary cancer (2), colon cancer (1), and skin cancer (1) were diagnosed in 15 patients. Over the 26-year follow up, 138 patients died of whom 12 died due to cancer. Cancer occurred in 4.7% of patients but accounted for 9.4% of deaths. Oral cancer occurred after a significantly longer latency of over 10 years (212 vs. 94 months, P = 0.00652). Despite the longer latency, oral cancer patients were younger at diagnosis (44.0 vs. 52 years, P = 0.01016) and had better outcome (Fisher's exact test, P = 0.0275). This was despite a longer overall follow-up for the oral cancer patients, reflecting the better outcome for these patients (24 vs. 4 months, P = 0.0278). This might be the result of relatively early diagnosis of oral cancers.

Superconducting gap structure in the electron doped BiS2-based superconductor

The influence of electron doping on semimetallic SrFBiS₂ has been investigated by means of resistivity, zero and transverse  -  field (ZF/TF) muon spin relaxation/rotation (μSR) experiments. SrFBiS₂ is semimetallic in its normal state and small amounts of La doping results in bulk superconductivity at 2.8 K, at ambient pressure. The temperature dependence of the superfluid density as determined by TF-μSR can be best modelled by an isotropic s  -  wave type superconducting gap. We have estimated the magnetic penetration depth [Formula: see text] nm, superconducting carrier density [Formula: see text] carriers m^-3 and effective-mass enhancement m ^*  =  1.558 m _e. Additionally, there is no clear sign of the occurrence of spontaneous internal magnetic fields below [Formula: see text], which implies that the superconducting state in this material can not be categorized by the broken time-reversal symmetry which is in agreement with the previous theoretical prediction.

Nutrient composition, digestible and metabolizable energy content, and prediction of energy for animal protein byproducts in finishing pig diets

An industry survey and animal experiment were conducted to evaluate compositional variability and DE and ME content of animal protein byproducts and to generate equations to predict DE and ME content based on chemical analysis. For the 220 samples collected, the greatest concentration of CP was observed in blood meal (BM) and the least in meat and bone meal (MBM) and the greatest concentration of ether extract was in meat meal and the least in BM, with ash content greatest in MBM and least in BM, with Ca and P levels being 36.1 and 16.3% of the ash content, respectively. For the balance experiment, a corn-soybean meal basal diet was used with test diets formulated by mixing 80% of the basal diet with 20% of the animal protein byproduct, except for BM, which was included at 10 and 20% of the test diets. Ten groups of 24 gilts (92.5 ± 7.4 kg final BW) were randomly assigned to the test or basal diet within each group, resulting in 16 replications per animal protein byproduct or basal diet, except for BM determinations (20 replications). Gilts were placed in metabolism crates and offered 2.4 kg daily of their assigned diet for 13 d, with total collection of feces and urine during the last 4 d. Gross energy in the diets, feces, and urine was used to calculate the DE and ME content of each ingredient by the difference procedure, using DE and ME of the basal diet as a covariate among groups of pigs. The DE content of the animal protein byproducts ranged from 5,367 to 2,567 kcal DE/kg DM, and ME ranged from 4,783 to 2,340 kcal ME/kg DM. Using all animal protein byproducts, the best-fit equations were as follows: DE (kcal/kg DM) = -2,468 + (1.26 × GE, kcal/kg DM), with of 0.84, SE = 390, and < 0.01, and ME (kcal/kg DM) = -2,331 + (1.15 × GE, kcal/kg DM), with of 0.86, SE = 327, and < 0.01. The apparent total tract digestibility (ATTD) of Ca and P were also determined using the difference procedure, with the average ATTD of Ca and P for the animal protein byproducts, excluding BM and feather meal, being 27.1 and 39.1%, respectively. These data indicate that DE and ME substantially varied among the animal protein byproducts and sources and that a variety of nutritional components can be used to accurately predict DE and ME for finishing pigs. In addition, it appears that high dietary inclusion rates of animal protein byproducts may result in low ATTD estimates of Ca and P, which may be due to excessive concentrations of total Ca and P affecting digestibility.

Pituitary adenomas - my personal experience

Introduction: The pituitary gland is also called the master gland of the body and its tumours represent 10- 15% of all intracranial tumors, with an annual incidence of 0.2-2.8 cases per 100,000 persons.Most are benign adenomas arising from the anterior pituitary (adenohypophysis), and most commonly present due to hormonal effects(includes hyperprolactinomia,Cushings Syndrome, acromegaly..),mass effect, as an incidental finding or infrequently with pituitary apoplexy.Objective: To describe the features of the patients with pituitary adenoma, different surgical approaches, and its outcome.Methodology: This is a prospective study of data of all patients operated from 2013 to 2015(3 years).The demographic factors of age, sex is studied along with the the size of adenoma, clinical symptoms before and after surgery, type of surgery, complications and final outcome.Result: The total number of cases was 18, with predominantly males (10 cases) than females (8 cases).The most common mode of presentation was with headache in 7 cases (39%), followed by visual changes in 6(33%). Hormonal changes was found in 10(56%) with pituitary apoplexy in 4 cases (22%). Tumour resection was complete in 92% of the cases and subtotal in the rest. There were no mortalities.Conclusion: Sublabial transphenoidal surgery is a effictive technique with low procedure related morbidity.

In vitro digestion and fermentation characteristics of canola co-products simulate their digestion in the pig intestine

Canola co-products are sources of amino acid and energy in pig feeds, but their fermentation characteristics in the pig intestine are unknown. Thus, we determined the in vitro fermentation characteristics of the canola co-products Brassica juncea solvent-extracted canola meal (JSECM), Brassica napus solvent-extracted canola meal (NSECM), B. napus expeller-pressed canola meal (NEPCM) and B. napus cold-pressed canola cake (NCPCC) in comparison with soybean meal (SBM). Samples were hydrolysed in two steps using pepsin and pancreatin. Subsequently, residues were incubated in a buffer solution with fresh pig faeces as inocula for 72 h to measure gas production. Concentration of volatile fatty acids (VFA) per gram of dry matter (DM) of feedstuff was measured in fermented solutions. Apparent ileal digestibility (AID) and apparent hindgut fermentation (AHF) of gross energy (GE) for feedstuffs were obtained from pigs fed the same feedstuffs. On DM basis, SBM, JSECM, NSECM, NEPCM and NCPCC contained 15, 19, 22, 117 and 231 g/kg ether extract; and 85, 223, 306, 208 and 176 g/kg NDF, respectively. In vitro digestibility of DM (IVDDM) of SBM (82.3%) was greater (P<0.05) than that of JSECM (68.5%), NSECM (63.4%), NEPCM (67.5%) or NCPCC (69.8%). The JSECM had greater (P<0.05) IVDDM than NSECM. The IVDDM for NSECM was lower (P<0.05) than that for NEPCM, which was lower (P<0.05) than that for NCPCC. Similarly, AID of GE was greatest for SBM followed by NCPCC, JSECM, NEPCM and then NSECM. Total VFA production for SBM (0.73 mmol/g) was lower (P<0.05) than that of JSECM (1.38 mmol/g) or NSECM (1.05 mmol/g), but not different from that of NEPCM (0.80 mmol/g) and NCPCC (0.62 mmol/g). Total VFA production of JSECM was greater (P<0.05) than that of NSECM. Total VFA production of NSECM was greater (P<0.05) than that of NEPCM or NCPCC, which differed (P<0.05). The ranking of feedstuffs for total VFA production was similar to AHF of GE. In conclusion, in vitro fermentation characteristics of canola co-products and SBM simulated their fermentation in the small and large intestine of pigs, respectively. The 30% greater VFA production for JSECM than NSECM due to lower lignified fibre of JSECM indicates that fermentation characteristics differ between canola species. The NSECM had the highest fermentability followed by NEPCM and then NCPCC, indicating that fat in canola co-products can limit their fermentability in the hindgut.

Ledipasvir and sofosbuvir for treatment of post- renal transplant hepatitis C infection: A case report with review of literature

Liver disease due to hepatitis C infection in renal transplant recipients is difficult to treat and often associated with reduced patient survival. A 43-year-old male, a renal allograft recipient, presented at 6 years follow-up with significant weight loss over 3 months. He was detected to have new onset diabetes mellitus together with hepatitis C virus (HCV) infection (genotype 1). His HCV load remained high despite the change of immuno-suppression from tacrolimus to cyclosporine. A decision to treat with a new anti-viral combination of ledipasvir and sofosbuvir for 12 weeks was taken. Within 3 weeks, his raised serum transaminases levels normalized and viral load became undetectable. At the end of 16 weeks, he continues to do well with normal renal function, has sustained remission from hepatitis C infection and resolution of diabetes.

Dirty limit scattering behind the decreased anisotropy of doped YBa2Cu3O7-δ thin films

We measured the resistivity of pulsed-laser-deposited BaCeO3 (BCO)-doped YBCO thin films containing spherical BCO particles in fields up to 30 T. The average diameter of the particles depends on the dopant concentration being below 4 nm in all the samples. Raised values of the upper critical field, Bc2, were observed in all the samples. Additionally, the parameter γ, describing the electron mass anisotropy, decreased from 6.2 in the undoped sample to 3.1 in the 8 wt.% BCO-doped sample. These results can be explained by the increased number of defects decreasing the mean free path of electrons and thus lowering the coherence length, which in turn increases Bc2.

Enzymes enhance degradation of the fiber-starch-protein matrix of distillers dried grains with solubles as revealed by a porcine in vitro fermentation model and microscopy

Effects of treating corn and wheat distillers dried grains with solubles (DDGS) with a multicarbohydrase alone or in combination with a protease on porcine in vitro fermentation characteristics and the matrix structure of the DGGS before and after the fermentation were studied. Three DDGS samples (wheat DDGS sample 1 [wDDGS1], wheat DDGS sample 2 [wDDGS2], and corn DDGS [cDDGS]) were predigested with pepsin and pancreatin. Residues were then subjected to in vitro fermentation using buffered mineral solution inoculated with fresh pig feces without or with a multicarbohydrase alone or in combination with protease in a 3 × 3 factorial arrangement. Accumulated gas production was measured for up to 72 h. Concentration of VFA was measured in fermented solutions. The matrix of native DDGS and their residues after fermentation was analyzed using confocal laser scanning microscopy and scanning electron microscopy to determine internal and external structures, respectively. On a DM basis, wDDGS1, wDDGS2, and cDDGS contained 35.5, 43.4, and 29.0% CP; 2.23, 0.51, and 6.40% starch; 0.82, 0.80, and 0.89% available Lys; and 24.8, 22.5, and 23.0% total nonstarch polysaccharides, respectively. The in vitro digestibility of DM for wDDGS1, wDDGS2, and cDDGS was 67.7, 72.1, and 59.6%, respectively. The cDDGS had greater ( < 0.05) total gas and VFA production than both wheat DDGS. The wDDGS2 had lower ( < 0.05) total gas production than wDDGS1. Multicarbohydrase increased ( < 0.05) total gas production for cDDGS and total VFA production for wDGGS1 but did not increase gas or VFA production for wDDGS2. Addition of protease with multicarbohydrase to DDGS reduced ( < 0.05) total gas and VFA productions and increased ( < 0.05) branched-chain VFA regardless of DDGS type. Confocal laser scanning microscopy and scanning electron microscopy revealed that DDGS were mainly aggregates of resistant and nonfermentable starchy and nonstarchy complexes formed during DDGS production. After in vitro fermentation with porcine fecal inoculum, particles of enzyme-treated DDGS were generally smaller than those of the untreated DDGS. In conclusion, cDDGS had a more porous matrix that was more fermentable than the wheat DDGS. The wDDGS2 was less fermentable than wDDGS1. Multicarbohydrase increased fermentability of cDDGS and wDDGS1 but not wDDGS2, indicating that its efficacy in DDGS is dependent on matrix porosity and DDGS source. Protease hindered efficacy of multicarbohydrase.

Distribution of hemoglobinopathies in patients presenting for electrophoresis and comparison of result with High performance liquid chromatography

Background: Nearly 226 million carriers of thalassemias and abnormal hemoglobin are present worldwide according to the World Health Organization (WHO). The laboratory plays an important role in the investigation of the thalassemias and hemoglobinopathies. Cellulose acetate electrophoresis at alkaline pH and diagnosis based mainly on visual impression of thickness of band may miss the thalassemic trait patients. The aim of this study was to find out different hemoglobinopathies and thalassemia presenting in our hospital and to compare electrophoresis results with HPLC.Materials and Methods: This study was performed in the hematopathology section of Department of Pathology of Tribhuvan University Teaching Hospital on cases sent for electrophoresis during 18 months period from October 2013 to March 2015 and included hemoglobinopathies and thalassemias identified by either electrophoresis or HPLC. 97 cases fulfilled the inclusion criteria and thus were included in the study. Electrophoresis at alkaline pH was done in all whereas HPLC was performed in 27 cases.Results: A sharp peak of hemoglobinopathies and thalassemias was seen in Tharu community though other communities are also affected. Thalassemia trait was the most common diagnosis (26.8%) followed by sickle cell anemia (21.6%).  Electrophoresis was efficient in detecting some alpha thalassemia variants but missed many cases of beta thalassemia trait.Conclusion: Beta Thalassemia trait and sickle cell anemia both are common in Nepal , along with some other hemoglobinopathies  A sharp peak of hemoglobinopathies and thalassemias are seen in Tharu community. These abnormal hemoglobins and thalassemias are mainly seen in Terai region. Electrophoresis fails to quantify hemoglobin percentage and thus is not appropriate test in beta thalassemia screening. 

Length of Stay of Orthopaedic Inpatients at a Teaching Hospital in Eastern Part of Nepal

INTRODUCTION

This study aimed to analyze the average length of stay of all inpatients in the department of Orthopaedics and to compare the variations in hospital stay between age, gender, traumatic and non-traumatic co-morbidities and modality of payment.

METHODS

This hospital based retrospective descriptive epidemiological study was based on patients discharged from a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to calculate length of stay and analyze the variations.

RESULTS

Average length of stay was 10.5 days. It was 10.7 days for males and 10.1 days for females. It was 10.12 days for patients paying themselves for their treatment whereas 14.98 days for patients receiving reimbursement (third party payment).

CONCLUSIONS

Average length of stay was more in elderly and patients of trauma (longest in pelvis injury). It was 1.5 times longer for patients receiving reimbursement for treatment.

Effect of pressure on superconductivity in the indium-doped topological crystalline insulator SnTe

We report on the impact of hydrostatic pressure on the superconductivity of optimally (indium)-doped SnTe which is established to be derived from a topological crystalline insulating phase. Single crystals of Sn(1-x)In(x)Te were synthesized by a modified Bridgman method that exhibited maximum superconducting Tc of 4.4 K for x = 0.5. Hydrostatic pressure up to 2.5 GPa was applied on the crystals of Sn0.5In0.5Te, and electrical resistivity as a function of temperature and pressure was measured. We observed a decrease in the onset superconducting transition temperature from 4.4 K to 2.8 K on increasing pressure from ambient to 2.5 GPa. The normal state resistivity also decreased abruptly by an order of magnitude at 0.5 GPa but for higher pressures, it decreased marginally. From onset, offset and zero resistivity values, dTc/dP of ∼ -0.6 K GPa(-1) was confirmed. The low temperature normal state resistivity followed T(2) dependence suggesting Fermi liquid behaviour both for ambient and high pressure data. This increase in metallic characteristics accompanied by normal state Fermi liquid behaviour is in accordance with a 'dome structure' for Tc variation with varying carrier concentration.

Evaluation of re-aeration equations for river Ghataprabha, Karnataka, India and development of refined equation

Stream re-aeration is an extremely important component to enhance the self-purification capacity of streams. To estimate the dissolved oxygen (DO) present in the river, estimation of re-aeration coefficient is mandatory. Normally, the re-aeration coefficient is expressed as a function of several stream variables, such as mean stream velocity, shear stress velocity, bed slope, flow depth and Froude number. Many empirical equations have been developed in the last years. In this work, 13 most popular empirical re-aeration equations, used for re-aeration prediction, have been tested for their applicability in Ghataprabha River system, Karnataka, India, at various locations. Extensive field data were collected during the period March 2008 to February 2009 from seven different sites located in the river to observe re-aeration coefficient using mass balance approach. The performance of re-aeration equations have been evaluated using various error estimations, namely, the standard error (SE), mean multiplicative error (MME), normalized mean error (NME) and correlation statistics. The results show that the predictive equation developed by Jha et al. (Refinement of predictive re-aeration equations for a typical Indian river. Hydrological Process. 2001;15(6):1047-1060), for a typical Indian river, yielded the best agreement with the values of SE, MME, NME and correlation coefficient r. Furthermore, a refined predictive equation has been developed for river Ghataprabha using least-squares algorithm that minimizes the error estimates.

Study of Contraceptive Use Among Comprehensive Abortion Care Clients in Family Planning Clinic of Tribhuban University Teaching Hospital

Aims: This study was done to assess the use of family planning method among comprehensive abortion care clients in Tribhuvan University Teaching Hospital (TUTH).   Methods: A hospital based observational study was conducted in family planning clinic at TUTH from 14th April 2009 to 14th June 2010 among one hundred clients who opted for comprehensive abortion care (CAC) at the hospital CAC centre and met the inclusion criteria of this study.   Results: Around 98% women had knowledge of different types of modern contraceptive methods. Majority of CAC clients (91%) had ever used contraceptive methods in the past. Injectables were the most common method of contraceptive used by the CAC clients (55%). Almost 22% clients had come for repeat induced abortion. About 43% clients opted CAC service for complete family and 33% for contraceptive failure. Withdrawal method failure was seen in 17% of clients. Almost 86% women intend to use contraceptive after CAC service in future.   Conclusions: This study concluded that despite knowledge of modern contraceptive methods and ever uses of different family planning methods, majority of clients had no consistency in use of various contraceptives. Effective family planning counseling along with information of emergency contraceptive is required for each CAC clients to prevent unwanted pregnancy and abortion.DOI: http://dx.doi.org/10.3126/njog.v9i2.11740

Proliferative glomerulonephritis associated with monoclonal immune deposits: A case report and review of literature

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a newly recognized entity caused by monoclonal deposition of IgG. PGNMID resembles immune complex glomerulonephritis (GN) on light and electron microscopy. The monotypic immunoglobulin deposits seen on immunofluorescence (IF) clinches the diagnosis. We report a case of proliferative GN associated MGRS and review the relevant literature. The patient had significant proteinuria and elevated serum creatinine. The renal biopsy showed proliferative GN with focal crescents and monoclonal immune deposits confirming a diagnosis of PGNMID. Serum work up showed no monoclonal proteins. Proliferative GN as a manifestation of a monoclonal gammopathy needs to be borne in mind especially in renal biopsies of older patients.

Beta thalassemia - a review

Thalassemia is a globin gene disorder that results in a diminished rate of synthesis of one or more of the globin chains. About 1.5% of the global population (80 to 90 million people) are carriers of beta Thalassemia. More than 200 mutations are described in beta thalassemia. However not all mutations are common in different ethnic groups. The only effective way to reduce burden of thalassemia is to prevent birth of homozygotes. Diagnosis of beta thalassemia can be done by fetal DNA analysis for molecular defects of beta thalassemia or by fetal blood analysis. Hematopoietic stem cell transplantation is the only available curative approach for Thalassemia. Many patients with thalassemia in underdeveloped nations die in childhood or adolescence. Programs that provide acceptable care, including transfusion of safe blood and supportive therapy including chelation must be established.DOI: http://dx.doi.org/10.3126/jpn.v4i8.11609 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 663-671

Puerperal Uterine Inversion

DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11148 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 57-58

Surgical Management of Spinal Dysraphism: Five -year Experience in a Central Hospital

Introduction: Spinal dysraphism is a heterogeneous group of congenital spinal anomalies resulting from defective closure of the neural tube early in fetal life and anomalous development of the caudal cell mass. Meningomyelocele is common among Neural tube defects. Patients with myelomeningocele present with a spectrum of impairments, including primary functional deficits like are lower limb paralysis, sensory loss, bladderbowel dysfunction and cognitive dysfunction. Medical, surgical management and rehabilitation have helped patients with neural tube defects to participate and be productive in mainstream society. The aims of this study were to review the clinical presentation, surgical management and their outcome in the patient with spinal dysraphism. Materials and Methods: This is a retrospective study of Forty-one cases of spinal dysraphism managed during a period of five years from January 2008 to December 2012 in Department of Neurosurgery, National Academy of Medical Sciences (NAMS), Bir Hospital. Demographic profiles, clinical presentation of patients with spinal dysraphism, associated hydocephalus, surgical management and outcome were studied. Results: Out of total 41 cases studied, male patients outnumbered female with 58.5% to 41.5%. Age ranged from 5 days to 29 years and mean age was 2.71 years whereas. Lump (97%) and paraparesis (88%) were frequent mode of presentation. Lumbar lesion (65%) was commonest followed by lumbosacral (29%). Hydrocephalus was present in 51% of cases and in 24% cases developed hydrocephalus later after repair. Total 75.6% of cases were treated with VP shunt. Conclusion: Spinal dysraphism is debilitating entity and management is challenging. Lump on back and weakness of limb are major factor for children and their parents seek medical service. Lesion in low back (lumbar and lumbosacral) were most common location. Besides repair, majority of them needed CSF diversion surgery for hydocephalus. Aim of surgical management was to prevent further deterioration, control of hydrocephalus or leak. DOI: http://dx.doi.org/10.3126/jnps.v34i1.9378 J Nepal Paediatr Soc 2014;34(1):34-38

Efficacy of Misoprostol as a Post Abortion Care

Aims: This study was done to find the efficacy of Misoprostol as a post-abortion care in our setting. Methods: Women with incomplete abortion of gestational age ≤ 12 weeks or uterine size ≤ 12 weeks with open cervical os, haemoglobin ≥ 9 gm% and stable physical condition; were given 600 microgram Misoprostol orally and were observed for 24 hours for complete expulsion. If the patient failed to expel within 24 hours of Misoprostol administration manual vacuum aspiration or suction evacuation was done. Results: One hundred and twenty-two women were enrolled in the study. Among them, 41% had complete expulsion within 24 hours of administration of misoprostol and 49% had incomplete expulsions. The success rate was high in the group of < 8 weeks of pregnancy. Among 50 (41%) successful cases, 38 (76%) belonged to 8 weeks of gestation by bimanual examination (p = 0.02). Conclusions: Single dose of oral Misoprostol was effective, safe and alternative method to the management of incomplete abortion compared to the manual vacuum aspiration or suction evacuation in case of early pregnancy abortion.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 71-74 DOI: http://dx.doi.org/10.3126/njog.v8i2.9778