Rare Guest-Induced Electrical Conductivity of Zn-Porphyrin Metallacage Inclusion Complexes Featuring π-Donor/Acceptor/Donor Stacks

Charge-transfer (CT) interactions between co-facially aligned π-donor/acceptor (π-D/A) arrays engender unique optical and electronic properties that could benefit (supra)molecular electronics and energy technologies. Herein, we demonstrate that a tetragonal prismatic metal-organic cage (MOC18+) having two parallel π-donor tetrakis(4-carboxyphenyl)-Zn-porphyrin (ZnTCPP) faces selectively intercalate planar π-acceptor guests, such as hexaazatriphenylene hexacarbonitrile (HATHCN), hexacyanotriphenylene (HCTP), and napthanelediimide (NDI) derivatives, forming 1:1 πA@MOC18+ inclusion complexes featuring supramolecular π-D/A/D triads. The π-acidity of intercalated π-acceptors (HATHCN ≫ HCTP ≈ NDIs) dictated the nature and strength of their interactions with the ZnTCPP faces, which in turn influenced the binding affinities (Ka) and optical and electronic properties of corresponding πA@MOC18+ inclusion complexes. Owing to its strongest CT interaction with ZnTCPP faces, the most π-acidic HATHCN guest enjoyed the largest Ka (5 × 106 M-1), competitively displaced weaker π-acceptors from the MOC18+ cavity, and generated the highest electrical conductivity (2.1 × 10-6 S/m) among the πA@MOC18+ inclusion complexes. This work demonstrates a unique through-space charge transport capability of πA@MOC18+ inclusion complexes featuring supramolecular π-D/A/D triads, which generated tunable electrical conductivity, which is a rare but much coveted electronic property of such supramolecular assemblies that could further expand their utility in future technologies.

Anatomic and physiologic diagnostic discrepancies in fetuses with single ventricle congenital heart disease in a contemporary cohort

OBJECTIVE

Image quality of fetal echocardiography (FE) has improved in the recent era, but few recent studies have reported the accuracy of FE specifically in single ventricle congenital heart disease (SV). Our study aims to assess the ability of FE to correctly predict postnatal anatomy and physiology in SV in a contemporary cohort.

METHODS

The contemporary, clinical reports of FE with SV performed from 7/2017 to 7/2021 were compared with postnatal echocardiograms in a formal quality assurance program. SV were grouped by anatomic subtype. Diagnostic errors were designated as major if the error would have resulted in significant alteration in fetal counseling or postnatal management. Remaining errors were classified as minor. Physiologic discrepancies, including prostaglandin dependency (PGE-D), atrioventricular valve regurgitation (AVVR), pulmonary venous obstruction, and atrial septal restriction were assessed by review of postnatal course.

RESULTS

A total of 119 subjects were analyzed. SV subtypes in the cohort included hypoplastic left heart syndrome (HLHS) (n=68), tricuspid atresia (n=16), double inlet left ventricle (n=12), unbalanced atrioventricular canal (UAVC) (n=11), heterotaxy (n=9), and other (n=3). The rate of major anatomic and physiologic errors was low (n=6, 5.0%). A higher proportion of minor errors were noted in HLHS and tricuspid atresia but the differences were not statistically significant. Physiologic discrepancies were uncommon, with three major discrepancies including underestimation of degree of venous obstruction in one non-HLHS fetus with total anomalous pulmonary venous return, overestimation of atrial septal restriction in one HLHS fetus, and incorrect prediction of PGE-D with 1 false-negative for pulmonary blood flow. No discrepancy in degree of AVVR or atrial septal restriction affected postnatal care. Minor physiologic discrepancies included two false-positive predictions of PGE-D with 1 false-positive for ductal-dependent systemic flow, and 1 false-positive for pulmonary blood flow.

CONCLUSIONS

In this contemporary review of FE in SV at our center, there was high accuracy in describing anatomic and physiologic findings in fetuses with SV. Major physiologic discrepancies were uncommon but included important cases of false-negative prediction of PGE-dependence and underestimation of obstruction of total anomalous pulmonary venous return. These data can both inform more accurate counseling of families with SV fetuses and guide diagnostic improvement efforts. This article is protected by copyright. All rights reserved.

Radiotherapy for Liver Cancer: An International Multi-Centre Pooled Analysis of 925 Cases

PURPOSE/OBJECTIVE(S)

Primary and secondary liver cancer incidence is growing and has a poor prognosis. The standard use of radiation has been hampered by studies with a wide range of patients, different management protocols and varied outcomes. To overcome this heterogeneity in the literature, larger and higher-level trials are warranted, but, so far, have been difficult to implement. Therefore, pooled analyses may offer the best way to determine the benefit of radiation, identify treatment parameters needed to optimize treatment techniques, and identify patient factors that allow for better patient selection.

MATERIALS/METHODS

Patients with liver cancer treated by radiotherapy at centers in Canada, United States and Australia was pooled. Patient and treatment characteristics were noted, as well as the clinical outcomes of local control within 1 year, recurrence and mortality. Stepwise Cox proportional hazards models were used to identify significant predictors for recurrence and mortality. Patients were stratified by center, and primary versus metastatic disease.

RESULTS

A total of 925 patients were included in this study. Mean age was 67 years, and 45% had a primary diagnosis of hepatocellular carcinoma. 1-year local control rate was 80%. Median survival was 1.8 years (1.9 years for primary liver cancer, and 1.4 years for metastatic liver cancer). Higher total dose and BED was associated with better survival. Median time to recurrence was 1.5 years. Higher total dose was associated with lower risk of recurrence CONCLUSION: As one of the largest pooled analyses in hepatic cancer, this international multi-center study provides pragmatic data on clinical outcomes of patients receiving radiotherapy for liver cancer. This database may assist in better selection of patients for future studies and answer questions such as what is the optimal dose and which patients benefit from treatment.

New Fluorine-Containing Diamine Monomers for Potentially Improved Polyimides

Two new fluorine-containing diamine monomers were designed with the goal of reducing charge transfer complex (CTC) interactions between neighboring chains in polyimides (i.e., high transparency/low color) while hopefully maintaining the well-known thermal stability and flexibility generally associated with polyimides. The proposed diamines have been prepared through (1) the functionalization of 1,3-bis[(pentafluorobenzyl)oxy]benzene with 4-aminophenol and (2) the addition of 2-chloro-5-nitrobenzotrifluoride to 4,4'-bicyclohexanol followed by reduction of the resulting dinitro compound. The new compounds have been characterized by multinuclear NMR and IR spectroscopy and high-resolution liquid chromatography-mass spectrometry as well as single-crystal X-ray diffraction on the new diamine prepared from 4,4'-bicyclohexanol. Not only was the structure of the proposed new diamine confirmed, but another interesting example of hydrogen bonding between an N-H proton and the π-system of an aromatic ring was observed and documented. Initial polymerizations have been carried out via the two-step imidization process.

The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study

STUDY DESIGN

Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine.

SETTING

Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS).

RESULTS

Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R² = 0.745, β = -0.833, p ≤ 0.001).

CONCLUSIONS

Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.

Constructing Lipoparticles Capable of Endothelial Cell-Derived Exosome-Mediated Delivery of Anti-miR-33a-5p to Cultured Macrophages

Atherosclerosis is driven by intimal arterial macrophages accumulating cholesterol. Atherosclerosis also predominantly occurs in areas consisting of proinflammatory arterial endothelial cells. At time of writing, there are no available clinical treatments that precisely remove excess cholesterol from lipid-laden intimal arterial macrophages. Delivery of anti-miR-33a-5p to macrophages has been shown to increase apoAI-mediated cholesterol efflux via ABCA1 upregulation but delivering transgenes to intimal arterial macrophages is challenging due to endothelial cell barrier integrity. In this study, we aimed to test whether lipoparticles targeting proinflammatory endothelial cells can participate in endothelial cell-derived exosome exploitation to facilitate exosome-mediated transgene delivery to macrophages. We constructed lipoparticles that precisely target the proinflammatory endothelium and contain a plasmid that expresses XMOTIF-tagged anti-miR-33a-5p (LP-pXMoAntimiR33a5p), as XMOTIF-tagged small RNA demonstrates the capacity to be selectively shuttled into exosomes. The cultured cells used in our study were immortalized mouse aortic endothelial cells (iMAECs) and RAW 264.7 macrophages. From our results, we observed a significant decrease in miR-33a-5p expression in macrophages treated with exosomes released basolaterally by LPS-challenged iMAECs incubated with LP-pXMoAntimiR33a5p when compared to control macrophages. This decrease in miR-33a-5p expression in the treated macrophages caused ABCA1 upregulation as determined by a significant increase in ABCA1 protein expression in the treated macrophages when compared to the macrophage control group. The increase in ABCA1 protein also simulated ABCA1-dependent cholesterol efflux in treated macrophages-as we observed a significant increase in apoAI-mediated cholesterol efflux-when compared to the control group of macrophages. Based on these findings, strategies that involve combining proinflammatory-targeting lipoparticles and exploitation of endothelial cell-derived exosomes appear to be promising approaches for delivering atheroprotective transgenes to lipid-laden arterial intimal macrophages.

A New Motif in Halogen Bonding: Cooperative Intermolecular S-Br⋅⋅⋅O, O⋅⋅⋅F, and F⋅⋅⋅F Associations in the Crystal Packing of α,ω-Di(sulfonyl bromide) Perfluoroalkanes

We recently reported the first examples of S-Cl⋅⋅⋅O halogen bonding complemented by short F⋅⋅⋅F contacts between neighboring chains that resulted in stabilized crystals of ClSO₂ (CF₂ )₄ SO₂ Cl and ClSO₂ (CF₂ )₆ SO₂ Cl. More recently, other researchers studied our crystallographic data further using an Independent Gradient Model (IGM), and they suggested if one goes beyond IUPAC's proposed 'less than the sum of the van der Waals radii' criterion that even more noncovalent interactions between fluorine atoms on neighboring chains as well as Cl⋅⋅⋅Cl, Cl⋅⋅⋅S, O⋅⋅⋅F, and O⋅⋅⋅S attractive interactions can be found. With that said, we have prepared samples of the related BrSO₂ (CF₂ )_n SO₂ Br derivatives (where n=4, 6, 8, and others), which give rise to even stronger S-Br⋅⋅⋅O halogen bonding interactions complemented minimally by O⋅⋅⋅F and F⋅⋅⋅F intermolecular interactions as shown by X-ray crystallography and computational chemistry using IGM isosurface plots. Additional spectroscopic characterization (multinuclear NMR, FT-IR, and MS) of the disulfonyl bromide derivatives BrSO₂ (CF₂ )₄ SO₂ Br, BrSO₂ (CF₂ )₆ SO₂ Br, and BrSO₂ (CF₂ )₈ SO₂ Br has also been obtained as well as some preliminary spectroscopic evidence for BrSO₂ (CF₂ )₂ SO₂ Br and BrSO₂ CF₂ O(CF₂ )₂ OCF₂ SO₂ Br. The implication of these results toward the preparation of the corresponding disulfonyl iodides is discussed.

Cardiovascular disease risk factors and outcomes of acute myocardial infarction in young adults in two nationwide cohorts in the united states

Funding Acknowledgements

Type of funding sources: None.

Background

Acute myocardial infarction (AMI) can have considerable morbidity and devastating socioeconomic and psychological consequences in young adults. Previous studies reveal that the decline in mortality in AMI has mainly been in the older population while being comparatively less significant in younger patients. This study compares young adults (18 to 44 years) hospitalized with AMI across two nationwide cohorts, 2007 and 2017, in the United States (US). It examines the burden of AMI hospitalizations, the prevalence of comorbidities, and in-hospital outcomes in young adults a decade apart. It highlights the rise in AMI hospitalizations, lack of decrease in mortality, sex-based and racial disparities, the surge in post-MI complications, and the decline in reperfusion interventions in young AMI patients over a decade.

Purpose

Coronary heart disease prevalence is challenging to ascertain in younger adults because of limited data and frequent silent clinical presentations. AMI and its complications can cause considerable morbidity, psychological trauma, and socioeconomic burden in the young.

Methods

We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample (NIS), which covers 20% of stratified data of all non-federal community hospitals in the US. We compared the following data between the two cohorts: admission rates, sociodemographic features, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the two cohorts. We used Pearson’s Chi-square test and Mann-Whitney U test to compare categorical and continuous variables, respectively. We also applied multivariable regression analyses to assess and compare the risk of cardiovascular complications and in-hospital mortality while controlling for confounders, including age, sex, race, median household income quartile, primary insurance enrolment, and pre-existing comorbidities.

Results

AMI’s incidence was higher in males in both the cohorts, although with a decline (71.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort (Table 1). We found no significant difference in all-cause mortality (aOR = 1.01 (0.93-1.10), p=0.749). Post-AMI complications, cardiogenic shock (aOR = 1.16 (1.06-1.27), p=0.001), and fatal arrhythmias increased. Reperfusion interventions decreased in the 2017 cohort (PCI; aOR=0.95 (0.91-0.98), p<0.001; CABG; aOR=0.66 (0.61-0.71), p<0.001) (Table 2).

Conclusion

Our study highlights the rise in AMI hospitalizations, plateauing of mortality, gender disparity, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over a decade.

Pulmonary artery injury in left atrial appendage closure device implantation: a systematic review of a potentially fatal complication

Background

Pulmonary artery (PA) injury is a rarely reported complication following percutaneous left atrial appendage closure (LAAC). This study aims to systematically review all reported cases of PA injury associated with LAAC.

Methods

PubMed/Medline, SCOPUS, EMBASE, Google Scholar and the MAUDE databases were searched to find studies reporting PA injury during or after LAAC with the Amplatzer Amulet (AA), Amplatzer Cardiac Plug (ACP) or Watchman device through October 2019. Categorical data were reported in terms of numbers and/or percentages (%).

Results

We found 13 cases (mean age 71.4 yrs) with reported PA injury associated with LAAC. Of these, 9 were case reports, 3 were reported in observational studies, and 1 was in the MAUDE database. Most cases (n=8) were reported in Europe followed by Australia (n=2) and Asia (n=2). The indication for device implantation in all patients was a high bleeding risk with anticoagulation for atrial fibrillation. Five cases were reported with the ACP (1/5 patients died), 5 with AA (2/5 patients died), and 3 with the Watchman (1/2 patients died). Acute and late presentations following implantation were reported for all three devices. 69.2% of cases (9/13) occurred acutely (during or within 24 hours of intervention). Of these, 3/9 occurred during device implantation. 2/4 of the delayed cases occurred >2 weeks following implantation. The mortality rate for acute and delayed cases was 22% (2/9 patients) and 50% (2/4 patients), respectively. A majority of the cases were attributable to barb/strut/hook injury of the PA. PA injury was associated with a mortality rate of approximately 31%. All surviving patients were managed with surgical intervention.

Conclusion

PA injury is an infrequently reported complication following LAAC and is associated with high mortality. Cases can present acutely (intra-procedurally or within 24 hours) or delayed (>24 hours post-implantation). A majority of cases are due to direct injury of the PA by the struts/hooks/barbs of the device. Practitioners should be cognizant of this life-threatening complication, which requires a high index of suspicion for diagnosis and can occur weeks after device implantation.

Funding Acknowledgement

Type of funding source: None

Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations

Background

Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.

Methods

PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.

Results

A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female >85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (<70 vs. >70 yrs), smaller sample size (n<100 vs. n>100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).

Conclusions

This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.

Funding Acknowledgement

Type of funding source: None

Fluorescent patterning of paper through laser engraving

While thermal treatment of paper can lead to the formation of aromatic structures via hydrothermal treatment (low temperature) or pyrolysis (high temperature), neither of these approaches allow patterning the substrates. Somewhere in between these two extremes, a handful of research groups have used CO2 lasers to pattern paper and induce carbonization. However, none of the previously reported papers have focused on the possibility to form fluorescent derivatives via laser-thermal engraving. Exploring this possibility, this article describes the possibility of using a CO2 laser engraver to selectively treat paper, resulting in the formation of fluorescent compounds, similar to those present on the surface of carbon dots. To determine the most relevant variables controlling this process, 3 MM chromatography paper was treated using a standard 30 W CO2 laser engraver. Under selected experimental conditions, a blue fluorescent pattern was observed when the substrate was irradiated with UV light (365 nm). The effect of various experimental conditions (engraving speed, engraving power, and number of engraving steps) was investigated to maximize the fluorescence intensity. Through a comprehensive characterization effort, it was determined that 5-(hydroxymethyl)furfural and a handful of related compounds were formed (varying in amount) under all selected experimental conditions. To illustrate the potential advantages of this strategy, that could complement those applications traditionally developed from carbon dots (sensors, currency marking, etc.), a redox-based optical sensor for sodium hypochlorite was developed.

New polymorphism and structural sensitivity in triphenylmethylphosphonium trihalide salts

PPh₃MeX₃ (X = I, Br) is studied on the basis of temperature and halide composition revealing new polymorphism structure types.

Innate and humoral recognition of the products of cell death: differential antigenicity and immunogenicity in lupus

While apoptotic debris is believed to constitute the original antigenic insult in lupus (which is characterized by a time-dependent diversification of autoreactivity), whether such debris and autoantibodies specifically recognizing its constituents mediate differential effects on innate and humoral responses in lupus-prone mice is currently unknown. Apoptotic blebs (as opposed to cellular lysate) enhanced preferentially the maturation of dendritic cells (DCs) from bone marrow precursors drawn from lupus-prone mice. Murine, somatically mutated, apoptotic cell-reactive immunoglobulin (Ig)G monoclonal antibodies demonstrated enhanced recognition of DCs and also displayed a prominent lupus strain-specific bias in mediating DC maturation. Further, immunization of such antibodies specifically in lupus-prone mice resulted in widespread humoral autoreactivity; hypergammaglobulinaemia (a hallmark of systemic autoimmunity) was observed, accompanied by enhanced antibody titres to cellular moieties. Induced antibodies recognized antigens distinct from those recognized by the antibodies employed for immunization; in particular, nephritis-associated anti-double stranded (ds) DNA antibodies and neonatal lupus-associated anti-Ro60 antibodies were elicited by a non-dsDNA, non-Ro60 reactive antibody, and Sm was a favoured target. Further, only in lupus-prone mice did such immunization enhance the kinetics of humoral anti-self responses, resulting in the advanced onset of glomerulosclerosis. These studies reveal that preferential innate and humoral recognition of the products of cell death in a lupus milieu influence the indices associated with autoimmune pathology.

Evaluation of supraspinatus strengthening exercises based on fiber bundle architectural changes

Supraspinatus strengthening is an integral part of rehabilitation programs. However, there is disparity regarding the best exercise. Thus, we investigated the effects of supraspinatus strengthening exercises on muscle fiber bundle architecture using real-time ultrasound. Participants were randomized into full-can (FC; n = 12), empty-can (EC; n = 11,) and prone horizontal abduction (PHA; n = 11) groups and performed three sessions/week for 8 weeks. Each session involved four sets of exercise for weeks 1-4 and six sets for weeks 5-8 with eight repetitions/set. Images of supraspinatus were captured in 0° (relaxed) and 60° (contracted) glenohumeral abduction. Fiber bundle length (FBL), pennation angle, and muscle thickness were measured at beginning, mid, and end of training. Maximum isometric abduction strength was measured in full-can, empty-can, and prone horizontal abduction positions using a hand-held dynamometer. FBL decreased after 4 weeks in FC [relaxed: Δ = -0.54 cm, P = 0.001, d = 0.92; contracted: Δ = -0.27 cm, P = 0.008, d = 0.27] and EC [relaxed: Δ = -0.59 cm, P = 0.008, d = 0.86; contracted: Δ = -0.36 cm, P = 0.013, d = 0.59], but not in PHA [relaxed: Δ = -0.11, P = 0.121, d = 0.31; contracted: Δ = -0.06 cm, P = 0.486, d = 0.13]. Strength increased significantly from week 4-8 only in PHA (Δ = +0.96 kg, P = 0.004, d = 0.47) when tested in prone horizontal abduction position. Maintenance of FBL with increased strength indicates prone horizontal abduction may be a better exercise to strengthen supraspinatus.

Elucidation of the potential disease-promoting influence of IgM apoptotic cell-reactive antibodies in lupus

The undigested remnants of apoptosis are believed to stimulate the generation of autoantibodies in lupus. The biological properties of initiator, disease-specific IgM antibodies that specifically recognize apoptotic cells, readily detected in the sera of lupus patients, remain unclear. Apoptotic cell-reactive IgM monoclonal antibodies (generated from lupus-prone mice), as opposed to control IgM, preferentially stimulated maturation of bone marrow-derived dendritic cells (BMDCs) derived from such mice, relative to BMDCs derived from healthy mice. An influence of both antibody specificity and cell genotype was also apparent in the secretion of signature inflammatory cytokines. Immunization of such antibodies in lupus-prone animals induced increases in total serum IgG levels, with the elicited antibodies also preferentially recognizing moieties on dying cells. An expanded specificity was apparent both upon Western blot on cellular lysate and from the enhanced recognition of dsDNA, Ro60, RNP68 and Sm; the antibody most efficient in mediating autoreactive diversity, while being germline encoded, also induced the highest degree of phenotypic changes on BMDCs. Apoptotic cell-reactive IgM antibodies may therefore be potentially capable of influencing the course of systemic autoimmune disease by affecting both innate and adaptive immunity.

Sternal tuberculosis

Extra-pulmonary tuberculosis constitutes 15-20% of total tuberculosis (TB) case load in immuno-competent patients. Affliction of the skeletal system is rare with still rarer presentation of sternal osteomyelitis even in endemic countries. A patient with primary sternal TB presenting with multiple cutaneous sinuses over the anterior chest wall is being reported. A high element of suspicion is needed more so in resource limited setting for early diagnosis and treatment.

Comparative Analysis of Birth Weight in a Hospital Over a Decade: Low Birth Weight Still a Major Problem

Introduction: The objective of this study was to compare the magnitude of birth weight and proportion of low birth weight in a hospital over a decade. Materials and Methods: A descriptive study was undertaken in a public funded hospital catering to rural and urban population of northern India. Pertinent information was collected for all intramural singleton births using structured proforma for a sample period in a calendar year. For comparison purpose birth data was extracted from log books for the corresponding period of previous decade also. Data management was done using MS excel sheet and analysis carried out by computing descriptive statistics using software statistical package. Results: The mean (2568 + 596.7 gm) & median (2600 gm) birthweight recorded for 2011 was low in-comparison to 2657 + 581.7gm (2750 gm) for 2001. The prevalence of low birth weight (LBW) was 36.1% (2011) in comparison to 30.5% (2001) and the state of deterioration was found to be statistically significant (p<0.001). Higher proportion of LBW birth was observed amongst un-booked ANC, pre-term, anemic mothers and whose residence was from outside the district of location of study institute (<0.001). Statistically significant (<0.001) and higher perinatal mortality was noticed in LBW neonates. Rising level of maternal education was protective against LBW. Mothers with their first pregnancy gave higher proportion of LBW births in comparison to mothers with higher gravida status (<0.001). DOI: http://dx.doi.org/10.3126/jnps.v33i1.6176 J Nepal Paediatr Soc. 2013;33(1):15-20.

Evolution of interventions for complex coronary lesions

The exponential growth of percutaneous coronary intervention (PCI) has in large part been due to expansion of the indications to include the procedure in patients with extensive coronary disease, multiple risk factors, older age and comorbidities. Improvement in PCI equipment, development of new interventional techniques, and availability of myocardial and systemic support techniques have all contributed to this growth. With these advances, patients once considered high risk for PCI are no longer considered high risk. This article reviews the complex coronary lesions challenges, various interventional and pharmacologic strategies for optimal results and novel technology.

Mechanism of arylating quinone toxicity involving Michael adduct formation and induction of endoplasmic reticulum stress

Quinones permeate our biotic environment, contributing to both homeostasis and cytotoxicity. All quinones generate reactive oxygen species through redox cycling, while partially substituted quinones also undergo arylation (Michael adduct formation) yielding covalent bonds with nucleophiles such as cysteinyl thiols. In contrast to reactive oxygen species, the role of arylation in quinone cytotoxicity is not well understood. We found that the arylating quinones, including unsubstituted 1,4-benzoquinone (1,4-BzQ) and partially substituted vitamin E congener gamma-tocopherol quinone (gamma-TQ), were cytotoxic, with gamma-TQ > 1,4-BzQ, whereas the fully substituted nonarylating vitamin E congener alpha-tocopherol quinone was not. In vitro, both arylating quinones formed Michael adducts with the thiol nucleophile N-acetylcysteine (NAC) at rates where 1,4-BzQ > gamma-TQ. In cultured cells, concurrent addition of NAC eliminated 1,4-BzQ caused toxicity, but preincubation was required for the same NAC detoxification effect on gamma-TQ. These data clearly established the role of arylation in quinone toxicity and revealed that arylating quinone structure affects cytotoxicity by governing detoxification through the rate of adduct formation. Furthermore, arylating quinones induced endoplasmic reticulum (ER) stress by activating the pancreatic ER kinase (PERK) signaling pathway including elF2alpha, ATF4, and C/EBP homologous protein (CHOP). Detoxification by NAC greatly attenuates CHOP induction in arylating quinone-treated cells, suggesting that ER stress is a cellular mechanism for arylating quinone cytotoxicity.

Tocopherol metabolism using thermochemolysis: chemical and biological properties of gamma-tocopherol, gamma-carboxyethyl-hydroxychroman, and their quinones

Identification and quantitative estimation of quinone metabolites of gamma-tocopherol (gamma-T) and its derivative gamma-carboxyethyl hydroxychroman (gamma-CEHC) are complicated by their functions as arylating electrophiles. We hypothesize that their biological properties are expressed through arylating quinone electrophile addition (Michael reaction) with thiol nucleophiles in cells and tissues. Glutathione (GSH) reacted with gamma-tocopheryl quinone (gamma-TQ) to form the hydroquinone adduct, which was identified by electrospray time-of-flight MS (ESI-TOF-MS). Tetramethylammonium hydroxide (TMAH) thermochemolysis reduced and methylated quinones and cleaved and methylated thioether adducts. These relatively nonpolar derivatives were readily separated by GC and identified by MS fragmentation patterns. gamma-CEHC was synthesized and oxidized to a product identified as the quinone lactone (gamma-CEHC-QL). TMAH methylated both gamma-CEHC-QL and its GSH adduct without opening the lactone ring, and these products were separated by GC and identified by MS fragmentation patterns. gamma-CEHC-QL reacted with both the cysteinyl enzyme papain and fetal bovine serum, and TMAH thermochemolysis showed that each product mixture contained unreacted precursor and thioether adduct. Cytotoxicities of phenolic precursors, gamma-T and gamma-CEHC, and their quinones, gamma-TQ and gamma-CEHC-QL, respectively, were compared in COS1, NT2, 3T3, and N2a cell lines. Phenolic precursor gamma-T had a small effect only with NT2 and 3T3 cells while gamma-CEHC had no effect in any cell line. Arylating quinones were highly cytotoxic in all cell lines with gamma-TQ showing a significantly greater cytotoxicity than gamma-CEHC-QL. These data are consistent with our arylating electrophile hypothesis as an explanation for some biological activities of Ts through their quinone metabolites.

On the electrophilicity of hydroxyl radical: a laser flash photolysis and computational study

The rate coefficients for reactions of hydroxyl radical with aromatic hydrocarbons were measured in acetonitrile using a novel laser flash photolysis method. Comparison of kinetic data obtained in acetonitrile with those obtained in aqueous solution demonstrates an unexpected solvent effect on the reactivity of hydroxyl radical. In particular, reactions of hydroxyl radical with benzene were faster in water than in acetonitrile, and by a significant factor of 65. Computational studies, at the B3LYP and CBS-QB3 levels, have confirmed the rate enhancement of hydroxyl radical addition to benzene via calculation of the transition states in the presence of explicit solvent molecules as well as a continuum dielectric field. The origin of the rate enhancement lies entirely in the structures of the transition states and not in the pre-reactive complexes. The calculations reveal that the hydroxyl radical moiety becomes more anionic in the transition state and, therefore, looks more like hydroxide anion. In the transition states, solvation of the incipient hydroxide anion is more effective with water than with acetonitrile and provides the strong energetic advantage for a polar solvent capable of hydrogen bonding. At the same time, the aromatic unit looks more like the radical cation in the transition state. The commonly held view that hydroxyl radical is electrophilic in its reactions with DNA bases is, therefore, strongly dependent on the ability of the organic substrate to stabilize the resulting radical cation.

Structural effects on encapsulation as probed in redox-active core dendrimer isomers

Three pairs of isomeric, iron-sulfur core dendrimers were prepared. Each isomer pair was distinguished by a 3,5-aromatic substitution pattern (extended) versus 2,6-aromatic substitution pattern (backfolded). Several observations were made that supported the hypothesis that the iron-sulfur cluster cores were encapsulated more effectively in the backfolded isomers as compared to their extended isomeric counterparts. The backfolded isomers were more difficult to reduce electrochemically, consistent with encapsulation in a more hydrophobic microenvironment. Furthermore, heterogeneous electron-transfer rates for the backfolded molecules were attenuated compared to the extended molecules. From diffusion measurements obtained by pulsed field gradient spin-echo NMR and chronoamperometry, the backfolded dendrimers were found to be smaller than the extended dendrimers. Comparison of longitudinal proton relaxation (T(1)) values also indicated a smaller, more compact dendrimer conformation for the backfolded architectures. These findings indicated that the dendrimer size was not the major factor in determining electron-transfer rate attenuation. Instead, the effective electron-transfer distance, as determined by the relative core position and mobility in a dendrimer, is most relevant for encapsulation.

Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi

AIM

To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season.

METHODS

Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001.

RESULTS

Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies.

CONCLUSIONS

This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.

Outcome in children receiving continuous venovenous hemofiltration

OBJECTIVE

Continuous venovenous hemofiltration (CVVH) alone or with dialysis (D) has become an important supportive therapy for critically ill children with acute renal failure. Previous reports of pediatric patient outcome either mix CVVH/D with other renal replacement modalities or do not examine severity of illness. The current study examines only outcomes of children receiving CVVH/D using Pediatric Risk of Mortality (PRISM) scores to control for severity of illness.

PATIENTS

Twenty-one patients (mean age: 8.8 +/- 6.3 years; mean weight: 28.3 +/- 20.8 kg) received 22 courses of CVVH/D.

OUTCOMES

Nine (42.8%) of 21 patients survived. Nine (75%) of 12 deaths occurred within 25 days of pediatric intensive care unit (PICU) admission. Mean PRISM score at PICU admission and CVVH initiation were 13.1 +/- 5.8 and 15.4 +/- 8.9, respectively. Mean patient weight, age, PRISM score at PICU admission and at CVVH/D initiation, maximum pressor number, estimated glomerular filtration rate at CVVH/D initiation and change in mean airway pressure did not differ between survivors and nonsurvivors. The degree of fluid overload at CVVH/D initiation was significantly lower in survivors (16.4% +/- 13.8%) compared with nonsurvivors (34.0% +/- 21.0%), even when controlled for severity of illness by PRISM score. Mean cost of providing CVVH/D accounted for only 1% of total PICU cost per patient.

CONCLUSIONS

The pattern of early multiorgan system failure and death, minimal relative cost of CVVH/D provision, and potential for improved outcome with initiation of CVVH/D at lesser degrees of fluid overload are factors that may support early initiation of CVVH/D in critically ill children with acute renal failure.

Multiple aortic thrombi associated with protein C and S deficiency

We describe a woman with an unusual case of thromboembolism of the mesenteric artery in whom multiple thrombi were subsequently found in the aorta and right heart chambers on transesophageal echocardiography. Further evaluation revealed a deficiency of protein C and S plasma proteins, inhibitors of the clotting system. The patient was treated successfully with systemic anticoagulation. Aortic thrombus is common in the setting of underlying atherosclerosis. However, the association of aortic thrombus with a deficiency of protein C and S is rare. To our knowledge, this is the first reported case of mural thrombus of the thoracic aorta associated with combined protein C and S deficiency. Our report underscores the important role of transesophageal echocardiography in the evaluation of patients with arterial thromboembolism.

Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease

BACKGROUND

Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease.

METHODS AND RESULTS

Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9+/-7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74+/-4% at 5 years and 54+/-7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z: value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients </=1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z: value <2 and aortic valve type predicted homograft valve failure.

CONCLUSIONS

Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.

Relationship between Af temperature and load changes in Ni-Ti orthodontic wire under different thermomechanical conditions

Simple three point bending tests were performed on Ni-Ti wires with three different Af points (1 degree C, 13 degrees C and 34 degrees C) to clarify the relationship between Af temperature and load changes under constant deformation. Each wire was deformed at 37 degrees C and then thermal changes were imposed by temperatures of 2 degrees C or 60 degrees C. The load changes with thermal changes from 37 degrees C to 2 degrees C or 60 degrees C showed the same tendency on the wires with different Af points: In the loading stage, the load became lower than the initial level at 37 degrees C and in the unloading stage, the load became higher than the initial load. The largest load change in the unloading stage was measured with the 13 degrees C Af point wire. Care must be taken when handling Ni-Ti wire with an Af point of less than 1 degree C in order to prevent it from reaching the limit of critical stress of slip deformation when the temperature in the mouth rises to above 40 degrees C.

Health status of children with special health care needs: measurement issues and instruments

The methods for measuring health care outcomes and monitoring the health status of the child with a chronic health condition must be available, accessible, and meaningful. This review was evoked by this need to identify reliable and valid instruments for measuring the health status of children with special health care needs. The objectives are as follows: (1) to review the methodologic and substantive issues related to the selection of instruments and (2) to identify those instruments available currently for collecting data regarding health status of children with special health care needs. A Medline search of the literature published since 1966 through 1998 and restricted to human subjects and the English language was conducted. Indexing terms included health status, quality of life, outcome assessment, functional status, and patient satisfaction. Multiple reviewers selected instruments based on their usefulness in clinical settings as generic, disease nonspecific, child health status instruments. Few instruments were identified that can be used by pediatricians for tracking and monitoring the health status of children with special health care needs. In conclusion, to progress in the field of outcomes measurement of children with special health care needs, it will be necessary to develop new measurement tools. These instruments must (1) provide valid and reliable information on health status; (2) be useful in guiding the management of patients; and (3) not be a burden for physicians, patients, or patient's families.

Evaluation of a real-time blood glucose monitor in children with diabetic ketoacidosis

Use of a real-time bedside glucose monitor was analyzed during the course of management of diabetic ketoacidosis (DKA) in children. Simultaneous determinations of blood glucose were obtained, using three methods: bedside glucose meter (One Touch II), laboratory glucose analyzer (YSI 2300 STAT), and a real-time bedside glucose monitor (VIA 1-01G Blood Chemistry monitor). Study patients included seventeen patients < 18 years of age admitted to a Pediatric Intensive Care Unit, with blood samples obtained during treatment of DKA by continuous insulin infusion. Four patients did not complete the study. Three experienced temporary technical problems with the monitor, and four required repeat IV placement. Duration of monitor use ranged between 6 and 47 h (mean 24 +/- 4 h). Blood glucose values ranged between 2.6 and 22.5 mmol/l. Overall correlation of blood glucose values were as follows: 0.965, 0.965, 0.973, VIA 1-01G vs. One Touch II, VIA 1-01G vs. YSI 2300 STAT, and One Touch II vs. YSI 2300 STAT, respectively (all P-values < 0.0001). This real-time bedside glucose monitor is accurate at glucose values < 13.8 mmol/l, and reliable for rapid, repetitive analyses. Results indicate that blood glucose values obtained using this real-time monitor are comparable to those using standard methods of measurement, and that this device is clinically applicable for use in management of children with DKA.

Long-term ingrowth and apposition of porous hydroxylapatite implants

Bone implant materials are often used to fill in bone gaps that frequently result from orthognathic and craniofacial reconstruction. The substrate hydroxylapatite (HA) is commonly implanted into the bone voids, resulting from these conditions due to its established biocompatibility and osteoconductive properties. The porous structure of HA provides a three-dimensional guideline for fibrovascular ingrowth, facilitating the process that ultimately results in the deposition of new bone. Porous HA (Interpore, 200) implants were implanted in the mandible or maxilla of nine humans and removed after 14-30 months (19.1-month mean). There was no evidence of an inflammatory response. The sample composition and apposition against the implant were determined using point counting and a digitizing tablet and software. Percent ingrowth in available space (%IAS) was defined as %Bone/(%Bone + %Void). A new measure of implant saturation (%IAS-%Apposition of bone) was established to help determine the fundamental manner in which long-term HA implants incorporate bone. In the mean, the samples were composed of 27% bone, 21% void, and 53% implant. The apposition percentages averaged 60% bone, 16% void, and 24% soft tissue. The %IAS averaged 58%, and implant saturation averaged -3%, indicating that a near-balance between the implant and surrounding bone has been established.

Condylar change after upward and forward rotation of the maxillomandibular complex

Tomographic radiographs of 44 healthy temporomandibular joints in 22 patients undergoing large upward and forward rotations of the maxillomandibular complex were evaluated. Immediate postsurgery results showed decreases in all areas of the joint space. Long-term results showed a decrease in the superior and posterior regions, 14.8% and 19.7%, with no significant change anteriorly. Simple and multiple regression analysis did not show any relationship with age, gender, or degree of change in the decrease of the occlusal plane angle, to the temporomandibular joint changes described. Some condylar remodeling was noted.

Nutritional status of school age children of salt-workers in Rajasthan

Nutritional status of 1044 school age children (6-18 yr) of salt workers in various salt manufacturing sites of Rajasthan, was assessed using anthropometry. Heights and weights of girls were observed to be better than in boys in the menarcheal age groups. Children of the present study showed reduced growth in comparison to National Centre for Health Statistics (NCHS), World Health Organisation (WHO), well-to-do Indian children and Rajasthan reference values of the same age groups. The prevalence of stunted with severe wasting was 4.5 per cent in the children of salt workers. Higher prevalence of severe wasting was observed in girls than the boys (P < 0.01).