Base editing of key residues in the BCL11A-XL-specific zinc finger domains derepresses fetal globin expression

BCL11A-XL directly binds and represses the fetal globin (HBG1/2) gene promoters, using 3 zinc-finger domains (ZnF4, ZnF5, and ZnF6), and is a potential target for β-hemoglobinopathy treatments. Disrupting BCL11A-XL results in derepression of fetal globin and high HbF, but also affects hematopoietic stem and progenitor cell (HSPC) engraftment and erythroid maturation. Intriguingly, neurodevelopmental patients with ZnF domain mutations have elevated HbF with normal hematological parameters. Inspired by this natural phenomenon, we used both CRISPR-Cas9 and base editing at specific ZnF domains and assessed the impacts on HbF production and hematopoietic differentiation. Generating indels in the various ZnF domains by CRISPR-Cas9 prevented the binding of BCL11A-XL to its site in the HBG1/2 promoters and elevated the HbF levels but affected normal hematopoiesis. Far fewer side effects were observed with base editing- for instance, erythroid maturation in vitro was near normal. However, we observed a modest reduction in HSPC engraftment and a complete loss of B cell development in vivo, presumably because current base editing is not capable of precisely recapitulating the mutations found in patients with BCL11A-XL-associated neurodevelopment disorders. Overall, our results reveal that disrupting different ZnF domains has different effects. Disrupting ZnF4 elevated HbF levels significantly while leaving many other erythroid target genes unaffected, and interestingly, disrupting ZnF6 also elevated HbF levels, which was unexpected because this region does not directly interact with the HBG1/2 promoters. This first structure/function analysis of ZnF4-6 provides important insights into the domains of BCL11A-XL that are required to repress fetal globin expression and provide framework for exploring the introduction of natural mutations that may enable the derepression of single gene while leaving other functions unaffected.

Radioactive seed localization is a safe and effective tool for breast cancer surgery: an evaluation of over 25,000 cases

Radioactive seed localization (RSL) provides a precise and efficient method for removing non-palpable breast lesions. It has proven to be a valuable addition to breast surgery, improving perioperative logistics and patient satisfaction. This retrospective review examines the lessons learned from a high-volume cancer center's RSL program after 10 years of practice and over 25 000 cases. We provide an updated model for assessing the patient's radiation dose from RSL seed implantation and demonstrate the safety of RSL to staff members. Additionally, we emphasize the importance of various aspects of presurgical evaluation, surgical techniques, post-surgical management, and regulatory compliance for a successful RSL program. Notably, the program has reduced radiation exposure for patients and medical staff.

Eco-safe composite edible coating of hydrocolloids with papaya leaf extract improves postharvest quality and shelf life of papaya fruit under ambient storage

Papaya postharvest management using low-temperature storage is discouraged as it is a tropical fruit. Extensive research is going on to preserve papaya quality at ambient storage using edible coatings and its composites. The present investigation examined the effects of an eco-safe composite edible coating consisting of hydrocolloid carboxymethyl cellulose (CMC) (1%), guar gum (1.5%), xanthan gum (0.3%), and Gum Arabic (10%) combined with papaya leaf extract (PLE) (1:1 ratio by volume) applied as dip treatment on "Red Lady" papaya fruit at ambient storage condition. Among all the attempted treatments, "PLE incorporated with CMC (1%)" was found to be the best, as the treated fruit exhibited the highest levels of biochemicals, whereas the lowest levels of physiological and enzymatic activity, which positively affected the shelf life. The "CMC + PLE" treatment enhanced the fruit gloss score by 70.1%, phenolics by 6.1%, ascorbic acid by 22.3%, total carotenoid content by 7.4%, and fruit predilection score by 22.0% over the control fruit. However, it lowered (controlling) the physiological loss in weight by 51.0%, decay incidence by 66.6%, and polygalacturonase and pectin methylesterase activity by 24.92% and 35.29%, respectively, over control. Moreover, this treatment exhibited the highest fruit purchase predilection score and prolonged the storage life for >3 days on the physiological loss standard basis (≤10%). This study indicates that "CMC (1%) with PLE (1:1)" composite coating application on papaya under ambient conditions might be an effective, environmentally friendly, and health-friendly way to retain the quality and extend the storage life.

Characterization of bioactive and fruit quality compounds of promising mango genotypes grown in Himalayan plain region

Twenty mango genotypes grown in the plains of the Himalayas were characterized by their physical, physiological, biochemical, mineral and organoleptic attributes: fruit firmness, weight, peel thickness, shape, dry seed weight, respiration rate, weight loss, and shelf life. Biochemical attributes such as soluble solids, total carotenoids, total phenolic content, antioxidant activity, titratable acidity, ascorbic acid and total sugars were also determined. In addition, mineral content and fruit-softening enzymes were measured, and an organoleptic evaluation was performed. Polygalactouronase (PG), pectin methylesterase (PME) and lipoxygenase (LOX) were measured from the pulp adjacent to the peel. Similarly, biochemical attributes and mineral content were evaluated using fruit pulp, while organoleptic evaluation included fruit pulp characters and the fruit's external appearance. The results of the study showed that the 'Malda' genotype exhibited the highest total phenolic content (560.60 µg/100 g), total antioxidant (5.79 µmol TE/g), and titratable acidity (0.37%) among the tested genotypes. 'Amrapali' had the highest soluble solid content (25.20 °B), 'Jawahar' had the highest ascorbic acid content (44.20 mg/100 g pulp), 'Mallika' had the highest total flavonoid content (700.00 µg/g) and 'Amrapali' had the highest total carotenoid content (9.10 mg/100 g). Moreover, the genotypes 'Malda', 'Safed Malda'and 'Suvarnarekha' had a shelf life of 4-5 days longer than other tested genotypes. The genotypes with high biochemical attributes have practical utility for researchers for quality improvement programmes and processing industries as functional ingredients in industrial products. This study provides valuable information on the nutritional and functional properties of different mango genotypes, which can aid in developing improved varieties with enhanced health benefits and greater practical utility for processing industries.

Impact of shield location on staff and caregiver dose rates for I-131 radiopharmaceutical therapy patients

The goal of this study is to investigate the effect of the location and width of a single lead shield on the dose rate of staff and caregivers in a hospital room with an I-131 patient. The best orientation of the patient and caregiver relative to the shield was determined based on minimizing staff and caregiver radiation dose rates. Shielded and unshielded dose rates were simulated using a Monte Carlo computer simulation and validated using real-world ionisation chamber measurements. Based on a radiation transport analysis using an adult voxel phantom published by the International Commission on Radiological Protection, placing the shield near the caregiver yielded the lowest dose rates. However, this strategy reduced the dose rate in only a tiny area of the room. Furthermore, positioning the shield near the patient in the caudal direction provided a modest dose rate reduction while shielding a large room area. Finally, increased shield width was associated with decreasing dose rates, but only a four-fold dose-rate reduction was observed for standard width shields. The recommendations of this case study may be considered as potential candidate room configurations where radiation dose rates are minimized, however these findings must be weighed against additional clinical, safety, and comfort considerations.

Efficient and error-free correction of sickle mutation in human erythroid cells using prime editor-2

Sickle cell anaemia (SCA) is one of the common autosomal recessive monogenic disorders, caused by a transverse point mutation (GAG > GTG) at the sixth codon of the beta-globin gene, which results in haemolytic anaemia due to the fragile RBCs. Recent progress in genome editing has gained attention for the therapeutic cure for SCA. Direct correction of SCA mutation by homology-directed repair relies on a double-strand break (DSB) at the target site and carries the risk of generating beta-thalassaemic mutations if the editing is not error-free. On the other hand, base editors cannot correct the pathogenic SCA mutation resulting from A > T base transversion. Prime editor (PE), the recently described CRISPR/Cas 9 based gene editing tool that enables precise gene manipulations without DSB and unintended nucleotide changes, is a viable approach for the treatment of SCA. However, the major limitation with the use of prime editing is the lower efficiency especially in human erythroid cell lines and primary cells. To overcome these limitations, we developed a modular lenti-viral based prime editor system and demonstrated its use for the precise modelling of SCA mutation and its subsequent correction in human erythroid cell lines. We achieved highly efficient installation of SCA mutation (up to 72%) and its subsequent correction in human erythroid cells. For the first time, we demonstrated the functional restoration of adult haemoglobin without any unintended nucleotide changes or indel formations using the PE2 system. We also validated that the off-target effects mediated by the PE2 system is very minimal even with very efficient on-target conversion, making it a safe therapeutic option. Taken together, the modular lenti-viral prime editor system developed in this study not only expands the range of cell lines targetable by prime editor but also improves the efficiency considerably, enabling the use of prime editor for myriad molecular, genetic, and translational studies.

Evaluation of 30-day morbidity and mortality of laparoscopic cholecystectomy: a multicenter prospective observational Indian Association of Gastrointestinal Endoscopic Surgeons (IAGES) Study

BACKGROUND

Laparoscopic cholecystectomy (LC) is the standard of care for benign gallstone disease. There are no robust Indian data on the 30-day morbidity and mortality of this procedure. A prospective multicentre observational study was conducted by the Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) to assess the 30-day morbidity and mortality of LC in India.

MATERIALS AND METHODS

Participating surgeons were invited to submit data on all consecutive LCs for benign diseases performed between 09/12/2020 and 08/03/2021 in adults. Primary outcome measures were 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify variables significantly associated with primary outcomes.

RESULTS

A total of 293 surgeons from 125 centres submitted data on 6666 patients. Of these, 71.7% (n = 4780) were elective. A total LC was carried out in 95% (n = 6331). Laparoscopic subtotal cholecystectomy was performed in 1.9% (n = 126) and the procedure were converted to open in 1.4% of patients. Bile duct injury was seen in 0.3% (n = 20). Overall, 30-day morbidity and mortality were 11.1% (n = 743) and 0.2% (n = 14), respectively. Nature of practice, ischemic heart disease, emergency surgery, postoperative intensive care, and postoperative hospital stay were independently associated with 30-day mortality. Age, weight, body mass index, duration of symptoms, nature of the practice, history of Coronavirus Disease-2019, previous major abdominal surgery, acute cholecystitis, use of electrosurgical or ultrasonic or bipolar energy for cystic artery control; use of polymer clips for cystic duct control; conversion to open surgery, subtotal cholecystectomy, simultaneous common bile duct exploration, mucocele, gangrenous gall bladder, dense adhesions, intraoperative cholangiogram, and use of drain were independently associated with 30-day morbidity.

CONCLUSION

LC has 30-day morbidity of 11.1%, 30-day mortality of 0.2%, conversion to open rate of 1.4%, and bile duct injury rate of 0.3% in India.

SUBSTANTIAL EXTERNAL DOSE RATE VARIABILITY OBSERVED IN A COHORT OF LU-177 PATIENTS INDEPENDENT OF BMI AND SEX

External dose rates were measured 1 m away from 230 Lu-177 patients to characterise the variability in normalised dose rates as a function of administered activity, body mass index (BMI) and sex. The largest dose rate observed was 0.07 mSv/h associated with an administered activity of 7.2 GBq. Substantial variability was found in the distribution of the normalised dose rate associated that had an average of 0.0037 mSv/h per GBq and a 95% confidence interval of 0.0024-0.0058 mSv/h per GBq. Based on this study, estimating the patient dose rate based on the Lu-177 gamma exposure factor overestimates the dose rate by a factor of 2. A statistically significant inverse relationship was found between the patient dose rate and patient BMI and an empirically derived equation relating these two quantities was reported. On average, male patient dose rates were 3.5% lower than female dose rates, which may be attributed to the larger average BMI of the male patient group.

173 Debridement, Antibiotics and Implant Retention (DAIR) in the Management of Prosthetic Joint Infections Following Primary Hip and Knee Arthroplaty: A DGH Experience

Aim

Prosthetic joint infections (PJI) are a devastating complication of arthroplasty surgery. Current gold standard one or two-stage revision, poses sincere surgical challenges and carry significant patient morbidity. If diagnosed promptly, a debridement, antibiotics, and implant retention (DAIR) procedure can be performed. We report the results of our experience with the DAIR procedure in a District General Hospital setting.

Method

Our study comprises of a single centre retrospective review of a prospectively updated database. All patients who underwent a DAIR procedure following hip or knee arthroplasty from August 2012 to July 2019 were included in the study with no exclusions.

Results

Four total knee replacements, sixteen total hip replacements (THR), two revision THR and three hemiarthroplasties were included in the study. Average duration from onset of symptoms to DAIR was 22 days for immediate post-operative patients and 6 days in patients presenting later with an acute infection. All patients had exchange of modular components during the DAIR procedure. Out of 25 DAIR procedures, 23 identified a positive microbiology culture. Most common causative organisms identified were Staphylococcos aureus (23%) and Staphylococcus epidermidis (23%). Average follow up in clinic was 55 months. 76% of patients had a stable post-operative recovery with no recurrence of infection. One patient required a revision THR for aseptic loosening; one patient required a knee arthrodesis and four patients died.

Conclusions

Infection was successfully eradicated in 19 patients. The success reported within the literature stem predominantly from tertiary units. Our study reflects this success in a DGH setting.

Mechanical, viscoelastic and gas transport behaviour of rotationally molded polyethylene composites with hard- and soft-wood natural fibres

Rotomolded uncompatibilized composites of LLDPE with softwood and hardwood flour dispersed phases are compared and contrasted with respect to their static (tensile, flexural and impact) and dynamic (creep modelling, storage and loss moduli) mechanical properties and transport (oxygen permeability). The static and dynamic mechanical properties are analysed as a function of dispersed phase weight fraction and pre and post ethanol sorption. Vital structural properties such as the equilibrium modulus, Kelvin Voigt modulus, Kelvin Voigt viscosity and relaxation times along with creep compliance trends are analysed. The interfacial porosity generated is then correlated to the overall gas transport using oxygen as the probe molecule. Two models are compared and it is found that the model of Alter which uses overall density as the modelling parameter, is able to predict composite gas permeability with high accuracy. Overall, owing to the uncompatibilized nature, most mechanical properties reduce with wood flour incorporation independent of the type of dispersed phase. However, these properties remain consistent pre and post ethanol sorption as long as the dispersed phase weight fraction is around 5%. This indicates that with some external scaffolding type support structures, the rotomolded composites have potential for use as storage units for liquid materials.

Graphical abstract

375 Discitis – A large cohort analysis of its management in a tertiary orthopaedics centre

Aim

Discitis is characterized as an infection of the intervertebral disc. It classically presents with fever and back pain. However, varied presentation and lack of adherence to guidelines leads to significant variation in its identification and management. We assessed adherence to guidelines, in the management of Discitis, in a tertiary orthopaedic centre.

Method

A retrospective study was conducted in a tertiary orthopaedic centre, between January 2017-September 2019. The study analysed patients with Magnetic Resonance Imaging (MRI) proven discitis.

Results

Out of the 305 spine MRIs reported as discitis, 152 (35%) had discitis based on imaging and only 38 patients (55%) clinically correlating, presenting symptoms. Back pain (47.3%) was the most common presenting complaint followed by fever. The commonest site of involvement was the lumbar vertebrae (70.4%). All patients had a baseline C-reactive protein and 34 (92.11%) had blood cultures taken. 70.5% patients with negative blood culture had Computerised Tomography (CT) -guided biopsy. Staphylococcus aureus was the most commonly isolated organism. Treatment was commonly with intravenous Flucloxacillin with 63% of the patients being treated for 6 weeks or more.

Conclusions

A structured follow up protocol will now be implemented within our centre. This will aim on correcting common errors within the management of discitis, including blood cultures prior to starting antibiotics and CT guided biopsies if blood cultures remain negative. We hope that the above will help achieve higher success rate in outcome of discitis.

Identification of novel HPFH-like mutations by CRISPR base editing that elevate the expression of fetal hemoglobin

Naturally occurring point mutations in the HBG promoter switch hemoglobin synthesis from defective adult beta-globin to fetal gamma-globin in sickle cell patients with hereditary persistence of fetal hemoglobin (HPFH) and ameliorate the clinical severity. Inspired by this natural phenomenon, we tiled the highly homologous HBG proximal promoters using adenine and cytosine base editors that avoid the generation of large deletions and identified novel regulatory regions including a cluster at the –123 region. Base editing at –123 and –124 bp of HBG promoter induced fetal hemoglobin (HbF) to a higher level than disruption of well-known BCL11A binding site in erythroblasts derived from human CD34+ hematopoietic stem and progenitor cells (HSPC). We further demonstrated in vitro that the introduction of –123T > C and –124T > C HPFH-like mutations drives gamma-globin expression by creating a de novo binding site for KLF1. Overall, our findings shed light on so far unknown regulatory elements within the HBG promoter and identified additional targets for therapeutic upregulation of fetal hemoglobin.

560 Case Report: A Very Rare Case of Incidentaloma of a Large Adrenal Cavernous Haemangioma

Introduction

Incidentaloma are asymptomatic and unanticipated adrenal tumours found on radiological imaging for unrelated diagnostic inquiries. Adrenal cavernous haemangioma is a rare, differentiated and benign tumour arising from the endothelial layer of blood vessels. This is a rare phenomenon with only 66 cases reported in the literature between 1955 and 2018.

Case Details

This is a case of a 79-year-old Caucasian gentleman who presented in March 2020 with vague abdominal discomfort and anaemia on a background of multiple co-morbidities including in particular, an asymptomatic left 5.6cm adrenal incidentaloma found in 2014. A computed tomography scan of abdomen-pelvis in June 2020 revealed progression in size of the incidentaloma to 20.8cm. Biochemical tests confirmed non-functioning adrenal tumour. The patient underwent open left adrenalectomy, left nephrectomy, splenectomy and distal pancreatectomy. The diagnosis of adrenal cavernous haemangioma was subsequently made on histopathological examination. Post-operatively, our patient made a good physiological recovery.

Discussion

There are no established diagnostic and treatment guidelines for adrenal cavernous haemangioma. Larger tumours are often treated surgically to exclude malignancies and to prevent potential complications as well as symptom relief. Literature reviews showed that most cases were surgically managed, and diagnoses were made through histology post-operatively.

Conclusions

Adrenal cavernous haemangioma typically present as incidentalomas which require further investigations. They are very rare non-functioning benign tumours that can be difficult to be differentiated from other adrenal malignancies.

P–172 Data-independent acquisition-proteomics of human embryo-spent medium and identification of potential embryo biomarkers

Study question

Can human embryo-derived protein(s) serve as viability biomarkers to predict pregnancy outcome, post embryo transfer?

Summary answer

The human embryo-spent medium proteome, using data-independent acquisition (DIA) approach, could identify novel biomarkers for use in elective embryo transfer.

What is known already

Morphological assessment is used for elective embryo transfer. To improve IVF outcomes and to avoid multiple gestations, embryo-viability assessment is required toward single embryo transfer. Embryo proteomics could provide a non-invasive approach to assess embryo viability. With the advent of DIA mode proteomics, a robust proteome of E-SM could be determined.

Study design, size, duration

This was a retrospective study performed between May and December, 2020 using ten E-SMs obtained from ten individual transferable-quality embryos. Frozen E-SMs, following post-thaw, were subjected to LC-MS-MS analysis. Identified proteome profiles were being potentially correlated to embryo quality scores and pregnancy outcomes in terms of live births.

Participants/materials, setting, methods

The E-SMs were processed for proteomic analysis and subjected to reduction, alkylation and trypsin digestion. Trypsin digested samples were desalted followed by LC-MS/MS using DIA method. Obtained results were searched against human peptide spectral library using Skyline. Differentially expressed proteins were identified by MSStat. Individual peptide peak area under the curve was normalized and analyzed using Student t-test. Fold change was calculated to identify differentially regulated proteins in blank and E-SM samples.

Main results and the role of chance

Using a high-resolution mass spectrometer and high throughput DIA method, we identified 5,502 peptides corresponding to 3,396 proteins from blank and E-SM samples, derived from five non-transferred embryos. We observed that 516 proteins were specific to E-SMs vies-a-vies those of embryo-free blank medium. Statistical analysis showed that 25 proteins were significantly present E-SMs vs. blank. Interestingly, we observed that 16 proteins were down regulated and 9 were up regulated in E-SMs vs. blank medium. Furthermore, E-SMs, from transferred embryos, contained 2,467 peptides corresponding to 1,741 proteins; of these, 1, 689 proteins were specific to E-SMs with 60 (58 down regulated and 2 up regulated) of them being significantly expressed in E-SMs vis-à-vis embryo-free blank medium. Considering the available met analysis published data, our study is the first to use DIA acquisition for high-throughput analysis of human embryo proteome and identification of biomarkers of embryo viability and for possible prediction of pregnancy outcome.

Limitations, reasons for caution

Proteins, other than HAS, detected in the blank medium could be because of non-purified HAS or undeclared proteins and DIA approach used. A large cohort study and meta-analysis using DIA mode are required to establish the embryo-proteome having predictive potential for embryo biological viability.

Wider implications of the findings: For the first time, using DIA mode, a global embryo proteome assessment could be made, establishing a novel embryo viability biomarkers. This, along with the morphological analysis, could be practiced for selection of transferable quality embryo(s)

Trial registration number

Not applicable

Fixed point results for weak contractions in partially ordered b-metric space

OBJECTIVES

We explore the existence of a fixed point as well as the uniqueness of a mapping in an ordered b-metric space using a generalized [Formula: see text]-weak contraction. In addition, some results are posed on a coincidence point and a coupled coincidence point of two mappings under the same contraction condition. These findings generalize and build on a few recent studies in the literature. At the end, we provided some examples to back up our findings.

RESULT

In partially ordered b-metric spaces, it is discussed how to obtain a fixed point and its uniqueness of a mapping, and also investigated the existence of a coincidence point and a coupled coincidence point for two mappings that satisfying generalized weak contraction conditions.

Impact of water deficit stress in maize: Phenology and yield components

Fifteen million farmers in India engaged in Maize cultivation. India would require 45 MMT of Maize by 2022. But, only 15% of cultivated area of maize is under irrigation and water shortage has been a challenge for sustainability of maize production. Water deficit stress (WDS) during pre-flowering and grain filling stages massively affects the plant performance due to imprecise traits function. Thus, the effect of WDS on non-drought tolerant (NDT) and drought tolerant (DT) maize lines were investigated. WDS increased the flowering days, days to maturity, anthesis silk interval, decreased the leaf number, abnormal expression of secondary stress responsive traits, loss of normal root architecture which overall lead to a reduction in GY/ha. WDS at flowering and grain filling stage leads to significant yield penalty especially in NDT lines than DT lines. The yield penalty was ranged from 34.28 to 66.15% in NDT and 38.48 to 55.95% in DT lines due to WDS. Using multiple statistics, traits which improve WDS tolerance in maize were identified viz; number of leaves, number of stomata on lower surface of leaf, leaf angle at ear forming node internodal length between 3^rd and 4^th leaf from top, flag leaf length, flag leaf width, ear per plants, leaf senescence, pollen stainability, root fresh weight and root length. These traits would help in trait specific breeding in maize for WDS tolerance.

P5718Effects of the fluoroquinolones moxifloxacin and levofloxacin on the QT subintervals: sex differences in ventricular repolarization

Background

The effects of medicines affecting cardiac repolarization can be further evaluated by assessing the balance of inward and outward currents. These can be detected in the ECG by analysing the QT subintervals. Pure hERG potassium channel block was shown to prolong both early repolarization (J-Tpeak) and late repolarization (Tpeak-Tend), whereas multichannel blockers may shorten or have no effect on J-Tpeak.

The gender dependency of ventricular repolarization is also well known. Recently, Matsukura indicated that moxifloxacin significantly increased J-Tpeak and Tpeak-Tend and females in their study were more sensitive than males to the drug-induced J-Tpeak prolongation and QTcF.

Purpose

The purpose of the present study is to use data from two Thorough QT (TQT) studies to characterize the differences in depolarization (QRS), early repolarization (J-Tpeak), and late repolarization (Tpeak-Tend) between moxifloxacin and levofloxacin and further define the sex differences in QTc and subintervals.

Methods

Data from two TQT studies were used to further investigate the impact of moxifloxacin (400 mg) and levofloxacin (1000 and 1500 mg) on QT subintervals using validated algorithms for measurement of QRS, J-Tpeak and Tpeak–Tend intervals. Concentration-effect analyses were performed to establish a potential relationship between the ECG effects and the concentrations of the two fluoroquinolones as typically males and females also show differences in plasma concentrations due to differences in body weight.

Results

The relationships between moxifloxacin and levofloxacin plasma concentrations and their respective predicted ΔΔQTcF, ΔΔQRS, ΔΔJ-Tpeakc and ΔΔTpeak-Tend values are shown in Fig 1.

The plasma concentrations were higher for females than males in both drugs.

Moxifloxacin was shown to be a more potent prolonger of QTcF and had a pronounced effect on J-Tpeakc, consistent with its effects on both IKr and IKs channels while levofloxacin had little effect on J-Tpeakc. For moxifloxacin, the concentration-effect modelling showed a greater effect for females on QTcF and J-Tpeakc while for levofloxacin the inverse was true. Based on the assumption that repolarization reserve of females relies to a greater extent on IKs channels it would be reasonable to assume that they are more affected by a medicine that blocks IKs in addition to IKr.

Figure 1

Conclusions

This study showed that levofloxacin elicited a smaller ΔΔQTcF and ΔΔJ-Tpeakc prolongation when compared to moxifloxacin. The results of this study also showed a different pattern of sex difference in repolarization after administration of both drugs. which may suggest a difference in expression of IKs and possibly IKr channels.

Hay Fever Treatment in General Practice: A Randomised Controlled Trial Comparing Standardised Western Acupuncture with Sham Acupuncture

The effect of standardised, Western acupuncture on hay fever symptoms was investigated in a randomised, controlled, single-blind trial in comparison with “sham” acupuncture. Three general practices, in Oxfordshire (rural), Lincolnshire (semi-rural), and Peterborough (urban), recruited 102 patients aged 16 or over with long-standing, moderate or severe hay fever symptoms that had required continuous therapy for at least one month of the year for three or more consecutive years.

The patients were asked to keep a diary to record: the amount of medication used daily; a daily symptom score (using a ten-point scale), from which was derived a weekly remission of symptoms score; and their assessment of the effect of acupuncture on the hay fever symptoms. Symptom scores and use of medication were similar in the two groups. In the four-week period following each patient's first treatment, remission of symptoms was reported by 39.0% in the active treatment group and 45.2% in the sham group; mean weekly symptom scores were 18.4 and 17.6 respectively; and mean units of medication used were 4.1 and 5.0 respectively. Sixteen out of 43 patients in the active treatment group and 14 out of 43 in the sham group felt that the acupuncture had had an excellent or very good effect on their hay fever. The treatments were simple, safe, reproducible and perceived as equally effective. Whether this represented an acupuncture effect, a placebo effect, or natural variation in a fluctuating condition, is not clear.

Acute-onset Restless legs syndrome in acute neurological conditions-a prospective study on patients with the Guillain-Barre syndrome and acute stroke

OBJECTIVES

While the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological illnesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate characteristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS.

METHODS

Consecutive patients diagnosed with GBS and eligible stroke patients, admitted to our Neurology services over a 1-year period, were enrolled. They were evaluated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP).

RESULTS

Forty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly monophasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P = .024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P < .001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists.

CONCLUSION

This is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population.

Detection of Cytochrome P450 Polymorphisms in Breast Cancer Patients May Impact on Tamoxifen Therapy

Background:

Breast cancer is the most common cancer among women worldwide. Tamoxifen (TAM), a selective estrogen receptor modulator, is widely used in its treatment. TAM is metabolized by cytochrome P450 (CYP450) enzymes, including CYP2D6, CYP3A5 and CYP2C19, whose genetic variations may have clinicopathological importance. However, reports on the association of various P450 polymorphisms with certain cancers are contradictory.

Methods:

We here investigated whether the prevalence of the four most common polymorphism in the CYP2D6*4 (G1934A), CYP2D6*10 (C188T), CYP3A5*3 and CYP2C19*2 alleles has any link with breast cancer using genomic DNA and polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis.

Results:

Prevalences of CYP2D6*4, CYP2D6*10 and CYP2C19*2 genotypes were differed significantly (P = 0.01 and P = 0.004) between breast cancer patients and controls. The CYP3A5*3 genotype did not demonstrate statistically significant variation.

Conclusion:

Polymorphisms in CYP2 appear to be associated with breast cancer risk. Our data taken together with other reports indicates that drug resistance gene polymorphisms might be indicators of response to tamoxifen therapy in breast cancer cases.

Rare Association of Waardenburg Syndrome with Minimal Change Disease

Waardenburg syndrome (WS) is a rare genetic disorder characterized by varying degrees of hearing loss, pigmentary anomalies, and defects of other neural crest cell-derived structures. The association of WS with renal anomalies has been described in the literature. However, nephrotic syndrome is a very rare association with WS, and only one case has been reported in the literature. We report a case of WS2 associated with biopsy-proven nephrotic syndrome (minimal change disease).

Persistent Left Superior Vena Cava in a Hemodialysis Patient

Awareness of persistent left superior vena cava (PLSVC), a rare congenital variant is helpful to a clinician to avoid the unnecessary complications. We report a case of PLSVC in a patient with chronic kidney disease which was identified following a difficult catheterization into the right internal jugular vein (IJV). The catheterization was attempted through the left IJV and the position of which could not be confirmed with check radiograph and two-dimensional echo. PLSVC was suspected in the computed tomography angiography and was confirmed following digital subtraction angiography.

Comorbid depressive symptoms in persistent delusional disorder: A retrospective study from India

Background

Previous studies have reported depressive symptoms in patients with persistent delusional disorder (PDD). Patients with PDD and depression may need antidepressants for treatment.

Aim

The aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms.

Methods

We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis.

Results

Of the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P > 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P < 0.05). There was no significant difference between the clinical presentation including mode of onset, the main theme of their delusion and secondary delusions (all P > 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([> 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001).

Discussion

Patients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Design of new multi-channel electrodes for surface electromyography signals for signal-processing

This paper covers the design aspects of a new multi-channel electrode for the acquisition of surface electromyography signals from a selected muscle. The new multi-channel electrode has 11 pins where the monopolar signals produced will be configured in a software either as Linear array or Laplacian configuration. The design specification of the pre-amplifier ideally was to have a voltage gain of 500 with bandpass filtering of 5 Hz-1 kHz. The final design of the pre-amplifier circuit using an INA 118 instrumentation amplifier was built and tested to give values for voltage gain of 484 with bandpass filtering of 6.8 Hz-1.02 kHz. The software configuration that gives clearer and more defined signals in terms of motor unit action potentials for future signal processing is the Laplacian rather than Linear array.