Oncological outcomes of visibly complete transurethral resection prior to neoadjuvant chemotherapy for bladder cancer

ABSTRACT Purpose: To evaluate the potential oncologic benefit of a visibly complete transurethral resection of a bladder tumor (TURBT) prior to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Materials and Methods: We identified patients who received NAC and RC between 2011-2021. Records were reviewed to assess TURBT completeness. The primary outcome was pathologic downstaging (<ypT2N0), with complete pathologic response (ypT0N0) and survival as secondary endpoints. Logistic regression and Cox proportional hazards models were utilized. Results: We identified 153 patients, including 116 (76%) with a complete TURBT. Sixty-four (42%) achieved <ypT2N0 and 43 (28%) achieved ypT0N0. When comparing those with and without a complete TURBT, there was no significant difference in the proportion with <ypT2N0 (43% vs 38%, P=0.57) or ypT0N0 (28% vs 27%, P=0.87). After median follow-up of 3.6 years (IQR 1.5-5.1), 86 patients died, 37 died from bladder cancer, and 61 had recurrence. We did not observe a statistically significant association of complete TURBT with cancer-specific or recurrence-free survival (p≥0.20), although the hazard of death from any cause was significantly higher among those with incomplete TURBT even after adjusting for ECOG and pathologic T stage, HR 1.77 (95% CI 1.04-3.00, P=.034). Conclusions: A visibly complete TURBT was not associated with pathologic downstaging, cancer-specific or recurrence-free survival following NAC and RC. These data do not support the need for repeat TURBT to achieve a visibly complete resection if NAC and RC are planned.

A Study On The Challenges Of Administration Of Criminal Justice System In Modern India.

The principal purpose of criminal justice administration is to preserve and defend the rule of law i.e, social control of law, maintenance of order, speedy trial, penalization of offenders, rehabilitation of offenders through the judicial system, and solace to victims of crimes. The current criminal justice system is affected by various loopholes and faults. The legal approach is time-consuming and generally geared towards the mind of the accused i.e., a system that is involved with the rights and interests of the offender instead of those of the victims. The current criminal justice system has been unsuccessful in delivering speedy and prompt justice to people and guaranteeing the certainty of penalization to perpetrators of crime. The necessity is therefore to offer a reformed look at the various aspects of the criminal justice system in the field of justice for people and regarding the increasing challenges of criminal justice reform.

Cotransplantation of marginal mass allogeneic islets with 3D culture-derived adult human skin cells improves glycemia in diabetic mice

Islet transplantation represents a therapeutic option for type 1 diabetes (T1D). Long-term viability of transplanted islets requires improvement. Mesenchymal stromal cells (MSCs) have been proposed as adjuvants for islet transplantation facilitating grafting and functionality. Stem cell aggregation provides physiological interactions between cells and enhances the in situ concentration of modulators of inflammation and immunity. We established a hanging-drop culture of adult human skin fibroblast-like cells as spheroids, and skin spheroid-derived cells (SphCs) were characterized. We assessed the potential of SphCs in improving islet functionality by cotransplantation with a marginal mass of allogeneic islets in an experimental diabetic mouse model and characterized the secretome of SphCs by mass spectrometry-based proteomics. SphCs were characterized as multipotent progenitors and their coculture with anti-CD3 stimulated mouse splenocytes decreased CD4+ T cell proliferation with skewed cytokine secretion through an increase in the Th2/Th1 ratio profile. SphCs-conditioned media attenuated apoptosis of islets induced by cytokine challenge in vitro and importantly, intratesticular SphCs administration did not show tumorigenicity in immune-deficient mice. Moreover, SphCs improved glycemic control when cotransplanted with a marginal mass of allogeneic islets in a diabetic mouse model without pharmacological immunosuppression. SphCs' protein secretome differed from its paired skin fibroblast-like counterpart in containing 70% of up- and downregulated proteins and biological processes that overall positively influenced islets such as cytoprotection, cellular stress, metabolism, and survival. In summary, SphCs improved the performance of transplanted allogeneic islets in an experimental T1D model, without pharmacological immunosuppression. Future research is warranted to identify SphCs-secreted factors responsible for islets' endurance.

The Upper Juruá Extractive Reserve in the Brazilian Amazon: past and present

Abstract Amazonian livelihoods are largely dependent on rivers, with local protein consumption mainly relying on several species of fish. The UJER (Upper Juruá Extractive Reserve - Reserva Extrativista do Alto Juruá) is located in the state of Acre, bordering Peru and several indigenous areas. Here we summarize the data we collected in 1993/1994 on the population living along the banks of the Juruá, Tejo, Bagé, Igarapé São João and Breu rivers on crop cultivation, animal husbandry, and use of game and fish resources. We interviewed 133 individuals (94 on the Juruá and Tejo, 16 on Bagé, 16 on Igarapé São João and 7 on Breu rivers). Our results include a comprehensive description on local livelihoods, including the most important fish species for local subsistence considering gender and seasonality, the main husbandry and game species, and the items cultivated on the local agriculture. Whenever more recent information was available in the literature, we compared changes in livelihoods over time in the same region and also with the recent patterns observed in the Lower and in the Middle Juruá River. We hope to provide useful information to understand temporal changes in local livelihoods, which can help adapt and shape the ecological management in the region.

Resumo Comunidades da Amazônia são amplamente dependentes dos rios, com o consumo local de alimentos baseado em várias espécies de peixes. A UJER (Reserva Extrativista do Alto Juruá - Reserva Extrativista do Alto Juruá) está localizada no estado do Acre, na fronteira com o Peru e com várias áreas indígenas. Aqui resumimos os dados que coletamos em 1993/1994 da população que vive às margens dos rios Juruá, Tejo, Bagé, Igarapé São João e Breu sobre cultivo, criação de animais e uso de recursos de caça e peixes. Foram entrevistados 133 indivíduos (94 nos rios Juruá e Tejo, 16 em Bagé, 16 em Igarapé São João e 7 no rio Breu). Nossos resultados incluem uma descrição abrangente dos meios de subsistência locais, incluindo as espécies de peixes mais importantes para a subsistência local, considerando gênero e sazonalidade, bem como as principais espécies de criação, de caça e os itens cultivados na agricultura local., Quando foi possível obter informações da literatura, comparamos as mudanças nos meios de subsistência ao longo do tempo na mesma região e também com os padrões recentes observados no Baixo e no Médio Rio Juruá. Esperamos fornecer informações úteis para o entendimento das mudanças temporais nos meios de subsistência locais, o que pode ser útil ao manejo ecológico da região.

Discovery and preclinical development of IIIM-160, a Bergenia ciliata-based anti-inflammatory and anti-arthritic botanical drug candidate / 中西医结合学报

OBJECTIVE@#Bergenia ciliata (Haw.) Sternb. is used in the Indian traditional system of medicine to treat various ailments including rheumatism and to heal wounds. The objective of the present study was to perform a preclinical characterization of the B. ciliata-based botanical extract IIIM-160.@*METHODS@#IIIM-160 was chemically standardized and analyzed for heavy metal content, aflatoxins, pesticides and microbial load. The in vitro and in vivo efficacies were determined in suitable models of inflammation, arthritis and nociception. An acute oral toxicity study was performed in Swiss albino mice. A suitable oral formulation was developed and characterized.@*RESULTS@#Bergenin was found to be the major component (9.1% w/w) of IIIM-160. The botanical lead displayed inhibition of lipopolysaccharide-induced production of proinflammatory cytokines in THP-1 cells, with selectivity toward interleukin-6 (IL-6) and had an excellent safety-window. It showed anti-inflammatory, anti-arthritic and antinociceptive activity in animal models and was not toxic at oral doses up to 2 g/kg in Swiss-albino mice. The gastroretentive, sustained-release capsule formulation showed sustained-release of the bergenin over the period of 24 h, resulting in improved plasma-exposure of bergenin in Sprague-Dawley rats.@*CONCLUSION@#The dual-activity of IL-6 inhibition and antinociception marks the suitability of IIIM-160 for treating rheumatoid arthritis. This study will serve as the benchmark for further research on this botanical formulation.

Evaluating Climate Change Mitigation and Adaptation Potential of Conservation Agriculture in Semi-arid Tropics of Southern India.

Aims: As climate change related rainfall and temperature variability is being increasingly experienced in the SAT regions, we assessed climate change mitigation and adaptation potential of Conservation Agriculture (CA) by studying effects of minimum tillage (MT) and residue management practices on rain water use efficiency (RWUE), soil moisture, runoff, energy use and carbon dioxide emission in two maize-legume cropping systems. Study Design: The experiment was laid out in split-split plot design with four replications. Place and Duration of Study: The study was conducted at the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) farm, Patancheru, Telangana, India during 2010-11 and 2011-12. Methodology: RWUE was calculated as maize equivalent yield divided by rainfall received during the crop season. Integrated digital runoff and soil loss monitoring unit (IDRSMU) was used to measure runoff. Soil moisture content was measured using the gravimetric method (0-30 cm depth) and neutron probe (60-90 cm depth). The soil organic carbon was analyzed following the Walkley-Black method [1]. The diesel consumption in MT and conventional tillage (CT) was estimated following Downs and Hansen (http://www.ext.colostate.edu/pubs) and emission of CO2 was estimated according to EPA, 2009 [2]. Results: Tillage and residue management practices did not show significant effect on RWUE except; CT having significantly higher RWUE over MT during 2011-12. Effect of cropping systems on RWUE was significant but variable during the two years of study. MT-RT (minimum tillageresidue retained) reduced total seasonal runoff by 28.62% and 80.22% compared to CT-RR (conventional tillage- residue removed) in 2010-11 and 2011-12, respectively. Similarly, MT-RT reduced rainwater loss and peak rate of runoff compared to CT-RR in both the years of study. During 2010, MT-RT had higher total soil moisture (v/v) in the 0-90 cm soil depth in sole as well as intercropped maize compared to CT-RR, however, during 2011 MT-RT had higher total soil moisture in sole maize only. As compared to CT, even though, MT improved SOC in 0-15 cm depth but lowered slightly in 15-30 cm depth. RT (residue retained) improved SOC in 0-15 and 15- 30 cm depths compared to residue removal (RR). MT-RT had higher or equal SOC in 0-15 and 15- 30 cm soil depths compared to CT-RR in both the maize-legume cropping systems. MT saved energy corresponding to 41.49 l of diesel per hectare annually compared to CT. Similarly, MT emitted 110.79 kg less CO2 annually on per hectare basis compared to CT due to reduced diesel use. Conclusion: CA, when adopted by following good agricultural practices and refined to suit the local conditions, could emerge as sustainable production system for climate change mitigation and adaptation of dryland cropping systems in semi-arid tropics of southern India.

Epidemiological Profile of Snake Bite in South 24 Parganas District of West Bengal with Focus on Underreporting of Snake Bite Deaths.

Background: Snake bite is a neglected public health problem in India. Very few community based epidemiological studies in India have been published so far on this issue. Most of the studies were carried out on hospital data. Previous community-based survey in the state revealed that only 22% snake bite victims attended hospitals. Objectives: The objective of the present study is to fi nd out the epidemiological profi le of snake bite in eight blocks of the South 24-Paraganas district of West Bengal and to explore the under reporting of snake bite deaths in health facilities in that area during the study period. Materials and Methods: A retrospective analysis of snake bite data was carried out from a community-based epidemiological survey on 1.9 million populations. This survey was done door-to-door from January 2009 to October 2010 to get epidemiological profi le of snake bite of the previous 2 years. The data of direct survey was compared with the offi cial report of the same area to evaluate the hospital-based data with focus on underreporting of snakebite deaths. Results: A total number of snake bite cases as found in the survey in the study area was 4871. There was a huge gap between the two data (direct survey and offi cial data). Only 7.23% snake bite deaths were offi cially reported. Only 22.19% of the snake bite victims attended the hospitals. Nearly 65.7% of the snake bite deaths were due to common krait bite, most of them occurring in the months of June to September. Conclusions: Offi cial reporting system is still having a huge defi ciency in India. Snake bite needs to get more attention from the health authority.

Screening for common mental disorders and substance abuse among temporary hired cleaners in Egyptian governmental hospitals, Zagazig city, Sharqia governorate

Informal employment is common in developing countries, including Egypt. This type of employment may have significant consequences on mental health. To determine the prevalence and risk factors of common mental disorders and substance abuse among temporary hired hospital cleaners. A cross-sectional study was conducted on 242 adult temporary cleaners and 209 permanent cleaners working in 4 governmental hospitals in Zagazig City, Sharqia Governorate, Egypt. All participants were invited to complete a structured questionnaire through a semi-structured interview which included the self-reporting questionnaire 20 items [SRQ-20] and the work stress scale. Assessment of drug use included urine-based screening tests for common substances abused. The prevalence of job stress, common mental disorders and substance abuse, particularly tramadol and cannabis [Bango], was significantly higher in the studied temporary cleaners compared to permanent cleaners. Risk factors associated with increased susceptibility of the temporary cleaners to common mental disorders were family history of substance abuse, high crowding index, history of physical illness, low educational level, and smoking; while being unmarried, male sex, family history of mental disorder, age > =40 years, smoking, and length of service > =8 years, were associated with substance abuse among the same group. Temporary hired hospital cleaners suffered from impaired mental health more than permanent cleaners. Therefore, expanding the coverage of current laws and occupational safety and health standards to cover workers in the informal sector especially in developing countries is recommended

Modelos lineares generalizados mistos na avaliação genética da prenhez precoce na raça Nelore / Generalized linear mixed models on genetic evaluation of early pregnancy in Nellore breed

Utilizaram-se os modelos lineares generalizados com as funções de ligação probit e logit na avaliação da prenhez precoce, e observaram-se os efeitos na variabilidade genética e na seleção de reprodutores quando diferentes idades são adotadas na definição dessa característica. A prenhez precoce foi estudada aos 15 (PP15) e 21 meses (PP21). Correlações entre os valores genéticos preditos e a porcentagem de touros em comum, considerando 10% dos touros com maiores valores genéticos (TOP10), entre a classificação dos modelos com função de ligação logit e probit e em cada modelo entre PP15 e PP21, foram calculadas. As herdabilidades para PP15 e PP21 foram próximas entre os modelos, exceto para PP15 utilizando a função de ligação probit. Aquelas entre os modelos e a TOP/10 foram altas. Os critérios de Akaike e Bayesiano apresentaram-se semelhantes entre os modelos. As correlações entre PP15 e PP21 e a TOP10, considerando o mesmo modelo, foram de média magnitude.

This study aimed to use the generalized linear models with probit and logit link function to evaluate early pregnancy, and to observe the effects on genetic variability and on sire selection when different ages are adopted in the definition of this trait. Early pregnancy was studied at 15 (EP15), and 21 (EP21) months. The analysis was done in R software. Pearson correlations (PC), between genetic predicted values and percentage of bulls in common considering only 10% of bulls with higher genetic values (TOP 10), between classification by logit and probit models and in each model among EP15 and EP21, were calculated. The heritability for EP15 and EP21 were close between models, except for EP15 using probit link function. PC and TOP10 among models were high. The Akaike and Bayesian criteria reported was similar between models. TOP10, considering the same model, among EP15-EP21 were moderated between EP15-EP21.

Unresponsive cutaneous leishmaniasis and HIV co-infection: Report of three cases.

Cutaneous leishmaniasis (CL) is a vector borne disease caused by various species of Leishmania parasite. CL is endemic in the Thar desert of Rajasthan state and Himachal Pradesh in India. Immune suppression caused by human immunodeficiency virus (HIV) infection is associated with atypical clinical presentation of CL which responds poorly to the standard treatment and causes frequent relapses. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which failed to respond to conventional intralesional/intramuscular sodium stibogluconate (SSG) injections. Initially, we did not think of HIV infection because CL is endemic in this region. When patients did not respond to SSG injections, we performed enzyme-linked immunosorbent assay (ELISA) tests for HIV and they turned out to be HIV positive. Our report showed that CL is emerging as an opportunistic infection associated with HIV/AIDS and may be the first manifestation in HIV positive patients in an endemic area.

Effects of calcium levels on distribution, fecundity and preponderanceof lymnaea Caillaudia infected with Clinostomum Tilapiae, [Ukoli 1966]

Lymnaea cailliaudia were reared in stock culture and subjected to either 7-day or 60-day acclimatization periods in a complex CaCo[3] media with calcium values ranging from 1.5mg/L to 75mg/L, Following 30-day acclimatization Snail from group I were each exposed to 100-eggs of Clinostomum tilapiae. Snails of group II were each exposed to a 10-eggs. Snails of both experimental regimes were observed for mortality, growth, rate of infection and number of cercariae shed. Group I snails were also monitored for fecundity during acclimatization and following eggs exposure. Calcium levels 1.5 and 75mg/L resulted in snail mortality. Shell growth and rates of infection were positively correlated with calcium maintenance level. Snails with high fecundity prior to eggs exposure subsequently shed more cercariae. In contrast, post exposure fecundity of snails reared in media with up to 30 mg/L calcium were negatively correlated with calcium level, rate of infection and number of cercariae shed. Maximal cercarial shedding occurred at 30mg/L calcium. These results suggest that environmental calcium affect both the distribution patterns of snail hosts of Clinostomum tilapiae and the productivity of intramolluscan infection

Comparison of external dacryocystorhinostomy and 5-fluorouracil augmented endonasal laser dacryocystorhinostomy. A retrospective review.

PURPOSE: To compare the success rates of external dacryocystorhinostomy (EXT-DCR) with 5-fluorouracil (5-FU) augmented endonasal laser dacryocystorhinostomy (ENL-DCR) and to record the complications associated with 5-FU augmented ENL-DCR MATERIALS AND METHODS: This was a retrospective non-randomised study. Forty-one patients with primary acquired nasolacrimal duct obstruction underwent an EXT-DCR (19 patients) or an ENL-DCR (22 patients) over a 3-year period. A Holmium YAG laser (Ho:YAG) was used in the latter group of patients. Silicone tubes intubated in all patients were removed at three months. 5-FU was applied intraoperatively at the site of the ostium in the ENL-DCR patients. The median follow-up was 12 months (range 3-24 months) for the ENL-DCR group and 22 months (range 6-28 months) for the EXT-DCR group. The patency of the lacrimal system and the severity of epiphora were assessed at a final-review. RESULTS: The median age of the EXT-DCR group was 77 years (range 53-87) and that of the ENL-DCR group was 71 years (range 23 to 84). There were 12 female patients in the former group and 19 in the latter. The percentage of success in the EXT-DCR group was 94.7% (95% confidence interval (CI) = 75.4-99.1) = ), and 63.6% in the ENL-DCR group (95% CI= 43.0-80.3). The confidence interval for the difference of 31.1% was 5.6-52.2. There was a statistically significant difference between the two groups, p=0.024 (Fisher exact test). CONCLUSIONS: These data suggest that EXT-DCR provides better results than 5-FU augmented ENL-DCR. However, ENL-DCR is the procedure of choice in certain circumstances such as in elderly, frail or medically unfit patients. Our results of 5-FU augmented ENL-DCR compare favourably with other published series.

Role of blood lactic acid in assessing the need for erythrocyte transfusion in healthy preterm infants with anemia of prematurity

The study included 60 healthy preterm infants [26 males and 34 females] with anemia of prematurity during the second week of life. Their gestational age ranged from 28 to 33 weeks. They were selected from the neonatology unit of A1-Hussein University Hospital during the period front June, 1994 to March, 1995. The aim of this work is to evaluate blood lactic acid as an indicator of early tissue hypoxia in identifying the need of blood transfusion to anemic otherwise healthy preterm infants and consequently save unnecessary blood transfusion. The results showed that the infant's body weight at transfusion and the estimated hemoglobin and hematocrit values were significantly increased after blood transfusion. There was a significant decrease in high blood lactate levels after blood transfusion while there was not such a decrease in normal lactate group following red cell transfusion. Moreover, there was a very high significant correlation between high blood lactate group and hematocrit values before and after blood transfusion, while such correlation was not found in nomal lactate group. We can conclude that elevated blood lactate levels is a good indicator to identify the need of anemic otherwise healthy preterm infants to save unnecessary blood transfusion

Evaluation of urinary leukocyte esterase and nitrite tests for diagnosis of bacterial urinary tract infections in the pediatric intensive care unit

This study included 100 infants and children with some urinary tract symptoms who were selected from the pediatric intensive care unit of Al-Hussein University Hospital. The aim of this work is to evaluate the diagnostic performance of the urinary leukocyte esterase and nitrite tests on random urine samples. Also, microscopic urinalysis and urine culture were done to patients with some urinary troubles in the pediatric ICU to provide guidelines for its use. The results showed that the urinary leukocyte esterase test had a sensitivity of 80.36% in detecting leukocyturia [> 10 leukocytes/mm3].The urinary nitrite test had a specifity of 98.01% in detecting bacteriuria. The combination of the urinary leukocyte esterase, nitrite tests and microscopic urinalysis for bacteriuria had a sensitivity of 100%, a specifity of 99.23% and a negative predictive value of 100%. We conclude that, the urinary leukocyte esterase and nitrite tests are rapid screening tests for diagnosis of bacterial urinary tract infections in the pediatric intensive care unit

Proteinase K activities from talaromyces flavus, with respect to its keratin hydrolyzing enzymes

Keratinolytic proteinase K is secreted by Talaromyces flaves in a media containing Goat hairs, as carbon and nitrogen sources. Maximal proteinase production was obtained at pH 605 after 9 days incubation at 28§ +/- under shaking condition. The enzyme was purified from the cell free filtrate of the culture by applying [NH4]2SO4 precipitation and performing sephadex G 200 column. Two proteinase A and B were obtained, the first with a purification folds 23 and the second with 38. It's purity was tested by applying the poly acrylamide gel electrophoresis. The molecular weight of the enzyme [s] was determined, [A] 31, 500 and [B] 36, 750. Its stability against storage, temperature, buffers, pH and different substrates was also tested

Psychoneurotic profile of paramedical students assessed by CCE1

Two hundred students from the Institute of Medical Technology [I.M.T] were chosen randomly to assess their Psychoneurotic Profile [p.p] using the Arabic version of the Crown Crisp Experiential Index [CCEI] One hundred and eighty eight, 166 females and 22 males, responded correctly to the questionnaire, with an age range of 19-23 years. Their mean scores were higher than 3 other samples, one English and two Iraqi studied by CCEI Significantly higher mean scores were found for students living in lodgings, for those with Psychiatric Symptoms, and for those with inadequate income. The probable factors which account for these findings are discussed

A study of aluminum phosphide (AlP) poisoning with special reference to electrocardiographic changes.

Ninety patients with aluminum phosphide poisoning have been studied over a period of 3 years. Epigastric pain and vomiting were the common initial clinical features, followed 12 to 24 hours later by cardiogenic shock, oliguria, altered mental state and respiratory distress. Death occurred within 24 to 72 hours presumably due to poison-induced toxic chemical myocarditis as reflected by electrocardiographic changes. The overall mortality was 63.3%. Intravenous magnesium sulphate, probably due to its membrane stabilizing action, appears to be related to the reduction in mortality from 90% to 52% in the latter 62 cases.