Phenotypic amikacin resistance may not indicate poor response to amikacin in Mycobacterium avium complex pulmonary disease

When using amikacin to treat Mycobacterium avium complex pulmonary disease (MAC-PD), a minimum inhibitory concentration resistance breakpoint of ≥64 mcg/mL is recommended. We explored whether amikacin resistance characterized by phenotypic drug susceptibility testing was associated with clinical outcomes or mutational resistance in a retrospective cohort of patients with MAC-PD. Despite little aminoglycoside exposure, amikacin resistance was common in our MAC-PD patients but was not associated with worse outcomes or rrs gene mutations.

A "Two-Step" Electrochemical Approach for Recovery of Plutonium and Uranium from Aqueous Acidic Waste Solutions

Chemical quality control of nuclear fuel, particularly the determination of Pu and U contents by chemical methods, results in analytical acidic aqueous waste solutions from which Pu and U must be recovered efficiently for the remediation of radioactive wastes. Reported methods involve several complicated steps requiring addition of chemical oxidants/reductants for valence adjustments and generation of secondary wastes, thereby making the recovery process cumbersome. Herein, we report a novel two-step electrochemical approach for Pu and U recovery from acidic aqueous waste solutions containing different metallic impurities (Fe, Cr, Mn, Cd, Al, Ni, Co, Zn, and Mg) by bulk electrolysis using a Pt gauze electrode. Pu and U are recovered from these waste solutions in a two-step process: (i) bulk electrolysis of the mixed solution at a constant potential of 0.1 V vs Ag/AgCl/3 M KCl that results in the reduction of PuO22+ to Pu3+ followed by the precipitation of Pu3+ as K2(K0.5Pu0.5)(SO4)2, which is then filtered and separated and (ii) the filtrate solution is again subjected to bulk electrolysis at a constant potential of -0.35 V vs Ag/AgCl/3 M KCl resulting in the reduction of UO22+ to U4+. The U4+ is then precipitated as K2(K0.67U0.33)(SO4)2, which is filtered and separated, leading to a Pu- and U-free aqueous acidic waste solutions. Biamperometry shows that 97.8% and 99.1% recovery of Pu and U, respectively, is possible, and emission spectrometry confirms the purity of K2(K0.5Pu0.5)(SO4)2 and K2(K0.67U0.33)(SO4)2. Because of its operational simplicity, potential for remote handling, and excellent extraction efficiency, the present methodology can easily replace traditional methods for the recovery of Pu and U from acidic aqueous waste solutions.

Fine mapping of a new common bean anthracnose resistance gene (Co-18) to the proximal end of Pv10 in Indian landrace KRC-5

KEY MESSAGE

Mapping and fine mapping of bean anthracnose resistance genes is a continuous process. We report fine mapping of anthracnose resistance gene Co-18 which is the first anthracnose gene mapped to Pv10. The discovery of resistance gene is a major gain in the bean anthracnose pathosystem research. Among the Indian common bean landraces, KRC-5 exhibit high levels of resistance to the bean anthracnose pathogen Colletotrichum lindemuthianum. To precisely map the anthracnose resistance gene, we used a Recombinant Inbred Line (F2:9 RIL) population (KRC-5 × Jawala). The inheritance test revealed that KRC-5 carries a dominant resistance gene temporarily designated as Co-18. We discovered two RAPD markers linked to Co-18 among 287 RAPD markers. These RAPD markers were eventually developed into SCARs (Sc-OPR15 and Sc-OPF6) and flank Co-18 on chromosome Pv10 at a distance of 5.3 and 4.2 cM, respectively. At 4.0-4.1 Mb on Pv10, we detected a SNP (single-nucleotide polymorphism) signal. We synthesized 58 SSRs and 83 InDels from a pool of 135 SSRs and 1134 InDels, respectively. Five SSRs, four InDels, and two SCARs were used to generate the high-density linkage map, which led to the identification of two SSRs (SSR24 and SSR36) that are tightly linked to Co-18. These two SSRs flank the Co-18 to 178 kb genomic region with 13 candidate genes including five NLR (nucleotide-binding and leucine-rich repeat) genes. The closely linked markers SSR24 and SSR36 will be used in cloning and pyramiding of the Co-18 gene with other R genes to develop durable resistant bean varieties.

Severity of Acute Portal Hypertension Determines the Clinical Outcomes in Severe Alcoholic Hepatitis

BACKGROUND

Severe alcohol-associated hepatitis (SAH) presenting as acute-on-chronic liver failure (ACLF) has high mortality. Severe hepatic inflammation and ongoing hepatocellular cell death lead to rapid rise in portal pressure, a hyperdynamic circulation that might precipitate infections and organ failures.

METHODS

Consecutive SAH patients were classified based on baseline HVPG measurement as 6to < 12 mmHg, 12to < 20 mmHg, and ≥ 20 mmHg. We analyzed portal hypertension severity in relation to fibrosis stage, ACLF at presentation, response to prednisolone, severity scores(MELD and Maddrey's Discriminant Function, mDF), and 90-day mortality.

RESULTS

Of 819 SAH patients (94.6% ACLF, 85.4% histological cirrhosis, median MELD and mDF scores 25 and 66, respectively), 250(30.5%) had HVPG ≥ 20 mmHg. Patients with HVPG ≥ 20 mmHg more often had large esophageal varices (25.2%vs.13.2%; p-0.001), higher baseline MELD (27.1 ± 5.6vs.25.3 ± 5.2; p-0.001), and mDF(76.1 ± 16vs.68.4 ± 15.1; p-0.01) scores. No patient without ACLF had HVPG ≥ 20 mmHg. Moreover, during hospital course these patients had higher incidence of variceal bleed (17.2%vs.8.8%; p-0.001), acute kidney injury (36.4%vs.25.3%; p-0.001), and spontaneous bacterial peritonitis (6.4%vs.3.5%; p-0.05). Of 412(50.3%) eligible patients treated with prednisolone, 69.2% showed response at day 7(Lille's score < 0.45). 90-day mortality was 27.6%; and baseline MELD > 25.5[HR 1.78], HVPG ≥ 20 mmHg [HR 1.86], the presence of HE[HR 1.63], and prednisolone ineligibility due to sepsis[HR 1.27] were independent predictors. Mortality was unrelated to varices grade, variceal bleed, and histological cirrhosis. Repeat HVPG performed in 114(19.2%) patients after a median of 5.2 months showed significant decrease (3.6 mmHg; p-0.001) which correlated with improvement in MELD score(13points; p-0.05).

CONCLUSION

Development of ACLF and complications in SAH are likely a result of acute rise in HVPG. "High-risk" SAH are SAH patients with HVPG ≥ 20 mmHg in the presence of ascites. Understanding the drivers for acute rise in portal pressure in SAH ACLF might help introduction of newer therapies.

Association of Serum ɣ-Glutamyl Transpeptidase Levels With Overall Survival in Intermediate and Advanced Hepatocellular Carcinoma Treated With Transarterial Chemoembolization

Introduction

This article aims to evaluate the prognostic significance of pretreatment serum ɣ-glutamyl transpeptidase (GGT) levels in patients with intermediate (BCLC B) and advanced stage (BCLC C) hepatocellular carcinoma receiving transarterial chemoembolization (TACE) as first-line treatment.

Methods

In this single-center retrospective study, a total of 608 patients with BCLC B and BCLC C class were included who received TACE as first-line treatment modality. Patients were divided into low and high GGT groups based on a cutoff value of pretreatment serum GGT levels calculated by receiver operating curve. Overall survival was evaluated with Kaplan-Meier method, and intergroup significance was calculated by log-rank test for overall patients, each BCLC B and BCLC C group. Univariate and multivariate analysis were used for significance for prognostic factors.

Results

Median follow-up time was 20, 22, and 9 months for overall patients, BCLC B, and BCLC C group, respectively. Optimal cut value for GGT was calculated at 90.5 U/L. One-year and 3-year survival rates were 84.2% and 27.9% in low GGT, 49.4% and 8.6% in high-GGT group for overall patients. Multivariate analysis in overall patients showed Child-Pugh B (HR,1.801; 95%CI, 1.373-2.362, P < .001), ascites (1.393, 1.070-1.812; P = .014), multiple tumors (1.397, 1.137-1.716; P = .001), AST >40 (1.407, 1.095-1.808; P = .008), albumin <3.2 (.735, .612-.884; P = .001), AFP > 400 (1.648, 1.351-2.011; P < .001), high GGT (2.009, 1.631-2.475; P < .001), or receipt of chemo/ablation (.463, .377-.569; P < .001) as independent risk factors for overall survival. Serum GGT levels and AFP showed significant correlation in between with significance coefficient of .155 (P < .001).

Conclusion

Elevated pretreatment serum GGT level was feasible and promising independent prognostic marker for overall survival in intermediate and advanced stage hepatocellular carcinoma patients treated with TACE.

Non-coding RNAs-mediated environmental surveillance determines male fertility in plants

Plants are continuously exposed to environmental stresses leading to significant yield losses. With the changing climatic conditions, the intensity and duration of these stresses are expected to increase, posing a severe threat to crop productivity worldwide. Male gametogenesis is one of the most sensitive developmental stages. Exposure to environmental stresses during this stage leads to male sterility and yield loss. Elucidating the underlying molecular mechanism of environment-affected male sterility is essential to address this challenge. High-throughput RNA sequencing studies, loss-of-function phenotypes of sRNA biogenesis genes and functional genomics studies with non-coding RNAs have started to unveil the roles of small RNAs, long non-coding RNAs and the complex regulatory interactions between them in regulating male fertility under different growth regimes. Here, we discuss the current understanding of the non-coding RNA-mediated environmental stress surveillance and regulation of male fertility in plants. The candidate ncRNAs emerging from these studies can be leveraged to generate environment-sensitive male sterile lines for hybrid breeding or mitigate the impact of climate change on male fertility, as the situation demands.

Resilience and self-compassion among persons with depressive disorders: Prerequisite for a positive mental health approach

Background

Treatment gap for common mental health problems, especially of the depressive disorders is consequential in developing countries like India. Positive mental health domains like resilience and self-compassion have been long hailed as protective factors against depression and viable for use in therapeutic aspects. The objectives were to find an association between resilience, self-compassion, and depression.

Methods

The study was conducted using a cross-sectional design among 75 respondents who were seeking treatment for major depressive disorders from a tertiary care center during the second wave of COVID-19. Three scales were administered online, namely Beck's Depression Inventory-II (BDI-II), Connor Davidson Resilience Scale (CD RISC-25), and Self-Compassion Scale-Short Form (SCS-SF). Spearman's rank correlation test, Chi-square with Fisher's exact test, and Kruskal Wallis H test were used to study the relationships and differences in average scores with respect to the severity of depression.

Results

Most of the respondents had moderate depressive features along with moderately high levels of resilience (CD RISC 25) and self-compassion (SCS-SF) scores. Resilience and self-compassion were found to have no significant relationship with respect to the severity of depression. There was a weakly positive correlation between resilience and self-compassion among those with moderate and severe depression.

Conclusion

Since the individuals with depression had higher scores on resilience and self-compassion, the levels of depression remained at moderate levels of severity despite the devastating impact of the second wave of COVID-19 in the Indian sub-continent. Results are to be interpreted with respect to psychosocial contexts arising during the COVID-19 pandemic. Mental health programs can incorporate the variables of resilience and self-compassion in intervention among individuals with depression which have likely been beneficial in their process of recovery.

NeuWS: Neural wavefront shaping for guidestar-free imaging through static and dynamic scattering media

Diffraction-limited optical imaging through scattering media has the potential to transform many applications such as airborne and space-based imaging (through the atmosphere), bioimaging (through skin and human tissue), and fiber-based imaging (through fiber bundles). Existing wavefront shaping methods can image through scattering media and other obscurants by optically correcting wavefront aberrations using high-resolution spatial light modulators-but these methods generally require (i) guidestars, (ii) controlled illumination, (iii) point scanning, and/or (iv) statics scenes and aberrations. We propose neural wavefront shaping (NeuWS), a scanning-free wavefront shaping technique that integrates maximum likelihood estimation, measurement modulation, and neural signal representations to reconstruct diffraction-limited images through strong static and dynamic scattering media without guidestars, sparse targets, controlled illumination, nor specialized image sensors. We experimentally demonstrate guidestar-free, wide field-of-view, high-resolution, diffraction-limited imaging of extended, nonsparse, and static/dynamic scenes captured through static/dynamic aberrations.

Immune drivers of HBsAg loss in HBeAg-negative CHB patients after stopping nucleotide analog and administration of Peg-IFN

BACKGROUND

The stoppage of nucleoside analog (NA) can lead to immune flare and loss of HBsAg in a proportion of HBeAg-negative chronic hepatitis B (CHB) patients. HBsAg loss could be improved by instituting Peg-Interferon therapy in those who show an immune flare after the stoppage of NA. We investigated the immune drivers of HBsAg loss in NA-treated HBeAg-negative CHB patients after stopping NAs and administration of Peg-IFN-α2b therapy.

METHODS

Fifty-five NA-treated eAg-ve, HBV DNA not detected CHB patients were subjected to stopping NA therapy. Twenty-two (40%) patients relapsed (REL-CHBV) within 6 months (HBV DNA ≥2000 IU/mL, ALT ≥2XULN) and were started on Peg-IFN-α2b (1.5 mcg/kg) for 48 weeks (PEG-CHBV). Cytokine levels, immune responses, and T-cell functionality were assessed.

RESULTS

Only 22 (40%) of 55 patients clinically relapsed, of which 6 (27%) cleared HBsAg. None of the 33 (60%) nonrelapsers cleared HBsAg. REL-CHBV patients had significantly increased IL-6 (p=0.035), IFN-γ (p=0.049), Th1/17 (p=0.005), CD4 effector memory (EM) (p=0.01), Tfh1/17 (p=0.005), and mature B cells (p=0.04) compared with CHBV. Six months after Peg-IFN therapy, immune resetting with a significant increase in CXCL10 (p=0.042), CD8 (p=0.01), CD19 (p=0.001), and mature B cells (p=0.001) was observed. HBV-specific T-cell functionality showed increased Tfh-secreting IFN-γ (p=0.001), IL-21 (p=0.001), and TNF-α (p=0.005) in relapsers and IFN-γ-secreting CD4 T cell (p=0.03) in PEG-CHBV.

CONCLUSIONS

Stopping NA therapy induces flare in about 40% of HBeAg-negative patients. Peg-IFN therapy given to such patients causes immune restoration with HBsAg loss in one fourth of them.

Histological and molecular insights in to in vitro regeneration pattern of Xanthosoma sagittifolium

A study on the effect of various phytohormonal combinations on in vitro propagation of Cocoyam [Xanthosoma sagittifolium (L.) Schott] was conducted to develop an improved and efficient in vitro regeneration protocol for its mass multiplication. Histological analysis to understand the in vitro regeneration pattern and genetic fidelity assessment of regenerated plants were also carried out. Single shoots excised from in vitro established cultures of X. sagittifolium were used as explants. Among the 32 different phytohormonal combinations tested, indirect organogenesis with intervening callus phase was observed on majority of the media combinations. Meristematic clump formation was optimally achieved on all the tested media combinations with maximum 43.54 ± 0.51 shoot primordia on MS medium containing 0.2 mg/L BAP + 0.1 mg/L NAA followed by 36.44 ± 0.76 shoot primordia on MS medium having 2.5 mg/L TDZ. Micro-morphological analysis of different morphogenetic structures revealed that the regeneration of cocoyam is well executed via meristematic nodules, shoot primordia formation that may evolve in to proper shoots. Adventitious shoots (> 2 cm) were successfully (100.00 ± 0.00%) rooted on the half-strength MS medium containing IBA (0.05-1.0 mg/L) and IAA (0.05-0.5 mg/L). The number of roots ranged from 0.78 ± 0.31 on the control half-strength MS medium to 13.94 ± 0.46 on half-strength MS supplemented with 1.0 mg/L IBA. Considering somaclonal variations as a potential restriction to in vitro multiplication of plants, genetic stability was assessed using 40 ISSR primers. The PCR amplification profiles obtained from all the tested propagules (calli, meristematic clumps, regenerated plantlets) were similar to the mother plants indicating the homogeneity of the individuals raised through the regeneration protocol reported here.

Safety and Efficacy of Endoscopic Retrograde Cholangio-Pancreatography in Patients of Liver Cirrhosis: A Case-Control Study

Background With the improvement in noninvasive diagnostic imaging modalities, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has evolved into a primarily therapeutic procedure. Besides being efficacious and one of the most commonly done procedures, ERCP is also associated with a high risk of complications. However, there is a lack of studies analyzing the safety and success of ERCP in patients with liver cirrhosis. We retrospectively evaluated the outcome of ERCP in patients with cirrhosis of the liver compared to non-cirrhotic patients using the database from our institute. Methods Patients with liver cirrhosis who underwent ERCP from January 2010 to March 2020 were analyzed. This was a matched case-control study in which one cirrhotic patient undergoing ERCP was age and gender-matched randomly to one non-cirrhotic patient. We compared adverse events and the success rate of ERCP between cirrhotic patients and non-cirrhotic patients. The primary outcome of the study was analyzing the prevalence of procedure-related adverse events and their independent risk factors in patients of cirrhosis compared to the non-cirrhotic population. Results Two hundred patients were analyzed in both groups. Choledocholithiasis was the most common reason for ERCP in both groups. Mean Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD) score in the cirrhosis group were 9.16 ±1.78 and 19.09 ±7.06 respectively. Patients in the cirrhosis group had a significantly higher frequency of complications compared to the controls: 41 (20.5 %) versus 15 (7.5%), p < 0.01. Bleeding was the most common adverse event in both groups: 19 (9.5%) vs 6(3%). High International Normalised Ratio (INR), low platelets, and cholangitis at presentation were independently predictive of post-ERCP complications. Despite a similar technical success rate, the clinical success rate was lower in the cirrhotic than in the noncirrhotic group (83.9% versus 97.9%, p=0.006). Conclusion The prevalence of complications following ERCP was nearly three-fold higher in patients with cirrhosis than in non-cirrhotic patients. These events were related primarily to cholangitis, coagulopathy, and the advanced status of chronic liver disease.

Endoscopic ultrasound-guided coiling and glue is safe and superior to endoscopic glue injection in gastric varices with severe liver disease: a retrospective case control study

BACKGROUND/AIMS

Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV.

METHODS

A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared.

RESULTS

In this study, the patients' age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation.

CONCLUSION

EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival.

Methods

We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models.

Findings

The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope).

Interpretation

This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.

Funding

Queen Elizabeth Diamond Jubilee Trust.

Affective symptoms as a predictor of internet addiction among young adults

OBJECTIVES

Mental health difficulties have been found to be associated with internet addiction, which makes it a multifaceted problem. The current study aimed to examine the relationship between internet addiction and affective states (depression, anxiety, and stress).

MATERIAL AND METHODS

The study sample consisted of 731 individuals (403 males and 328 females) ranging in age from 18 to 25 years. We used an observational survey design to study participants with an internet addiction test and depression, anxiety, and stress scale.

RESULTS

The mean age ± standard deviation of the sample was 22.58 ± 2.80 years. Stress and depression were found to play a major role in internet addiction in the regression analysis.

CONCLUSIONS

The study supports the association between internet use and stress and depression. The findings imply the need for early identification and intervention of affective states in the context of unhealthy internet use.

Collateral Impact on Patients of Liver Diseases in the Second COVID-19 Wave: A Retrospective Cohort Study

Background

The second wave of the COVID-19 pandemic in India started in April 2021. This necessitated a change in focus from chronic ailments. This wave lasted till May 2021. Its impact on liver disease patients without COVID-19 infection has not been analyzed.

Methods

Records of liver disease patients from the Institute database admitted from April to May 2021 were compared with that from April to May 2019 i.e., prior to the pandemic. The primary outcome was a comparison of in-hospital mortality rates. Secondary outcomes were a comparison of 30 and 90-day readmission rates and liver transplantation rates.

Results

Seven hundred and seventy-one patients in April-May 2019 (group 1) and 545 patients in April-May 2021 (group 2) were analyzed. Patients in group 2 were sicker with higher PT (INR), urea, creatinine, CTP, and MELD score and low serum sodium, albumin, and platelet count with a higher prevalence of variceal bleed, hepatic encephalopathy, and acute kidney injury. There was higher mortality in group 2 (128/545; 23.5%) than group 1 (124/ 771;16.1%), OR 1.6, 95% CI 1.2 - 2.1, p<0.01. 30 day readmission rate was numerically higher in group1; 18.3% vs 16.9%, p=0.5. The 31-90 day readmission rate was higher in group 1; 29.4% vs 16.9%, p<0.01. There was no significant difference in the number of patients undergoing liver transplantation in two groups, 19 in group 1 and 14 in group 2 (p=0.90).

Conclusion

The second wave of the COVID-19 pandemic had a significant collateral impact on liver disease patients even without causing infection in them. Patients were sicker at the time of admission with higher mortality.

Morphogene-assisted transformation of Sorghum bicolor allows more efficient genome editing

Sorghum bicolor (L.) Moench, the fifth most important cereal worldwide, is a multi-use crop for feed, food, forage and fuel. To enhance the sorghum and other important crop plants, establishing gene function is essential for their improvement. For sorghum, identifying genes associated with its notable abiotic stress tolerances requires a detailed molecular understanding of the genes associated with those traits. The limits of this knowledge became evident from our earlier in-depth sorghum transcriptome study showing that over 40% of its transcriptome had not been annotated. Here, we describe a full spectrum of tools to engineer, edit, annotate and characterize sorghum's genes. Efforts to develop those tools began with a morphogene-assisted transformation (MAT) method that led to accelerated transformation times, nearly half the time required with classical callus-based, non-MAT approaches. These efforts also led to expanded numbers of amenable genotypes, including several not previously transformed or historically recalcitrant. Another transformation advance, termed altruistic, involved introducing a gene of interest in a separate Agrobacterium strain from the one with morphogenes, leading to plants with the gene of interest but without morphogenes. The MAT approach was also successfully used to edit a target exemplary gene, phytoene desaturase. To identify single-copy transformed plants, we adapted a high-throughput technique and also developed a novel method to determine transgene independent integration. These efforts led to an efficient method to determine gene function, expediting research in numerous genotypes of this widely grown, multi-use crop.

Clinical Outcomes of Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate (NBCA) in Cirrhotic Patients

Purpose

To evaluate the clinical outcomes of transcatheter arterial embolization (TAE) with n-butyl-2-cyanoacrylate (NBCA) for treatment of bleeding in cirrhotic patients.

Materials and methods

A total of 35 cirrhotic patients (26 men, 9 women; mean age, 48.4 ± 11.1) who underwent TAE with NBCA for bleeding from January 2011 to December 2020 were retrospectively analysed. Only cirrhotic patients with active arterial bleeding confirmed on computed tomography (CT) were included. Fifteen patients were hemodynamically unstable before embolization procedure, and coagulopathy was observed in 32 patients. The mean MELD score and Child Pugh score were 24 ± 9.9 and 9.9 ± 2.2, respectively. The mean haemoglobin level and mean number of RBC units transfused before embolization were 7.4 ± 1.4 g/dL and 10.2 ± 4, respectively. The technical, clinical success rate and 30-day mortality rate were evaluated.

Results

Technical success and clinical success rates were achieved in 100% and 82.8% of patients, respectively. Overall 30-day mortality rate was 48%. No major complications related to the embolization procedure was seen. Only the greater number of RBC units transfused before the embolization procedure (OR = 1.81, 95% CI = 1.17-2.80, P = 0.007) was significantly associated with clinical failure. Greater number of RBC units transfused (OR = 1.53, 95% CI: 1.00-2.34, P = 0.004) and higher Child Pugh score (OR 2.44, 95% CI 1.26-4.71, P = 0.008) were significantly associated with higher 30-day mortality rate.

Conclusion

Transcatheter arterial embolization using NBCA can be used as the effective treatment option for bleeding in cirrhotic patients which has a high technical and clinical success despite the grave prognosis associated with cirrhosis.

Electrochemical recovery of plutonium from aqueous carbonate waste solutions

Recovery of plutonium from aqueous carbonate waste solutions generated during the reprocessing of spent nuclear fuel is a key concern for sustainable nuclear energy programmes and the remediation of radioactive waste. Reported methods proceed through secondary waste generation caused by acidification of carbonate waste and make the recovery process cumbersome. Herein, we report a simple method for the recovery of Pu as solid PuO₂ powder from carbonate waste solution in a two-step process. (i) Pu was selectively electrochemically precipitated as plutonium-hydroxide in the presence of interfering U, Th, Ru, Zr, Nb, Cs and the degradation products of tri-butyl phosphate by bulk electrolysis at -0.9 V using a Pt gauze electrode and (ii) the precipitate was annealed at 973 K for conversion to pure PuO₂ powder. The present approach is simple, avoids the generation of secondary waste and reduces the exposure of working personnel to radiation.

Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study

Introduction:

Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control.

Aims and Objectives:

We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month.

Materials and Methods:

Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections.

Results:

Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3.

Limitations:

Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period.

Conclusion:

MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.

Divergence among rice cultivars reveals roles for transposition and epimutation in ongoing evolution of genomic imprinting

Parent-of-origin-dependent gene expression in mammals and flowering plants results from differing chromatin imprints (genomic imprinting) between maternally and paternally inherited alleles. Imprinted gene expression in the endosperm of seeds is associated with localized hypomethylation of maternally but not paternally inherited DNA, with certain small RNAs also displaying parent-of-origin-specific expression. To understand the evolution of imprinting mechanisms in Oryza sativa (rice), we analyzed imprinting divergence among four cultivars that span both japonica and indica subspecies: Nipponbare, Kitaake, 93-11, and IR64. Most imprinted genes are imprinted across cultivars and enriched for functions in chromatin and transcriptional regulation, development, and signaling. However, 4 to 11% of imprinted genes display divergent imprinting. Analyses of DNA methylation and small RNAs revealed that endosperm-specific 24-nt small RNA-producing loci show weak RNA-directed DNA methylation, frequently overlap genes, and are imprinted four times more often than genes. However, imprinting divergence most often correlated with local DNA methylation epimutations (9 of 17 assessable loci), which were largely stable within subspecies. Small insertion/deletion events and transposable element insertions accompanied 4 of the 9 locally epimutated loci and associated with imprinting divergence at another 4 of the remaining 8 loci. Correlating epigenetic and genetic variation occurred at key regulatory regions-the promoter and transcription start site of maternally biased genes, and the promoter and gene body of paternally biased genes. Our results reinforce models for the role of maternal-specific DNA hypomethylation in imprinting of both maternally and paternally biased genes, and highlight the role of transposition and epimutation in rice imprinting evolution.

Digital resilience mediates healthy use of technology

Excessive use of online technology brings with it the risk of problematic digital behaviour like over-use of social media, online gambling, webinar fatigue, digital burnout, and in extreme cases doom surfing, and doom scrolling. In addition, digital failures can cause significant mental health distress to people, and unhealthy interactions on social media can also lead to deviant behaviour such as cyber bullying and cybercrime. This paper discusses the various vulnerabilities an individual is predisposed to on the internet, and highlights the importance of "Digital Resilience". Digital resilience is a new concept which refers to the learning, recovery, and bouncing back process after having negative or adverse experiences online. A comprehensive and holistic model to introduce Digital Resilience to everyone through a multitier approach that includes Individual, Societal, and Community intervention is formulated and elaborated. The importance of addressing these concerns from both a psychological and legal perspective is also discussed.

Assessment of non-point source of pollution using chemical mass balance approach: a case study of River Alaknanda, a tributary of River Ganga, India

The low ionic concentration meltwaters of the rivers originating from the Himalayan glaciers play a significant role in diluting the high solute load emanating from Ganga plain catchments. Hence, any change in the qualitative and quantitative characteristics of the Himalayan tributaries of River Ganga under the changing climatic scenario will impact the hydrochemical parameters of River Ganga as well. Hydrochemical investigations have been carried out in the River Alaknanda, a tributary of River Ganga during the period September 2016-May 2018 and revealed that TSS and COD values were observed above the prescribed criteria limit of 10 mg/L for drinking purpose for river as prescribed by CPCB. The anions for all sampling sites and seasons were observed to be in decreasing order of HCO₃^-  > SO₄^2-  > Cl^-  > NO₃^- and cations Ca²⁺  > Mg²⁺  > Na⁺  > K⁺. The weathering of rock forming minerals of drainage basin is responsible for the chemical composition of river water. HCO₃^- being the dominant anion in the study area accounts for its presence due to carbonate and silicate weathering. Ion exchange process controls the major ion chemistry of the river water. The assessment and management of non-point sources (NPS) pollution are difficult by any deterministic method and require a vast amount of data to compensate for their extent of contamination, in the account of their prevailing nature in response to hydrological processes and land use patterns. In the present investigation, the application of a simple chemical mass balance approach based on law of conservation of mass/matter has been applied on River Alaknanda, a tributary of River Ganga for measuring the chemical mass loadings of some selected water quality constituents, viz., major cations (sodium, potassium, calcium, magnesium, and ammonium) and major anions (chloride, sulfate, nitrate, and phosphate) at upstream and downstream of different point source locations for examining the contribution made by non-point sources of pollution to the river. Time series analysis of various ion concentrations at point source sites and upstream/downstream sites inferred that the fluvial variations pertaining to ion concentration and flux are strongly dependent on the seasonal changes. More contribution (> 30-50%) for almost all constituents from uncharacterized sources was observed in the months of November to February, which may be attributed to intensified agricultural activities during the winter months particularly cereals and vegetables.

Efficacy of ondansetron and palonosetron in prevention of shivering under spinal anesthesia: A prospective randomized double-blind study in patients undergoing elective LSCS

Background and Aims:

Postanesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5HT₃ antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics is currently in use by clinicians. Hence, a study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia.

Material and Methods:

A total of 84 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups (Group O & P). Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively. Sublingual temperature was recorded regularly. All patients were observed for 90 min postspinal for PAS. Observations were analyzed statiscally.

Results:

No statistically significant intergroup difference was observed in the duration of surgery, and sublingual temperature. However, statistically significant difference was recorded for PAS (23.8% in ondansetron group, 9.5% in palonosetron group).

Conclusion:

Prophylactic administration of palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

An environmental gamma spectrometry system with CsI(Tl) scintillator and FPGA based MCA for open field deployment

Inorganic scintillator-based gamma spectrometry is typically carried out under laboratory conditions by using systems that require AC mains supply and dedicated computers for their operation. In this study, an in-house grown CsI(Tl) single crystal scintillator is optically coupled to a bialkali photomultiplier tube (PMT). The output of the PMT is fed to a pulse processing chain consisting of a preamplifier followed by an in-house designed and developed field programmable gate array (FPGA) based multichannel analyzer (MCA). Spectral data from this MCA is sent via serial communication to a microcontroller. A global system for mobile communications (GSM) modem transmits this data in the form of short message service (SMS) packets to a central receiving station, where the spectrum is reconstructed. The requirement of on-site data logging computer to store large spectral data has thereby been eliminated, which, in turn, has eliminated the requirement of AC power supply, reduced the overall power consumption and size of the system, and made it possible to develop a standalone solar-powered unit. For further reduction of overall power consumption, the spectrometer is turned-on only when a Geiger Mueller (GM) counter based gross gamma detection circuit, also included in the system, detects an ambient gamma dose rate beyond a pre-set threshold level. A mathematical methodology has also been implemented for restoration of recorded spectra, shifted due to temperature variations in the environment. All these features have been integrated and a standalone, solar-powered and battery operated field-deployable environmental gamma spectrometry system (EGSS) has been developed and tested for open field deployment. Presence of ⁴¹Ar in ambient air was successfully detected by the system.

Mediative fuzzy logic mathematical model: A contradictory management prediction in COVID-19 pandemic

This paper presents a model based on mediative fuzzy logic in this COVID-19 pandemic. COVID-19 (novel coronavirus respiratory disease) has become a pandemic now and the whole world has been affected by this disease. Different methodologies and many prediction techniques based on various models have been developed so far. In the present article, we have developed a mediative fuzzy correlation technique based on the parameters for COVID-19 patients from different parts of India. The proposed mediative fuzzy correlation technique provides the relation between the increments of COVID-19 positive patients in terms of the passage of increment with respect to time. The peaks of infected cases in connection with the other condition are estimated from the available data. The mediative fuzzy logic mathematical model can be utilized to find a good fit or a contradictory model for any pandemic model. The proposed approach to the prediction in COVID-19 based on mediative fuzzy logic has produced promising results for the continuous contradictory prediction in India.

Stabilization of uranyl(v) by dipicolinic acid in aqueous medium

Preparation of a stable U(v) complex in an aqueous medium is a challenging task owing to its disproportionation nature (conversion into more stable U(vi) and U(iv) species) and sensitivity to atmospheric oxygen. The stable uranyl (UO₂²⁺)/dipicolinic acid (DPA) complex ([U^(VI)O₂(DPA)(OH)(H₂O)]^-) was formed at pH 10.5-12.0, which was confirmed by potentiometric and spectrophotometric titrations, and NMR, ESI-MS and EXAFS spectroscopy. The complex [U^(VI)O₂(DPA)(OH)(H₂O)]^- can be electrochemically reduced on the Pt electrode at -0.9 eV (vs. Ag/AgCl) to [U^(V)O₂(DPA)(OH)(H₂O)]^2- in aqueous medium under an anaerobic environment. According to cyclic voltammetric analysis, a pair of oxidation and reduction waves at E'₀ = -0.592 V corresponds to the [U^(VI)O₂(DPA)(OH)(H₂O)]^-/[U^(V)O₂(DPA)(OH)(H₂O)]^2- redox couple and the formation of [U^(V)O₂(DPA)(OH)(H₂O)]^2- was confirmed by the electron stoichiometry (n = 0.97 ± 0.05) of the reduction reaction of [U^(VI)O₂(DPA)(OH)(H₂O)]^-. The pentavalent uranyl complex [U^(V)O₂(DPA)(OH)(H₂O)]^2- was further characterized via UV-vis-NIR absorption spectrophotometry and X-ray absorption (XANES and EXAFS) spectroscopy. The [U^(V)O₂(DPA)(OH)(H₂O)]^2- complex is stable at pH 10.5-12.0 in anaerobic water for a few days. DFT calculation shows the strong complexing ability of DPA stabilizing the unstable oxidation state U(v) in aqueous medium.

Risky Riding and Its Correlates in Two-Wheeler Riding Young Men: Pillion Riders' Perspective

Background

Risky riding is one of the major contributing factors in road fatalities. The present study aimed to explore the risky riding behaviors and its correlates in two-wheeler riding young men, as ascertained from pillion riders' perspective.

Materials and Methods

A survey that captured perspective of pillion riders about two-wheeler riding young men with whom they used to pillion ride most frequently was administered on 115 subjects. The survey consisted of items pertaining to risky riding, perceived impact of negative emotion on riding, expression of negative emotion on roads in response to frustrating situations, road traffic accidents, and pillions' strategies to reduce anger/stress in their two-wheeler riders.

Results

Two-wheeler riders who comprised young men were categorized into two groups: (i) high-risk riding group (n = 54 [48%]) and (ii) low-risk riding group (n = 61 [52%]) based on the subjective report of risky riding behaviors by their pillion riders. The results showed that negative emotions were perceived to have adverse influence on riding in persons with high-risky riding. Pillion riders reported that two-wheeler riding young men with high-risky riding expressed more aggressive behaviors (verbal and nonverbal) while riding in response to frustrating situations and also experienced near misses and minor accidents more frequently than their counterparts. Pillion riders reported utilizing various strategies to regulate emotions and behaviors of two-wheeler riders.

Conclusions

The present study highlights assessing risky riding and their correlates from pillion riders' perspective and strengthening their positive influence on two-wheeler riding. It has significant implications in minimizing risky behaviors on roads and enhancing road safety.

Gene Expression Dynamics in Rice Peduncles at the Heading Stage

Improving grain yield in the staple food crop rice has been long sought goal of plant biotechnology. One of the traits with significant impact on rice breeding programs is peduncle elongation at the time of heading failing which leads to significant reduction in grain yield due to incomplete panicle exsertion. To decipher transcriptional dynamics and molecular players underlying peduncle elongation, we performed RNA sequencing analysis of elongating and non-elongating peduncles in two Indian cultivars, Swarna and Pokkali, at the time of heading. Along with genes associated with cell division and cell wall biosynthesis, we observed significant enrichment of genes associated with auxins, gibberellins, and brassinosteroid biosynthesis/signaling in the elongating peduncles before heading in both the genotypes. Similarly, genes associated with carbohydrate metabolism and mobilization, abiotic stress response along with cytokinin, abscisic acid, jasmonic acid, and ethylene biosynthesis/signaling were enriched in non-elongating peduncles post heading. Significant enrichment of genes belonging to key transcription factor families highlights their specialized roles in peduncle elongation and grain filling before and after heading, respectively. A comparison with anther/pollen development-related genes provided 76 candidates with overlapping roles in anther/pollen development and peduncle elongation. Some of these are important for carbohydrate remobilization to the developing grains. These can be engineered to combat with incomplete panicle exsertion in male sterile lines and manipulate carbohydrate dynamics in grasses. Overall, this study provides baseline information about potential target genes for engineering peduncle elongation with implications on plant height, biomass composition and grain yields in rice.

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

BACKGROUND AND AIMS

COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis.

METHODS

Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19.

RESULTS

Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients.

CONCLUSIONS

SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.

Phylogenomic Analysis of R2R3 MYB Transcription Factors in Sorghum and their Role in Conditioning Biofuel Syndrome

Background

Large scale cultivation of sorghum for food, feed, and biofuel requires concerted efforts for engineering multipurpose cultivars with optimised agronomic traits. Due to their vital role in regulating the biosynthesis of phenylpropanoid-derived compounds, biomass composition, biotic, and abiotic stress response, R2R3-MYB family transcription factors are ideal targets for improving environmental resilience and economic value of sorghum.

Methods

We used diverse computational biology tools to survey the sorghum genome to identify R2R3-MYB transcription factors followed by their structural and phylogenomic analysis. We used in-house generated as well as publicly available high throughput expression data to analyse the R2R3 expression patterns in various sorghum tissue types.

Results

We have identified a total of 134 R2R3-MYB genes from sorghum and developed a framework to predict gene functions. Collating information from the physical location, duplication, structural analysis, orthologous sequences, phylogeny, and expression patterns revealed the role of duplications in clade-wise expansion of the R2R3-MYB family as well as intra-clade functional diversification. Using publicly available and in-house generated RNA sequencing data, we provide MYB candidates for conditioning biofuel syndrome by engineering phenylpropanoid biosynthesis and sugar signalling pathways in sorghum.

Conclusion

The results presented here are pivotal to prioritize MYB genes for functional validation and optimize agronomic traits in sorghum.

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

BACKGROUND AND AIMS

COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon comorbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis.

METHODS

Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19.

RESULTS

Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR = 2.1 (1.1-3.7), p = 0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR = 8.1 (1.9-38.8), p = 0.002] predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5 (11.6%)] or acute decompensation [4 (9%)]. Liver related complications increased (p < 0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC 0.94, HR = 19.2 (95 CI 2.3-163.3), p < 0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis patients.

CONCLUSIONS

SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.

Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study).. [DOI: 10.21203/rs.3.rs-36338/v1]

Background and Aims: COVID-19 is a dominant pulmonary disease, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis and 43 with cirrhosis] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver disease (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease; a Child-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis. Conclusions: SARS-Cov-2 infection causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity are more vulnerable and should be closely monitored.

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives

To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants

A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures

Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results

The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions and Relevance

This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Nanomaterial based gene delivery: a promising method for plant genome engineering

Nanomaterials have attracted considerable attention from researchers in recent years due to their unique architecture and small dimensions. Significant progress has been made in the therapeutics, diagnostics, and delivery of biomolecules in animal cells. However, nanotechnology is still in its infancy in plant science. Nanotechnology offers tremendous opportunities for crop improvement and would make significant contributions to increase agricultural productivity. There are several reports where nanomaterial-induced improvement of the agronomic traits has been successfully achieved. However, very little is known about the interactions of nanomaterials with plant cells and the mechanism of internalization and delivery of biomolecules using nanoparticles as a carrier. Due to the presence of the cell wall, the delivery of biomolecules such as nucleic acids is a major challenge, which limits the application of nanomaterials in genetic engineering-mediated crop improvement. However, in recent years, the use of various nanomaterials like carbon nanotubes, magnetic nanoparticles, mesoporous silica nanoparticles, etc. for nucleic acid delivery in plant cells has been reported as proof of concept. Here, we intend to update researchers about the use of various nanomaterials as a novel gene delivery tool for plant genetic engineering. This review also explores the progress made in nanoparticle-mediated nucleic acid delivery in plant cells and their role in plant genome engineering.

Insight into Speciation and Electrochemistry of Uranyl Ions in Deep Eutectic Solvents

Understanding the speciation of metal ions in heterogeneous hydrogen-bonded deep eutectic solvents (DES) has immense importance for their wide range of applications in green technology, environmental remediation, and nuclear industry. Unfortunately, the fundamental nature of the interaction between DES and actinide ions is almost completely unknown. In the present work, we outline the speciation, solvation mechanism, and redox chemistry of uranyl ion (UO₂²⁺) in DES consisting of choline chloride (ChCl) and urea as the hydrogen-bond donor. Electrochemical and spectroscopic techniques along with molecular dynamics (MD) simulations have provided a microscopic insight into the solvation and speciation of the UO₂²⁺ ion in DES and also on associated changes in physical composition of the DES. The hydrogen-bonded structure of DES plays an important role in the redox behavior of the UO₂²⁺ ion because of its strong complexation with DES components. X-ray absorption spectroscopy and MD simulations showed strong covalent interactions of uranyl ions with the constituents of DES, which led to rearrangement of the hydrogen-bonding network in it without formation of any clusters or aggregations. This, in turn, stabilizes the most unstable pentavalent uranium (UO₂⁺) in the DES. MD analysis also highlights the fact that the number of H-bonds is reduced in the presence of uranyl nitrate irrespective of the presence of water with respect to pristine reline, which suggests high stability of the formed complexed species. The effect of added water up to 20 v/v % on speciation is insignificant for DES, but the presence of water influences the redox chemistry of UO₂²⁺ ions considerably. The fundamental findings of the present work would have far reaching consequences on understanding DES, particularly for application in the field of nuclear fuel reprocessing.

A web-based tool for the prediction of rice transcription factor function

Transcription factors (TFs) are an important class of regulatory molecules. Despite their importance, only a small number of genes encoding TFs have been characterized in Oryza sativa (rice), often because gene duplication and functional redundancy complicate their analysis. To address this challenge, we developed a web-based tool called the Rice Transcription Factor Phylogenomics Database (RTFDB) and demonstrate its application for predicting TF function. The RTFDB hosts transcriptome and co-expression analyses. Sources include high-throughput data from oligonucleotide microarray (Affymetrix and Agilent) as well as RNA-Seq-based expression profiles. We used the RTFDB to identify tissue-specific and stress-related gene expression. Subsequently, 273 genes preferentially expressed in specific tissues or organs, 455 genes showing a differential expression pattern in response to 4 abiotic stresses, 179 genes responsive to infection of various pathogens and 512 genes showing differential accumulation in response to various hormone treatments were identified through the meta-expression analysis. Pairwise Pearson correlation coefficient analysis between paralogous genes in a phylogenetic tree was used to assess their expression collinearity and thereby provides a hint on their genetic redundancy. Integrating transcriptome with the gene evolutionary information reveals the possible functional redundancy or dominance played by paralog genes in a highly duplicated genome such as rice. With this method, we estimated a predominant role for 83.3% (65/78) of the TF or transcriptional regulator genes that had been characterized via loss-of-function studies. In this regard, the proposed method is applicable for functional studies of other plant species with annotated genome.

Sulphate contamination in groundwater and its remediation: an overview

Most abundant form of sulphur in the geosphere has been sulphate. Sulphate, with sulphur in the plus six oxidation state is very stable. Sources of sulphate in groundwater include mineral dissolution, atmospheric deposition and other anthropogenic sources (mining, fertilizer, etc.). Gypsum is an important contributor to the high levels of sulphate in many aquifer of the world. Sulphate is not as much as toxic, but it can cause catharsis, dehydration and diarrhoea, and when ingested in higher amount through dietary absorption, the levels of methaemoglobin and sulphaemoglobin are changed in human and animal body. The role of sulphate in aqueous phase and sedimentary phase has been discussed. There is only limited work on sulphate pollution remediation in groundwater at national and international level; therefore, in the light of rising attention in sulphate as a contaminant, different sources of sulphate, its distribution and available different remediation techniques for groundwater system reported so far have been discussed in the present paper. Abiologic processes' thermochemical sulphate reduction (TSR) also plays significant role in reduction of sulphate.

Comparative Study of Ultrasound-guided Percutaneous Omental Biopsy in Cirrhotics and Noncirrhotics

BACKGROUND

To evaluate the safety and efficacy of ultrasound-guided (US-guided) omental biopsy in patients with liver cirrhosis and compare these with the noncirrhotic patients.

METHODS

We retrospectively studied the US-guided omental biopsies (73 males, 14 females with mean age 52.71 ± 15.90 y) between January 2012 and December 2018. Patients with biopsy-proven liver cirrhosis (n = 31) who underwent omental biopsy were included in Group 1, and patients without any features of the chronic liver disease (n = 56) were included in Group 2. The technical success, diagnostic parameters, complications, imaging appearance, and histopathology spectrum were compared between the two groups. Also, univariate analysis was done to evaluate the association of a parameter with histopathology.

RESULTS

The technical success, sample adequacy, diagnostic accuracy of Group 1 were 100%, 96.77%, and 96.77%, respectively, and for Group 2, these were 100%, 98.21%, and 98.21%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value of Group 1 were 95%, 100%, 100%, 91.67%, respectively, and for Group 2, these were 97.92%, 100%, 100%, 88.89%, respectively. There was one complication of abdominal wall hematoma in Group 1 (3.2%), which was managed conservatively. Smudged imaging appearance and nonspecific inflammation on histopathology were more common in Group 1, and there was a significant association of increased omental thickening with specific pathology in Group 1.

CONCLUSION

US-guided omental biopsy in patients with liver cirrhosis is safe and effective with comparable results to noncirrhotic patients.

Fragmentation analysis of 88Mo* compound nucleus in view of different decay mechanisms

In reference to the experimental data, the decay mechanism of 88Mo* compound system formed in 48Ti+40Ca reaction is investigated at three beam energies (Ebeam = 300, 450, and 600 MeV) using the collective clusterization approach of Dynamical Cluster decay Model (DCM). The calculations are done for spherical choice of fragmentation and with the inclusion of quadrupole (β2) deformations having “optimum” orientations. According to the experimental evidence 88Mo* decays via Fusion-Evaporation (FE) and Fusion-Fission (FF) processes, thus the decay cross-sections of this hot and rotating compound system are calculated for both channels. In FF decay mode, the explicit contribution of Intermediate Mass Fragments (IMF), Heavy Mass Fragments (HMF) and fission fragments (symmetric/asymmetric) is detected within DCM framework. The calculated FE and FF decay cross-sections find nice agreement with the available experimental data. Experimentally, it has been observed that the total contribution of FE and FF decay cross-sections is less than the total reaction cross-sections possibly due to the presence of some nCN component such as deep inelastic collisions (DIC), which generally contributes above critical angular momentum (ℓcr). The possibility of DIC contribution can be addressed as a future assignment in view of diminishing pocket of interaction potential above ℓcr.

Correction to: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

The article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher's internet portal (currently SpringerLink) on June 06, 2019 without open access.

Self-Reported Anger: Vulnerability for Risky Behaviors in Two-Wheeler Riding Young Men

OBJECTIVES

Aggressive driving and road accidents are major concerns in the public health sector. This study aimed to explore risk to aggressive and risky behaviors on the road in two-wheeler riding young men.

METHODS

The study comprised 433 young male two-wheeler riders from an urban city of India. A two-wheeler riding survey that captured subjective perception of difficulty in managing anger in general, easy provocability to anger, and aggressive and risky behaviors on the road, and Negative Mood Regulation (NMR) scale were administered.

RESULTS

Of the 433 participants, 83 (19%) reported experiencing problematic anger in general, whereas 175 (40.42%) did not endorse experiencing problematic anger. Based on this, two groups were formed, namely, problematic anger-present group and problematic anger-absent group. The problematic anger-present group reported high score on easy provocability to anger, difficulty in controlling anger, specific motives related to riding fast than usual, and severity of aggressive responses to frustrating situations while riding, and low score on NMR scale. Statistical analysis revealed a significant difference between the groups.

CONCLUSION

This study highlights the relevance of assessing subjective perception of problematic anger in two-wheeler riding young men. This has implications for designing interventions for enhancing road safety.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the "APASL ACLF Research Consortium (AARC)" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the 'Golden Therapeutic Window', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

Influence of sulfuric acid concentration in the simultaneous voltammetric determination of uranium and plutonium in nuclear fuels

Interfacial coupled chemical reaction between U(iv) (formed at the electrode surface) and Pu(iv) (diffuses from the bulk towards the electrode) regenerates U(vi) at the electrode-solution interface and causes enhancement in the U(vi) reduction current, thus creating problems in the simultaneous voltammetric determination of U and Pu. Despite such interference between U(iv) and Pu(iv), the simultaneous voltammetric determination of U and Pu in FBTR Mark-1 fuel samples in sulfuric acid (1 M H₂SO₄) on a poly(3,4-ethylenedioxythiophene) (PEDOT)-poly(styrenesulfonate) (PSS)-modified glassy-carbon (GC) electrode (PEDOT-PSS/GC) has been reported. However, the reported method is applicable only for FBTR mark-1 fuel samples, in which the ratio [Pu]/[U] > 2 is always maintained. For nuclear samples having [Pu]/[U] < 2 (e.g., PFBR fuel), the simultaneous voltammetric determination of U and Pu is extremely challenging. Herein, we report a modified version of the earlier method for the simultaneous determination of U and Pu in nuclear samples ((U, Pu)C and (U, Pu)O₂), irrespective of the [Pu]/[U] ratio. The effect of acidity (H₂SO₄ conc.) on the coupled chemical reaction between U(iv) and Pu(iv) was examined. It was observed that an increase in the acidity of H₂SO₄ minimized the coupled chemical reaction, and at 5 M H₂SO₄, change in the Pu(iv) concentration did not have any effect on the U(vi) reduction current. The coupled chemical reaction between U(iv) and Pu(iv) ceased at 5 M H₂SO₄ and hence, the simultaneous voltammetric determination of U and Pu was possible on PEDOT-PSS/GC, irrespective of the [Pu]/[U] ratio in 5 M H₂SO₄. The method was applied for both (U, Pu)O₂ (PFBR) and (U, Pu)C (FBTR) samples and was compared with the well-established biamperometric method. The present method shows accuracy and precision comparable to biamperometry and did not show any interference from the commonly encountered impurities in nuclear samples. Thus, both FBTR and PFBR nuclear fuels having different [Pu]/[U] ratios can be analyzed by the present approach and it is a strong competitor to replace the well-established biamperometric method for routine sample analysis.

Assessment of system characteristics of Gangotri glacier headwater stream

The study examine the major ion chemistry and p(CO₂) variations of Ganga headwater stream for a stretch of 18 km from Gangotri glacier snout at Gomukh to Gangotri for characterising the open and closed system conditions and its temporal variations. The study has been carried out at three locations along the stream continuum, at the glacier snout (0 km), Bhojwasa (4 km) and Gangotri (18 km) covering three consecutive melt seasons from the year 2014 to 2016 and reveals the persistence of closed system conditions along the stream stretch. The year 2014 and 2016 melt seasons experience high p(CO₂) closed system conditions associated with high suspended sediment flux, whereas the year 2015 experienced low p(CO₂) closed system condition associated with low sediment flux suggesting in-stream sulphide oxidation during high sediment flux years and results into low values of the C-ratio. On the other hand, the melt season with low sediment flux such as the year 2015 showed dominance of HCO₃^- over SO₄^2- and higher C-ratio. The study shows that the headwater reach of River Bhagirathi from Gomukh to Gangotri has prevalence of high p(CO₂) closed system characteristics associated with high sediment flux and dominance of SO₄^2- during the seasonal peak flow. This is suggested as a unique characteristic of the meltwaters of the upper Bhagirathi basin.

Case Control Study of Post-endoscopic Variceal Ligation Bleeding Ulcers in Severe Liver Disease: Outcomes and Management

Background and Aims: The management of post-endoscopic variceal ligation (EVL) bleeding ulcers (PEBUs) is currently based on local expertise and patients liver disease status. The present retrospective study investigated associations between the endoscopic morphology of PEBUs and patient outcomes. Methods: Patients underwent EVL (primary or secondary), from January 2015 to January 2018, in two tertiary care hospitals in India (ILBS New Delhi and Dharamshila Narayana New Delhi). Mortality rates were determined at post-EVL day five and week six. PEBUs were typified based on Jamwal & Sarin classification system as follows: A, ulcer with active spurting; B, ulcer with ooze; C, ulcer base with visible vessel or clot; and D, clean or pigmented base. Results: Of 3854 EVL procedures, 141 (3.6%) patients developed PEBU, and 46/141 (32.6%) suffered mortality. Among the former, the PEBU types A, B, C, and D accounted for 17.7, 26.2, 36.3, and 19.8%, respectively. Of those who died, 39.1, 30.4, 21.7, and 8.8% had PEBU types A, B, C, and D. Treatments included transjugular intrahepatic portosystemic shunts (TIPS), esophageal self-expandable metal stent (SEMS), glue and sclerosant injection, Sengstaken-Blakemore tube placement and liver transplant. On univariate analysis, no correlation with hepatic venous pressure gradient, TIPS placement, size of varices, or number of bands was found. The Model for End-Stage Liver Disease (MELD)-sodium score correlated positively with outcome. After adjusting for MELD-sodium score, mortality was best predicted by type-A ulcer (p = 0.024; OR 8.95, CI 1.34-59.72). Conclusions: PEBU occurred in 3.6% of a large EVL cohort. Stratifying patients based on PEBU type can help predict outcomes, independent of the MELD-sodium score. Classifying PEBUs by endoscopic morphology may inform treatment strategies, and warrants further validation.

Anticipatory pleasure for future experiences in schizophrenia spectrum disorders and major depression: A systematic review and meta-analysis

OBJECTIVES

Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure.

METHODS

Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review.

RESULTS

A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders.

CONCLUSIONS

Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder.

PRACTITIONER POINTS

Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.

Development of indices for surface and ground water quality assessment and characterization for Indian conditions

Water quality indices are mathematical equations that transform water quality data into a particular number which describe the status of water. A number of water quality indices have been developed by various researchers for categorizing the water quality for different uses. These indices are developed based on classification criteria, sub-indices, and aggregation function. In the present study, a generalized Composite Water Quality Index (CWQI) is developed to classify the water into five categories, viz excellent, good, fair, poor, and polluted. For this purpose, the concentration ranges have been categorized on the basis of the Indian Standards (IS) and Central Pollution Control Board (CPCB) standards and considering International standards of World Health Organization (WHO) and European Commission (EC). Twenty-five water quality parameters are selected based on the social and environmental impacts, and weights are computed using the Saaty's Analytic Hierarchy Process (AHP) Multiple Criteria Decision Analysis (MCDA) tool. These parameters are selected such that the same indices can be used to assess the quality of both surface and ground water. The computed weights minimize the subjectivity in assigning the parameter weights. The proposed index improves understanding of water quality issues by integrating complex data and generates a score which describes the status of water quality. The index will be very useful for the water management authorities to maintain good health of surface water resources.