A two-generational reproductive study to assess the effects of Juglans regia on reproductive developments in the male and female rats

Environmental pollutants and lifestyle severely threaten human and animal health, leading to disturbances of various functions, including infertility. So, exploring a safe treatment that could effectively reverse infertility remains a challenge. The current study was intended to explore the fertility-enhancing effect of Juglans Regia oil in two successive generations of rats; F0 and F1. J. Regia oil was initially tested for in vitro antioxidant assay via ROS and DPPH, followed by in vivo toxicity testing. In the fertility assessment, eighteen pairs of male and female rats (n=36, 1:1, F0 generation) were divided into three groups and dosed with 1 mL/kg and 2 mL/kg daily of J. Regia oil and saline, respectively, up to pre-cohabitation, cohabitation, gestation and lactation periods. The reproductive performance, including body weight, live birth index, fertility index, and litter size, was assessed. Hormonal and antioxidant markers of F1 generations were assessed with the histopathological evaluation of male and female organs. The oil of J. Regia showed great antioxidant potential (P < 0.05) in DPPH (1,1-diphenyl-2-picrylhydrazyl) and ROS (Reactive Oxygen Species) methods (P<0.05). The continued exposure of the F0 and F1 generations to J. Regia oil did not affect body weight, fertility index, litter size, and survival index. We have found pronounced fertility outcomes in both genders of F0 and F1 generations with J. Regia 2 mL/kg/day in comparison to the control. Results showed that J. Regia significantly increased (P < 0.05) luteinizing hormone (LH), plasma testosterone, follicular stimulating hormone (FSH), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in both generations. Histology of both generations reveals improved spermatogenesis and folliculogenesis with enhanced architecture. Altogether, the present results suggest that J. Regia improved fertility in both male and female rats by improving hormonal activities and oxidative stress.

An evaluation of a one-day pain science education event in a high school setting targeting pain related beliefs, knowledge, and behavioural intentions

BACKGROUND

Persistent pain is a common condition affecting one in four UK adults. Public understanding of pain is limited. Delivering pain education within schools may improve public understanding in the longer term.

OBJECTIVE

To evaluate the impact of a one-day Pain Science Education (PSE) event on sixth form/high school students' pain beliefs, knowledge and behavioural intention.

METHODS

Exploratory, single-site, mixed-methods, single-arm study involving secondary school students ≥16 years old attending a one-day PSE event. Outcome measures included the Pain Beliefs Questionnaire (PBQ), Concepts of Pain Inventory (COPI-ADULT), a vignette to assess pain behaviours; and thematic analysis of semi-structured interviews.

RESULTS

Ninety (mean age 16.5 years, 74% female) of the 114 attendees, agreed to participate in the evaluation. PBQ scores improved on the Organic beliefs subscale [mean difference -5.9 (95% CI -6.8, -5.0), P < 0.01] and Psychosocial Beliefs subscale [1.6 (1.0, 2.2) P < 0.01]. The COPI-Adult revealed an improvement [7.1 (6.0-8.1) points, P < 0.01] between baseline and post intervention. Pain behavioural intentions improved post education for work, exercise, and bed rest related activities (p < 0.05). Thematic analysis of interviews (n = 3) identified increased awareness of chronic pain and its underpinning biology, beliefs that pain education should be widely available, and that pain management should be holistic.

CONCLUSIONS

A one-day PSE public health event can improve pain beliefs, knowledge and behavioural intentions in high school students and increase openness to holistic management. Future controlled studies are needed to confirm these results and investigate potential long-term impacts.

Change in surface characteristics and permeability of human enamel after subjecting to radiation therapy

BACKGROUND

Radiation-related caries is a complex destructive lesion leading to uncompromising damage of enamel and dentin in patients suffering from head and neck cancer managed with radiotherapy.

AIM

The purpose of this study was to evaluate the changes in the permeability of enamel and to assess the morphological and chemical changes of teeth surface subjected to 6 MV photon beam irradiation.

MATERIALS AND METHODS

For this in vitro study, coronal portion of 20 premolars were sectioned mesiodistally into halves and then grouped into two. Samples in group 1 (control) were not subjected to cycles of irradiation and those in group 2 (experimental) were subjected to a cumulative uniform radiation dose of 70 Gray fractioned in 35 fractions with 6 MV photons. The silver nitrate penetration method was used to assess the change in permeability of enamel. The variations in surface topography and mineral content were assessed using scanning electron microscopy with energy dispersive X-ray analysis. Dye penetration scores of surface texture changes were compared between the two groups utilizing the Chi-square test. The change in the elemental levels between enamel surfaces of the two groups was compared using an independent t-test.

RESULTS

The application of 6 MV photon radiation did not change enamel permeability and surface topography. However, a noteworthy reduction in the carbon content (P = 0.002) was observed in teeth subjected to irradiation.

CONCLUSIONS

Though radiation exposure did not alter the enamel permeability and surface topography, it had caused significant chemical compositional changes. Carbon content was significantly reduced in irradiated enamel samples.

AB0254 PATIENT CHARACTERISTICS, COMORBIDITIES, AND INFECTION OUTCOMES AMONG RHEUMATOID ARTHRITIS (RA) PATIENTS IN PUERTO RICO (PR)

Background:

Although the burden of comorbidities and infections in RA patients in the US is well established,1there is an evidence gap for RA patients in the US territory of PR.

Objectives:

To describe the patient demographics, clinical characteristics, and infection rates in patients with RA in PR

Methods:

A retrospective cohort of adults age ≥18 years from PR with ≥2 diagnosis of RA were identified using International Classification of disease codes (ICD-9 or ICD-10) on separate days from Jan 1, 2006 to June 30, 2018 using the Truven MarketScan™ database. Patients were divided into three treatment cohorts: no treatment, conventional disease-modifying anti-rheumatic drugs (csDMARD) user, and biologic DMARD (bDMARD) user. Patients in the no treatment group were followed from their first RA diagnosis date to the date of initiation of any DMARDs. The csDMARD users were followed from the initiation of csDMARD until the initiation of any bDMARD or targeted synthetic DMARDs (tsDMARDs). Patients were censored at the last observed medical claim if treatments were not initiated during follow-up. bDMARD users were followed from the date of initiation of bDMARD or tsDMARD until their last observed medical claim. Crude incidence rates /1000 person-years (PY) were reported for opportunistic infections (e.g. Mycobacterium, Cytomeglavirus, Candidiasis, and Chlamydial infections) and infections requiring hospitalisation.

Results:

Of the 623 patients in the cohort of RA patients from PR, majority were women (75.4%), aged 41-64 years (67.1%), employed full time (69.8%), with PPO health plan (89.4%), and with mean length of follow-up of 5.77 years from index RA diagnosis. Our results shows that cardiovascular conditions (CVD, hypertension, and hyperlipidemia) were the most prevalent comorbidities in PR patients with RA (Table 1), followed by diabetes (55.7%) in the total RA patient population. The crude IR/1000 PY for opportunistic infections was 23.35 for patients in the no treatment cohort, 48.52 for patients in csDMARD, and 28.31 for bDMARD users. For hospitalized infections, the crude IR/1000 PY was 26.00 for patients in the no treatment cohort, 22.08 for csDMARD users, and 41.90 for bDMARD users.

Table 1.

Patient Clinical Characteristics

Patient CharacteristicsTotal PatientsNo TreatmentcsDMARD userbDMARD userN%N%N%N%Total623100.060697.3168279415.1CCI ScoreMean (SD)2.31 (1.85)2.39 (1.82)1.85 (1.47)2.57 (2.41)ComorbiditiesTotal Patients57191.7%48680.2%13077.4%7680.9%Asthma17029.8%12525.7%3325.4%2532.9%Chronic Kidney Disease478.2%326.6%75.4%810.5%COPD13824.2%10822.2%2216.9%1621.1%Cardiovascular disease35762.5%27857.2%6146.9%5572.4%Hypertension44778.3%37176.3%8766.9%6382.9%Hyperlipidemia41873.2%35072.0%6650.8%4761.8%Malignancy12421.7%10120.8%1813.9%2026.3%Peripheral artery disease7413%5811.9%107.7%1114.5%T2DM31855.7%25151.7%5844.6%3748.7%

Note: Comorbidities and CCI was calculated for patients during follow-up in respective cohort

Conclusion:

Puerto Rican patients with RA have a significant burden of comorbidities, infections and hospitalisations. Trends indicate a variation in the burden by the type of treatment. Furthermore studies are warranted to better understand the potential healthcare implications of comorbidities in patients with RA.

References:

[1]Yun, Huifeng et al. “Comparative risk of hospitalised infection associated with biologic agents in rheumatoid arthritis patients enrolled in Medicare.” Arthritis & Rheumatology 68, no. 1 (2016): 56-66.

Disclosure of Interests:

Manasi Suryavanshi Consultant of: Bristol Myers Squibb, Sonick Suri Consultant of: Bristol Myers Squibb, Ying Bao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, Maribelis Ruiz Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vardhaman PATEL Employee of: Bristol Myers Squibb, Eory Madera-Miranda Employee of: Bristol Myers Squibb

Dynamics of cluster-forming hub-filament systems: The case of the high-mass star-forming complex Monoceros R2

CONTEXT

High-mass stars and star clusters commonly form within hub-filament systems. Monoceros R2 (hereafter Mon R2), at a distance of 830 pc, harbors one of the closest such systems, making it an excellent target for case studies.

AIMS

We investigate the morphology, stability and dynamical properties of the Mon R2 hub-filament system.

METHODS

We employ observations of the 13CO and C18O 1→0 and 2→1 lines obtained with the IRAM-30m telescope. We also use H2 column density maps derived from Herschel dust emission observations.

RESULTS

We identified the filamentary network in Mon R2 with the DisPerSE algorithm and characterized the individual filaments as either main (converging into the hub) or secondary (converging to a main filament) filaments. The main filaments have line masses of 30-100 M ⊙ pc-1 and show signs of fragmentation, while the secondary filaments have line masses of 12-60 M ⊙ pc-1 and show fragmentation only sporadically. In the context of Ostriker's hydrostatic filament model, the main filaments are thermally supercritical. If non-thermal motions are included, most of them are trans-critical. Most of the secondary filaments are roughly transcritical regardless of whether non-thermal motions are included or not. From the morphology and kinematics of the main filaments, we estimate a mass accretion rate of 10-4-10-3 M ⊙ yr-1 into the central hub. The secondary filaments accrete into the main filaments with a rate of 0.1-0.4×10-4 M ⊙ yr-1. The main filaments extend into the central hub. Their velocity gradients increase towards the hub, suggesting acceleration of the gas.We estimate that with the observed infall velocity, the mass-doubling time of the hub is ~ 2:5 Myr, ten times larger than the free-fall time, suggesting a dynamically old region. These timescales are comparable with the chemical age of the Hii region. Inside the hub, the main filaments show a ring- or a spiral-like morphology that exhibits rotation and infall motions. One possible explanation for the morphology is that gas is falling into the central cluster following a spiral-like pattern.

Permanent tooth agenesis in individuals with non-syndromic Robin sequence: a systematic review and meta-analysis

OBJECTIVES

To evaluate prevalence rates and patterns of permanent tooth agenesis in individuals with non-syndromic Robin sequence (ns-RS).

MATERIAL AND METHODS

Two investigators independently carried out a literature search, using PubMed, Web of Science, Ovid, EMBASE and the Cochrane Library, identifying articles relating to permanent tooth agenesis, diagnosed using panoramic radiographs, in individuals with ns-RS. The outcomes desired were prevalence rates and patterns of permanent tooth agenesis. The final search was carried out in January 2017.

RESULTS

Six articles were selected for inclusion, with a total of 448 individuals with ns-RS. Data available in each study varied which allowed conducting further specific meta-analyses only on sample sizes of 339 or 378 individuals from three or four of the six included articles. The overall estimated prevalence rate of permanent tooth agenesis was 42% (95% CI: 35%-48%), excluding third molars, with no sex predilection. In individuals with tooth agenesis, approximately 30% had one missing tooth while 40% had two missing teeth. Tooth agenesis was more commonly bilateral (Relative Risk 2) and found in the mandible (Relative Risk 1.6). The highest prevalence of permanent tooth agenesis was found for mandibular second premolars (26%) followed by maxillary second premolars (14%). The most common tooth agenesis patterns were the agenesis of both mandibular second premolars, followed by the agenesis of all second premolars.

CONCLUSION

Individuals with ns-RS have high prevalence rates of permanent tooth agenesis. The most prevalent tooth agenesis patterns are bilateral symmetric tooth agenesis, most commonly agenesis of both mandibular second premolars.

Impact of automated ICA-based denoising of fMRI data in acute stroke patients

Different strategies have been developed using Independent Component Analysis (ICA) to automatically de-noise fMRI data, either focusing on removing only certain components (e.g. motion-ICA-AROMA, Pruim et al., 2015a) or using more complex classifiers to remove multiple types of noise components (e.g. FIX, Salimi-Khorshidi et al., 2014 Griffanti et al., 2014). However, denoising data obtained in an acute setting might prove challenging: the presence of multiple noise sources may not allow focused strategies to clean the data enough and the heterogeneity in the data may be so great to critically undermine complex approaches. The purpose of this study was to explore what automated ICA based approach would better cope with these limitations when cleaning fMRI data obtained from acute stroke patients. The performance of a focused classifier (ICA-AROMA) and a complex classifier (FIX) approaches were compared using data obtained from twenty consecutive acute lacunar stroke patients using metrics determining RSN identification, RSN reproducibility, changes in the BOLD variance, differences in the estimation of functional connectivity and loss of temporal degrees of freedom. The use of generic-trained FIX resulted in misclassification of components and significant loss of signal (< 80%), and was not explored further. Both ICA-AROMA and patient-trained FIX based denoising approaches resulted in significantly improved RSN reproducibility (p < 0.001), localized reduction in BOLD variance consistent with noise removal, and significant changes in functional connectivity (p < 0.001). Patient-trained FIX resulted in higher RSN identifiability (p < 0.001) and wider changes both in the BOLD variance and in functional connectivity compared to ICA-AROMA. The success of ICA-AROMA suggests that by focusing on selected components the full automation can deliver meaningful data for analysis even in population with multiple sources of noise. However, the time invested to train FIX with appropriate patient data proved valuable, particularly in improving the signal-to-noise ratio.

Emphysema in heavy smokers with normal chest radiography: Detection and quantification by HRCT

Purpose: To determine the severity and extent of emphysema in heavy smokers by high-resolution CT (HRCT) and to correlate the findings with spirometric tests (STs) and symptomatology.

Material and Methods: Fifty adult smokers with a mean age of 53 years with a smoking history of more than 30 pack years and normal chest radiographs underwent HRCT of the chest and ST (FEV1, FEV1/FVC, PEFR). Among these, 22 had symptoms of pulmonary disease and 28 were asymptomatic. Quantification of emphysema was done using a density mask program and the visual scoring method. The results were correlated with ST and symptomatology.

Results: 58% (29 out of 50) of the subjects had significant emphysema on HRCT. Eleven out of 15 with normal ST showed emphysema on HRCT while 2 with airflow obstruction on ST showed normal CT scores. 14% (4 out of 28) asymptomatic subjects had severe emphysema compared to 64% of symptomatic subjects. Emphysematous changes were predominantly seen in upper lung zones in 48% of the patients while in 52% it was distributed equally in both upper and lower zones. The number of pack years of smoking showed a positive correlation with CT scores. The correlation between HRCT scores and ST was statistically significant.

Conclusion: A significant number of asymptomatic and clinically undiagnosed smokers tend to have significant emphysema. HRCT helps in early detection of disease and thus helps implementation of preventive measures.

Imaging of esophageal tuberculosis: A review of 23 cases

Purpose: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis.

Material and Methods: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment.

Results: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

Nitric oxide in human gingival crevicular fluid after orthodontic force application

Nitric oxide (NO) is involved in bone remodelling and has been shown to play a role in regulating the rate of orthodontic tooth movement (OTM) in rat models. In humans, however, the role of NO in OTM remains less clear. In this study, NO concentration in gingival crevicular fluid (GCF) was measured in patients undergoing orthodontic treatment. Thirteen male participants (ages 11-18 years) planned for non-extraction fixed orthodontic therapy were recruited. Samples of GCF were collected from each maxillary central incisor and first and second molar immediately before (T0), 1h after (T1), and 3-4 days after (T2) application of light orthodontic forces. The maxillary second molars were not included in the appliance and served as controls. Measureable NO levels were consistently obtained from all sampled sites. Total NO levels showed significantly higher NO levels (p<0.05) at T1 at the buccal surfaces of the central incisors when compared to the first and second molars. The results indicate a possible role for NO in OTM at the pressure sites of incisors at early time points. Further studies are required to determine whether NO levels in the periodontal ligament tissues of human teeth during OTM are affected by a force gradient and the magnitude of the applied force.

Differences in structural and pain phenotypes in the sodium monoiodoacetate and meniscal transection models of osteoarthritis

OBJECTIVES

To characterize differences in joint pathology and pain behavior between two rat models of osteoarthritis (OA) in order to inform selection of animal models for interventional studies.

METHOD

Knee OA was induced in Sprague Dawley rats by either meniscal transection (MNX) or intra-articular injection of monosodium iodoacetate (MIA). Controls were subjected to sham surgery or saline-injection. In a separate experiment, a single intra-articular injection of triamcinolone acetonide was administered 14 days after MNX or MIA arthritis induction. Pain behavior and joint pathology were quantified.

RESULTS

Both models displayed synovial inflammation, chondropathy and osteophytosis. Chondropathy scores increased with time similarly in the two models. Inflammation and osteophyte scores were greater in MNX model compared to the MIA model. At day 49, the MNX model exhibited a greater number of channels crossing the osteochondral junction compared to all other groups. The MNX model exhibited greater weight bearing asymmetry compared to the MIA model, whereas the MIA model displayed more consistent hindpaw allodynia. Triamcinolone attenuated weight bearing asymmetry and distal allodynia to control levels in the MNX model, but distal allodynia was unaltered in the MIA model.

CONCLUSIONS

The comparison of the two models of OA in rats, using identical assessment tools has demonstrated that although both models display features of OA, there are differences between the models which may represent different aspects of human OA. Thus, model selection should be based on the pathological aspects of OA under investigation.

2D-Ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia

OBJECTIVES

To study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome.

STUDY DESIGN

Prospective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE).

MAIN OUTCOME MEASURES

Basal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11-13 + 6 weeks, MS inhibin A at 15-22 weeks and birthweight centile at delivery.

RESULTS

In the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD.

CONCLUSION

The basal plate surface area at 11-14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE.

Comparison of helical and axial mode indirect computed tomographic venography in patients with pulmonary thromboembolism

OBJECTIVE

To compare the helical and axial modes of indirect computed tomographic (CT) venography (CTV) for accuracy for diagnosing deep venous thrombosis (DVT) of the lower extremities as well as for their radiation burden in patients proven to have pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA).

SUBJECTS AND METHODS

Of patients evaluated with CTPA for suspected acute PE, 20 of patients who were found to have PTE underwent both indirect CTV of the lower extremities and color Doppler examination. For indirect CTV, patients were randomly assigned to helical and axial modes. The CTV and Doppler findings were interpreted by two experienced radiologists who were blinded to the results of each other.

RESULTS

Out of total of 260 venous segments analyzed (130 venous segments each by helical or axial CTV), thrombi were seen in 43 venous segments (15 and 28 each by helical or axial CTV respectively). On comparison with Doppler, helical CTV had 82.35% sensitivity and 99.11% specificity, whereas axial CTV had 96.6% sensitivity and 100% specificity. The mean radiation dose was significantly higher for helical (1153.57 mgy.cm) as compared to axial mode CTV (806.28 mgy.cm) with P value of <0.0001.

CONCLUSION

Axial CTV results in decreased radiation dose without significant change in the accuracy, as compared to helical CTV in the evaluation of DVT.

Tuberculous meningo-encephalitis mimicking herpes simplex encephalitis on MRI

A 30-year-old man was admitted in PGIMER with the complaints of fever, altered sensorium and seizures. Magnetic resonance imaging (MRI) showed bilateral symmetrical temporal and frontal hyperintensities, which were highly suggestive of herpes simplex encephalitis. However, brain autopsy revealed it to be tuberculous meningo-encephalitis.

Production, characterization, in vitro and ex vivo studies of babchi oil-encapsulated nanostructured solid lipid carriers produced by a hot aqueous titration method

An aqueous dispersion of solid fat nanoparticles of babchi oil (BOSLN) was prepared by means of the hot water titration method. Surface morphology was determined by HR-TEM which revealed a fairly spherical shape of the formulations. Further they were evaluated for in vitro drug release characteristics and ex vivo skin permeation profile, zeta potential and particle diameter, rheological measures and droplet size distribution. Highest values for steady state flux (Jss), permeability coefficient (Kp) and enhancement ratio (Er) were observed for formulation, BOSLN3 comprised of oil [10% v/v; BO (3.33%), CAT (6.67%)], Tween 80 (9.25% v/v), transcutol-P (28.75% v/v) and distilled water (53% v/v). These results suggest that the studied SLN might be promising vehicles for babchi oil in the management of psoriasis.

Assessment of night eating syndrome among late adolescents

With the increase in the trend of social networking, celebrations, over a couple of decades weather in the hostel or at home. Snacking has become an important aspect of activity. Today teen prefer snacks more than a proper meal. Skipping of meal and nibbling in between meal is a common practice. The main meals (breakfast, lunch and dinner) are missed and total proportions of calories are consumed from the snacks eaten. Hence, this disordered eating behavior when continued may further lead to development of serious syndrome i.e., night eating syndrome. A purposive random sample comprising 188 males and 192 females (N=380), adolescents (18-22 years) were selected including hostlers and day scholars. The subjects were administered with self-organized questionnaire so to analyze the pattern of NES among them. Out of total 380 respondents, the numbers of hostlers were 211 and day scholars 169, while boys were 188 and girls were 192 in number. Results indicated that nearly half the percentage of adolescents snacked at night, out of which very few respondents met the criteria of NES, in which the number of hostlers were quite more than the day scholars, i.e.,76.3%.

Quercetin and its major metabolites selectively modulate cyclic GMP-dependent relaxations and associated tolerance in pig isolated coronary artery

BACKGROUND AND PURPOSE

Quercetin is a major flavonoid that contributes to the reduced risk of cardiovascular disease associated with dietary ingestion of fruits and vegetables. We have pharmacologically characterized the effect of quercetin, and its sulphate and glucuronide metabolites, on vasoconstrictor and vasodilator responses in the porcine isolated coronary artery.

EXPERIMENTAL APPROACH

Segments of the porcine coronary artery were prepared for either isometric tension recording or determination of cyclic GMP content. The effect of quercetin and metabolites on submaximal responses to U46619 was examined in the presence and absence of substance P, bradykinin, forskolin, sodium nitroprusside (SNP) and glyceryl trinitrate (GTN).

KEY RESULTS

Quercetin and quercetin 3'-sulphate inhibited endothelin and U46619-induced contractions with greater potency (three- to fivefold) against the former, while quercetin 3-glucoronide was inactive. Quercetin enhanced both the cyclic GMP content of the artery (threefold) and cyclic GMP-dependent relaxations to GTN and SNP (two to threefold), but forskolin-induced relaxations were unaffected. Although the effect of quercetin was qualitatively similar to that noted for UK-114,542, a selective inhibitor of phosphodiesterase 5, it was still evident against SNP-induced relaxations in the presence of 10 nM UK-114,542. Quercetin and quercetin 3'-sulphate significantly reduced the development of GTN-associated 'tolerance'.

CONCLUSIONS AND IMPLICATIONS

Quercetin and quercetin 3'-sulphate inhibited receptor-mediated contractions of the porcine isolated coronary artery by an endothelium-independent action. Quercetin selectively enhanced cyclic-GMP-dependent relaxations by a mechanism not involving phosphodiesterase 5 inhibition. In addition, quercetin and quercetin 3'-sulphate opposed GTN-induced tolerance in vitro, which may be beneficial for patients treated for angina pectoris.

Twin pregnancy presenting as a praevia complete hydatidiform mole and coexisting fetus complicated by a placental abscess

BACKGROUND

A twin pregnancy consisting of a complete hydatidiform mole and a coexisting normal fetus (CMCF) is a rare and challenging condition when diagnosed prenatally and is associated with major obstetric complications.

CASE REPORT

We present a case of CMCF in which the molar component presented as a major placenta praevia at 19 weeks, and which was complicated by a placental abscess with maternal septicaemia from 26 weeks. An emergency caesarean section, performed at 28 weeks' gestation due to severe maternal septicaemia, resulted in the delivery of a live male infant. Despite the molar mass being praevia, the delivery was not complicated by extensive haemorrhage.

CONCLUSION

This is only the second case of CMCF complicated by a molar praevia and the first complicated by a placental abscess. We believe that the 2 conditions are linked and that the absence of normal fetal membranes surrounding the molar mass enabled secondary colonization by vaginal bacteria. Therefore, we recommend that immediate antibiotic treatment is initiated in cases of CMCF presenting as a praevia when maternal and/or fetal symptoms of infection develop.

Multidetector CT angiography in Takayasu arteritis

OBJECTIVE

To analyse the spectrum of Takayasu's arteritis (TA) on multidetector CT angiography (MDCTA).

MATERIALS AND METHODS

A retrospective analysis of the MDCTA findings was performed on 15 patients clinically diagnosed as Takayasu's arteritis. The spectrum and incidence of imaging findings on CTA were compared to studies in literature on catheter angiography in Takayasu's arteritis. Laboratory parameters were available in nine patients. The disease was considered active if erythrocyte sedimentation rate (ESR) levels were elevated and 'C' reactive protein (CRP) was positive. An attempt was made to correlate disease activity with the imaging findings.

RESULTS

Ascending aorta, arch of aorta and descending thoracic aorta were involved in 14 out of 15 (93%) patients. The wall thickness varied between 1 and 10mm with maximal involvement in arch and descending thoracic aorta. Major neck vessels were involved in 11 (73%) patients with most pronounced changes seen in the brachiocephalic trunk, left common carotid artery (CCA) and left subclavian artery (SCA). Abdominal aorta and its branches were involved in all the 11 (100%) patients in whom abdominal CTA was performed. Celiac axis and SMA were involved in 10 (91%) and seven (64%) patients, respectively while renal artery stenosis was present in five (45%) patients. In six patients, ESR was elevated and CRP was positive indicating active disease. All patients in whom the laboratory parameters were available showed mural thickening in the aorta and at least one of the neck vessels except for one patient with inactive disease who had aortic mural thickening only.

CONCLUSION

MDCTA provides information about both the vessel wall and lumen in patients with Takayasu's disease.

Magnetic resonance imaging of brain in patients with cirrhotic and non-cirrhotic portal hypertension

BACKGROUND

Hyperintense signals in the basal ganglia, namely the globus pallidus, have been reported on magnetic resonance imaging (MRI) in 70-100% of patients with cirrhosis of the liver. Deposition of paramagnetic substances, particularly manganese (Mn), has been reported to be responsible for these hyperintense signals. They are found in cirrhotics with or without overt/subclinical hepatic encephalopathy. Deposition of Mn has been attributed to hepatocellular failure and/or portosystemic shunting. Reports of MRI brain findings in patients with extra hepatic portal venous obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF) are scanty in the literature.

AIMS

The purpose was to determine the basal ganglia changes on MRI in patients with EHPVO and NCPF and to compare it with patients with cirrhosis of the liver.

PATIENTS AND METHODS

A total of 27 patients (EHPVO = 10, mean age 28.4 +/- 19.0 years, NCPF = 7, mean age 37.1 +/- 10.4 years, cirrhosis = 10, mean age 47.0 +/- 19.6 years) was studied prospectively from January to December 2001. MRI of the brain was done with a standard spin echo axial T1- and fast spin echo T2-weighted scan obtained on a 1.5-T MRI unit. Two radiologists in a blinded fashion graded the signal intensity of basal ganglia on T1-weighted (T1 W) sequences by comparing it with the adjacent unaffected grey matter.

RESULTS

None of the patients with EHPVO or NCPF had any past history of hepatic decompensation and/or overt encephalopathy. Seven (70%) of the cirrhotics had a past history of overt encephalopathy. None of the patients with EHPVO showed any hyperintensity of basal ganglia on T1-weighted MRI images. Hyperintense globus pallidus was seen in four (57%) and eight (80%) patients with NCPF and cirrhosis, respectively.

CONCLUSION

Hyperintense globus pallidus on MRI is common in patients liver cirrhosis and also occurs in patients with NCPF. Patients with EHPVO do not have hyperintense globus pallidus on T1-weighted MRI images.

Dynamic Magnetic Resonance Imaging Evaluation of Craniovertebral Junction Abnormalities

OBJECTIVES

To evaluate the role of dynamic magnetic resonance imaging (MRI) in craniovertebral junction (CVJ) abnormalities.

MATERIALS AND METHODS

Twenty-five patients with suspected CVJ abnormalities underwent dynamic MRI of the CVJ, and in 20 of these patients, noncontrast computed tomography scan of the CVJ was done. The images were evaluated for atlantoaxial instability (AAI), spinal canal narrowing, cord compression, presence of altered cord signal intensity, and bony abnormalities in neutral, flexion, and extension.

RESULTS

Dynamic MRI detected 15 cases of AAI (10 fixed and 5 mobile AAI), 21 patients had varying degrees of spinal canal narrowing. Five patients showed increased narrowing on flexion/extension. Two patients demonstrated direct cord compression in flexion, whereas in neutral position, only dural compression was seen. One patient had cord compression on extension that was not seen in neutral or flexed position.

CONCLUSION

Dynamic MRI was able to detect cases of cord compression that were not seen in neutral position and was diagnostic in all cases of mobile AAI where mobility at this joint affects the treatment options. Dynamic MRI is extremely useful for evaluating craniovertebral junction abnormalities and, in particular, cord compression.

Comparison of multidetector computed tomographic colonography and conventional colonoscopy for detection of colorectal polyps and cancer

BACKGROUND

Computed tomographic colonography (CTC) is a new technique for detecting colonic neoplasms. Data on the utility of this method in the Indian population are limited.

METHODS

Forty-two patients with symptoms of colonic disease underwent CTC and conventional colonoscopy (CC) within one week of each other and the findings at these two investigations were compared.

RESULTS

The entire colon could be evaluated in 38 patients on CTC and in 23 patients on CC. Of the 19 patients who had incomplete CC, 14 had occlusive colonic lesions. Of the 86 lesions detected on CC, 76 (88.4%) were correctly identified on CTC with regard to location and size. CTC was false negative for 10 lesions and false positive for 5 lesions in 3 patients. The sensitivity and specificity of CTC were 65% and 77%, respectively, for lesions 1-5 mm; 97% and 83% for 6-9 mm-sized lesions; and 100% and 100% for lesions 10 mm or larger. Extracolonic findings were seen in 24 of 42 patients (57%).

CONCLUSIONS

CTC is reliable for detecting lesions 6 mm or larger in size. It permits evaluation of the region proximal to an occlusive growth, which is often not possible with CC.

Comparison of CT venography with MR venography in cerebral sinovenous thrombosis

OBJECTIVE

The purpose of this study was to compare cerebral CT venography with MR venography and determine the reliability of CT venography in the diagnosis of cerebral sinovenous thrombosis.

SUBJECTS AND METHODS

Fifty patients who were clinically suspected of having cerebral sinovenous thrombosis, irrespective of age and sex, underwent cerebral CT venography and MR venography. Projection venograms were displayed using maximum-intensity-projection images for both CT venography and MR venography. The CT venograms were also displayed using the integral algorithm, which depicts the average intensity value of the first five voxels deep in relation to the model surface that is nearest the viewer, allowing direct visualization of the thrombus in the sinuses. All CT venograms and MR venograms were independently evaluated by experienced neuroradiologists.

RESULTS

Of these 50 patients, 30 patients were diagnosed as having cerebral sinovenous thrombosis on both CT venography and MR venography. The total numbers of sinuses involved were 81 and 77 (CT venography and MR venography). When MR venography was used as the gold standard, CT venography was found to have both a sensitivity and a specificity of 75-100%, depending on the sinus and vein involved.

CONCLUSION

CT venography is as accurate as MR venography for diagnosing cerebral sinovenous thrombosis.

A polyherbal vaginal pessary with spermicidal and antimicrobial action: evaluation of its safety

A polyherbal vaginal pessary (Praneem) has been formulated that has antimicrobial properties against genital pathogens in addition to spermicidal action. Thus, it has dual potential as a barrier method for contraception and for providing protection against some sexually transmitted infections. The present study reports the findings of a multicentre trial that was conducted to evaluate the safety of this product. Trials were carried out in 23 women in three centres in India: the Postgraduate Institute of Medical Education and Research, Chandigarh; Safdarjang Hospital, New Delhi; and Kamla Nehru Memorial Hospital, Allahabad. Thorough clinical and pelvic examinations were carried out as well as cervical cytology, blood biochemistry and haematology before and after use of the polyherbal pessary intravaginally once daily for 7 consecutive days. No toxicity was observed on clinical examination or by laboratory investigations. Daily intravaginal use of this pessary for 7 days had no adverse effects on cervical cytology or on metabolic and organ functions.

Comparison Between Contrast-enhanced Magnetic Resonance Imaging and Technetium 99m Glucohepatonic Acid Single Photon Emission Computed Tomography With Histopathologic Correlation in Gliomas

OBJECTIVE

: To determine and compare the accuracy of contrast-enhanced magnetic resonance imaging (MRI) and Technetium 99m glucohepatonic acid single photon emission computed tomography (Tc-GHA SPECT) in grading of gliomas, compared with neuropathologic findings.

MATERIALS AND METHODS

: The study included 20 adult patients (13 men and 7 women) with clinical/radiological suspicion of brain tumor (glial tumor) who were subjected to magnetic resonance examination and Tc-GHA brain SPECT.The lesions were evaluated by using MRI imaging score, based on 9 MRI criteria. Based on the discrimination threshold of 0.9 for mean MRI score, the gliomas were graded as low- or high-grade glioma. The Tc-GHA SPECT retention index was calculated as the ratio between delayed and early uptake ratios. Based on the discrimination threshold of 1 for Tc-GHA SPECT retention index, the gliomas were graded as low- or high-grade glioma.The diagnosis was verified by means of histopathologic examination in all patients (open surgery in 19 patients and stereotactic biopsy in 1 patient). Correlation between MRI findings/scores, SPECT scores, and histopathologic grades was done in all the patients, and comparison between MRI and Tc-GHA SPECT was made using paired Student t test and correlation coefficient.

RESULTS

: The study revealed significant difference between the mean MRI scores and early uptake ratio, delayed uptake ratio, and retention index of low-grade (grades I-II) and high-grade (grades III-IV) gliomas. No statistically significant difference could be demonstrated between the abilities of contrast-enhanced MRI and Tc-GHA SPECT to allow differentiation between high- and low-grade gliomas. The accuracy of MRI (78.4%), however, was slightly higher than that of Tc-GHA SPECT (73.68%). However, Tc-GHA SPECT allowed differentiation between high-grade gliomas (between grades III and IV gliomas).

CONCLUSIONS

: The accuracy of contrast-enhanced MRI in the distinction of high- and low-grade malignancy was higher than that of Tc-GHA SPECT. The performance of Tc-GHA SPECT adds little in determining tumor grade when MRI is performed. However, it may act as a useful adjunct to differentiate between grades III and IV gliomas.

Arterial contamination: a useful indirect sign of cerebral sino-venous thrombosis

BACKGROUND

Various imaging findings of cerebral sino-venous thrombosis (CSVT) have been described on magnetic resonance venography (MRV).

OBJECTIVE

The purpose of this study was to evaluate the significance of visualization of the arterial system on cerebral MRV, also described as arterial contamination, as an indirect sign of CSVT.

METHODS

Forty patients with a clinical suspicion of venous sinus thrombosis underwent MR imaging of the brain, followed by MRV sequence, based on 2D time of flight technique in the coronal oblique plane. Patient's clinical symptoms and signs were noted with particular interest for papilloedema. Twenty-seven patients were diagnosed to have cerebral venous thrombosis on MRV, and of these, arterial contamination was visualized in 16 patients. In the remaining 13 cases, in which there was no evidence of venous sinus thrombosis, arterial contamination was absent. The sensitivity of this finding was 59.25% (n = 16/27), specificity was 100%, positive predictive value was 100% and negative predictive value was 54.2%. Of these 16 patients with arterial contamination, 12 patients had evidence of increased intracranial pressure in the form of papilloedema.

CONCLUSION

Visualization of the arterial system is a useful indirect sign of CSVT, and may be an indicator of increased intracranial pressure in these patients.

Is tongue thrust that develops during orthodontic treatment an unrecognized potential road block?

The role of tongue thrust has often been suspected, long debated and largely dispelled as a primary etiological factor of malocclusion. However, tongue thrust may contribute to poor occlusal intercuspation both during and after treatment. A tongue thrust may also develop during orthodontic mechanotherapy as a result of the transient creation of intra and interarch spaces and this little recognized phenomenon was found to occur in many randomly followed cases. In many instances, this seemingly adaptive and secondary response of the tongue posture and function may persist and thereafter impede the resolution of intra and interarch problems.

Calcified neonatal renal vein and vena caval thrombosis

We present an unusual case of an extensive venous thrombosis (involving the inferior vena cava, bilateral renal veins, gonadal vein and iliac veins) diagnosed in the neonatal period. The CT images revealed the typical diagnostic pattern.

MDCT in the staging of gallbladder carcinoma

OBJECTIVE

The purpose of our study was to determine the utility of dual-phase MDCT with 3D reconstruction in the staging and resectability of gallbladder carcinoma.

SUBJECTS AND METHODS

Twenty-seven consecutive patients with suspected gallbladder carcinoma on clinical examination and routine sonography were prospectively analyzed with dual-phase MDCT. Of these patients, only 20 who underwent a laparotomy for extended cholecystectomy or a palliative surgery were included in the study. Three-dimensional volume-rendered reconstruction was used for evaluation of the vascular invasion and anatomy. The staging and resectability as determined on CT were compared with preoperative findings.

RESULTS

On the basis of the CT findings, eight tumors were resectable and 12 were unresectable. On surgery, 11 tumors were found to be resectable and the remaining were unresectable. Overstaging by CT occurred in three patients due to overassessment of duodenal infiltration. CT had a sensitivity of 72.7%, a specificity of 100%, and an accuracy of 85% for determining resectability of gallbladder carcinoma. For the diagnosis of hepatic and vascular invasion by the tumor, there was 100% correlation between CT and surgery. Vascular variations were found in six of the 11 patients who underwent radical cholecystectomy.

CONCLUSION

Dual-phase MDCT with 3D reconstruction is a comprehensive imaging technique for staging gallbladder carcinoma and determining the vascular road map before surgery.

Preoperative embolization of a large vaginal leiomyoma: Report of a case and review of the literature

Leiomyoma of the vagina is a very rare tumour of the lower urogenital tract. These slow-growing masses may be asymptomatic or present with pain, dyspareunia or urinary symptoms. Rarely, these tumours may present with life-threatening haemorrhage. These hypervascular tumours are treated by surgical excision. Preoperative embolization therefore may aid in devascularization of these tumours before surgical excision. We present the MRI features of a case of vaginal leiomyoma, which was managed by preoperative embolization and was then excised in toto. To the best of our knowledge, this is the first report where preoperative embolization was performed before excision of a vaginal leiomyoma with minimal peroperative blood loss.

In vitro evaluation ofin situ gels as short term vitreous substitutes

Dysfunction of the vitreous humor, present in the posterior cavity of the eye, leads to its detachment from the retina and vision loss. In this study, biopolymers were evaluated as in situ gels for short term vitreous substitution. Biophysical characterization revealed that the viscosity of the vitreous was >4000 cP at a shear rate of 0.15/s and it formed a gel with elastic modulus G' greater than the viscous modulus G''. Biopolymers of gellan and hyaluronic acid (8:2 w/w, 1% concentration) were low viscosity liquids at 37 degrees C and gelation was triggered both by the addition of 0.18 mM CaCl(2) as well as ocular temperature, thus making them feasible as in situ gels. Gelation was confirmed by viscoelastic moduli where G' was greater than G'', similar to the vitreous and unlike that of silicone oil, a common vitreous substitute. The gels had a viscosity >5000 cP at a shear rate of 0.512/s, excellent light transmittance and absence of syneresis. Contact angle studies with water and simulated ocular fluids showed that gellan hyaluronic acid gels had similar wetting properties to that of vitreous with contact angles of 27 degrees +/- 1 degrees , 36.7 degrees +/- 1.6 degrees , and 33.7 degrees +/- 0.5 degrees for water, simulated tear fluid, and simulated aqueous humor, respectively. The results of this study suggest that biopolymers of gellan and hylauronic acid are suitable as in situ gels, have biophysical properties similar to that of the vitreous, and may be promising as alternatives to silicone oil as short-term vitreous substitutes.

Esophageal duplication cyst: an unusual cause of respiratory distress in infants

Esophageal duplication cysts are rare congenital anomalies. These should be recognized as a cause of respiratory distress in infants and are usually associated with feeding difficulties. We report 2 such cases of esophageal duplication cyst in infants, causing acute respiratory distress. Excision was curative.

Rosai-Dorfman disease: unusual cause of diffuse and massive retroperitoneal lymphadenopathy

Rosai-Dorfman disease (RDD), originally described as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. Patients usually present with massive cervical lymphadenopathy. However other nodal sites (mediastinal and inguinal) are also frequently involved. The retro-peritoneum is an infrequent site of involvement. This uncommon entity should also be included in the list of differential diagnoses of diffuse and massive lymphadenopathy, which includes includes infectious/granulomatous conditions, lymphomatous and metastatic disease.

Role of tissue harmonic imaging in focal hepatic lesions: comparison with conventional sonography

BACKGROUND

The purpose of the present study was to compare iissue harmonic imaging (THI) and conventional sonography in focal hepatic lesions.

METHODS

Fifty patients with focal hepatic lesions were enrolled for study. Conventional grayscale and THI was performed in all the patients and two sets of images of the lesions were recorded (one each for THI and conventional) and assessed for fluid-solid differentiation, detail and overall image quality. These images were compared with conventional sonographic images and graded better, same or worse as per the case. Lesions were confirmed by fine-needle aspiration cytology (FNAC)/surgery/other modalities such as computed tomography (CT) or magnetic resonance imaging (MRI).

RESULTS

Out of 50 patients with focal hepatic lesions, 21 patients had metastatic lesions (two single; 19 multiple) five patients had hepatocellular carcinoma (HCC), five patients had hydatid cysts, nine had simple hepatic cyst whereas five patients had liver abscess, three had focal fatty infiltration; and lymphoma and hemangioma were seen in one patient each. The first observer ranked THI better than standard sonography in 40 patients (80%) for fluid-solid differentiation, in 38 (76%) for detail and in 39 (78%) for overall image quality. The second observer ranked THI better than standard sonography in 39 patients (78%) for fluid-solid differentiation, in 40 (80%) for detail and in 42 (84%) for overall image quality. Tissue harmonic imaging provided additional information in eight patients (16%) and resulted in treatment alteration in three patients (6%).

CONCLUSION

Tissue harmonic imaging was significantly better than conventional sonography for fluid-solid differentiation, detail and total image quality in focal hepatic lesions, especially in obese patients and patients with poor acoustic window.

Retroperitoneal plexiform neurofibroma mimicking psoas abscesses

Retroperitoneal plexiform neurofibroma is a rare finding in neurofibromatosis type I, or von Recklinghausen's disease. A case of retroperitoneal plexiform neurofibroma mimicking psoas abscesses is reported here with its CT and MRI findings.

Case report: bilateral multilocular cystic nephromas: a rare occurrence

We present a rare case of bilateral renal cystic tumours in an 18-month-old female child, which proved to be cystic nephromas on imaging and histopathology. Although unilateral cystic nephromas are known in children; the occurrence of bilateral tumours is rare.