Assessment and Comparison of Three Dimensional Exoscopes for Near-Infrared Fluorescence-Guided Surgery Using Second-Window Indocyanine-Green

Objective@#: Compared to microscopes, exoscopes have advantages in field-depth, ergonomics, and educational value. Exoscopes are especially well-poised for adaptation into fluorescence-guided surgery (FGS) due to their excitation source, light path, and image processing capabilities. We evaluated the feasibility of near-infrared FGS using a 3-dimensional (3D), 4 K exoscope with nearinfrared fluorescence imaging capability. We then compared it to the most sensitive, commercially-available near-infrared exoscope system (3D and 960 p). In-vitro and intraoperative comparisons were performed. @*Methods@#: Serial dilutions of indocyanine-green (1–2000 μg/mL) were imaged with the 3D, 4 K Olympus Orbeye (system 1) and the 3D, 960 p VisionSense Iridium (system 2). Near-infrared sensitivity was calculated using signal-to-background ratios (SBRs). In addition, three patients with brain tumors were administered indocyanine-green and imaged with system 1, with two also imaged with system 2 for comparison. @*Results@#: Systems 1 and 2 detected near-infrared fluorescence from indocyanine green concentrations of >250 μg/L and >31.3 μg/L, respectively. Intraoperatively, system 1 visualized strong near-infrared fluorescence from two, strongly gadoliniumenhancing meningiomas (SBR=2.4, 1.7). The high-resolution, bright images were sufficient for the surgeon to appreciate the underlying anatomy in the near-infrared mode. However, system 1 was not able to visualize fluorescence from a weakly-enhancing intraparenchymal metastasis. In contrast, system 2 successfully visualized both the meningioma and the metastasis but lacked high resolution stereopsis. @*Conclusion@#: Three-dimensional exoscope systems provide an alternative visualization platform for both standard microsurgery and near-infrared fluorescent guided surgery. However, when tumor fluorescence is weak (i.e., low fluorophore uptake, deep tumors), highly sensitive near-infrared visualization systems may be required.

Transatrial approach for total correction of tetralogy of Fallot: our centre experience over three years

Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching.Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females.Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding.  There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up.Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.

Patterns of failure and clinical outcomes of post-operative buccal mucosa cancers treated with adjuvant ipsilateral radiotherapy

Purpose@#Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. @*Materials and Methods@#One hundred sixteen cases of post-operative buccal mucosa cancers—pT3 or more, node positive, close margins (1–5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm—treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60–66 Gy (44 Gy in the first phase and a coned down boost of 16–22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. @*Results@#Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). @*Conclusion@#Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.

Diallyl Trisulfide Inhibits Leptin-induced OncogenicSignaling in Human Breast Cancer Cells but Fails toPrevent Chemically-induced Luminal-type Cancer in Rats

Previous studies have demonstrated inhibitory effect of garlic component diallyl trisulfide (DATS) on growth of breast cancer cellsin vitro and in vivo. This study investigated the effect of DATS on oncogenic signaling regulated by leptin, which plays an importantrole in breast carcinogenesis. Leptin-induced phosphorylation and nuclear translocation of STAT3 was inhibited significantly in thepresence of DATS in MCF-7 (a luminal-type human breast cancer cell line) and MDA-MB-231 (a basal-like human breast cancer cellline). Leptin-stimulated cell proliferation, clonogenic cell survival, and migration and/or invasion ability in MCF-7 and/or MDA-MB-231cells were also suppressed by DATS treatment. DATS exposure resulted in inhibition of leptin-stimulated expression of protein and/or mRNA levels of Bcl-2, Bcl-xL, Cyclin D1, vascular endothelial growth factor, and matrix metalloproteinase-2. Western blotting revealeda decrease in protein levels of phosphorylated STAT3 in breast cancer xenografts from DATS-treated mice when comparedto controls in vivo. However, the incidence of N-methyl-N-nitrosourea-induced luminal-type breast cancer development in rats wasnot affected by oral administration of 5 mg/kg or 25 mg/kg DATS. The present study reveals that oncogenic signaling induced byleptin is inhibited in the presence of DATS but higher doses of this phytochemical may be required to achieve chemopreventive activity.

Comparative Study To Assess The Role Of Yoga Practice On Blood Glucoselevels Of Diabetes Mellitus Type 2 Patients In Tertiary Care Institution, Tirupati

Introduction: Diabetes mellitus is plausibly one of the earliest diseases known to mankind. Effect of yoga as an intervention in the treatment of diabetes mellitus varies widely. While many researchers conceptualize yoga as a form of physical activity others argue that yoga is a holistic intervention incorporating body postures (asanas), breathing techniques (pranayamas),meditation, cleansing, modification of attitudes and behavior and mental discipline.Materials and Methods: A Comparative study was conducted among Diabetes Mellitus Type 2 patients visiting the endocrinology outpatient department in a tertiary care institution in Tirupati. The study group consists of 30 patients who were practicing yoga and the control group consists of 30 patients who were not practicing yoga. Data collection was done by questionnaires on the sociodemographic profile, diabetic history, yoga practice, and their blood glucose levels (fasting blood glucose, post prandial blood glucose) were recorded before and after the study period.Results: The blood glucose levels in the study group were lower when compared to those of the control group both before and after the study period. In our study yoga is not taken as an intervention, but the comparison was done between yoga practicing and not practicing groups.Conclusions: Yoga is effective in controlling blood sugar levels in patients with type 2 diabetes mellitus, it can be practiced as an adjuvant to conventional treatment with anti- diabetic medication.

Andrographolide inhibits chikungunya virus infection by up-regulating host innate immune pathways

Objective:To investigate the therapeutic efficacy of andrographolide, a plant derived compound, against chikungunya virus (CHIKV) infection.Methods:Using flow cytometry and immunoblotting assay, in vitro viral protein expression was studied in THP-1 cells line. In Balb/c mouse neonates, viral RNA copy number was determined by real time PCR.Results:The results showed reduced CHIKV protein expression on andrographolide treatment in CHIKV-infected human peripheral blood mononuclear cells, Vero cells and THP-1 cell line. In vivo, andrographolide treatment to CHIKV-infected neonates reduced viral RNA copy number. Further, andrographolide also increased cytotoxic T lymphocytes both in vitro and in vivo. Andrographolide also activated host innate immune pathways, viz., protein kinase R, phosphorylated eukaryotic initiation factor 2α , retinoic acid inducible gene-I and interferon regulatory factor 3/7, thereby increasing IFN- α secretion. CHIKV-induced nuclear factor κ light chain enhancer of activated B cells and tumor necrosis factor- α was also reduced on andrographolide treatment.Conclusion:Andrographolide inhibits CHIKV by suppressing viral protein expression and up-regulating host innate immunity and hence could be an effective therapeutic agent against CHIKV infection.

Dengue virus non-structural 1 protein interacts with heterogeneous nuclear ribonucleoprotein H in human monocytic cells

OBJECTIVE@#To study protein-protein interaction between heterogeneous nuclear ribonucleoprotein H (hnRNP H) and Dengue virus (DENV) proteins.@*METHODS@#DENV proteins were screened against the host hnRNP H protein, in order to identify the host-viral protein-protein interactions in DENV infected THP-1 cells by co-immunoprecipitation. The co-localization of the interacting proteins was further confirmed by immunofluorescence microscopy.@*RESULTS@#The host protein hnRNP H was found to interact with DENV non-structural 1 protein and help the virus to multiply in the cell.@*CONCLUSIONS@#The non-structural 1 glycoprotein is a key modulator of host immune response and is also involved in viral replication. Therefore, disruption of this key interaction between hnRNP H and DENV non-structural 1 could be an important therapeutic strategy for management of DENV infection.

Performance and carcass characteristics of guinea fowl fed on dietary Neem [Azadirachta indica] leaf powder as a growth promoter

The present work aimed at studying growth pattern and carcass traits in pearl grey guinea fowl fed on dietary Neem [Azadirachta indica] leaf powder [NLP] over a period of 12 weeks. Day old guinea fowl keets [n=120] were randomly assigned to four treatment groups, each with 3 replicates. The first treatment was designated as control [T[0]] in which no supplement was added to the feed, while in treatments T[1], T[2] and T[3], NLP was provided as 1, 2 and 3 g per kg of feed, respectively. The results revealed a significant increase in body weight at 12 weeks; 1229.7 for T[1], 1249.8 for T[2], and 1266.2 g T[3] compared to 1220.0 g for the control group [P<0.05]. The results also showed that the supplementation of NLP significantly increased feed intake [P

Improved Antidepressant Remission in Major Depression via a Pharmacokinetic Pathway Polygene Pharmacogenetic Report

OBJECTIVE: Major depressive disorder (MDD) is projected to be a leading cause of disability globally by 2030. Only a minority of patients remit with antidepressants. If assay of polymorphisms influencing central nervous system (CNS) bioavailability could guide prescribers to more effectively dose patients, remission rates may improve and the burden of disease from MDD reduce. Hepatic and blood brain barrier (BBB) polymorphisms appear to influence antidepressant CNS bioavailability. METHODS: A 12-week prospective double blind randomized genetically guided versus unguided trial of antidepressant dosing in Caucasian adults with MDD (n=148) was conducted. RESULTS: Subjects receiving genetically guided prescribing had a 2.52-fold greater chance of remission (95% confidence interval [CI]=1.71-3.73, z=4.66, p<0.0001). The number needed to genotype (NNG)=3 (95% CI=1.7-3.5) to produce an additional remission. CONCLUSION: These data suggest that a pharmacogenetic dosing report (CNSDose(R)) improves antidepressant efficacy. The effect size was sufficient that translation to clinical care may arise if results are independently replicated.

Management of female uro-genital fistulas: framing certain guidelines

The study was carried out to discuss the pathogenesis and management protocol of seven different varieties of female uro-genital fistulas [FUGFs]. During 2000-2007, total of 15 FUGFs were operated, which belonged to seven different varieties requiring different routes and surgical procedures for their repair. Different fistulas with different pathophysiological factors required specific examinations and investigations preoperatively. The results of the repaired FUGFs, following the general surgical principles, were acceptable with formation of only one residual fistula. Successful correction of FUGFs is a surgical challenge. Detailed history, through examination and planning, atraumatic tissue handling, routine use of the interposition or onlay reinforcement flaps and vigilant postoperative care were found the key factors in successful outcome of the repaired fistulas

experimental study of zinc in diabetes mellitus

Present study was conducted to observe the changes in body weight, physical endurance and levels of zinc in serum and tissues in experimentally induced diabetes in rats. Oral zinc sulfate supplementation was done in three different doses [50 mg/kg, 150 mg/kg, and 300mg/kg] to see if zinc supplementation has any effect on the above parameters. After 7 days of alloxan treatment, rats having blood sugar levels of more than 350 mg/dl were selected for the present study. Serum zinc level in diabetic rats was significantly low as compared to control. Brain zinc level of diabetic rats was significantly low, whereas kidney and liver zinc levels in diabetic rats were significantly high. Swimming time and body weight were significantly decreased in diabetic rats as compared to control rats. On oral zinc supplementation serum zinc levels of diabetic groups II and III rats increased significantly from 4th week as compared to the control and diabetic group I rats. Brain zinc level of diabetic group III rats was found to be increased significantly as compared to diabetic groups I and II, whereas kidney zinc level of diabetic group III was significantly low as compared to diabetic groups I and II, but no significant change was noted in liver zinc level. Gain in body weight with improved physical endurance was observed along with elevated serum zinc levels in experimental diabetic rats

Benign monomelic amyotrophy- a report of 7 cases

Monomelic amyotrophy [M.A.] is a rare, benign motor neuron disorder. The characteristic clinical features are insidious onset in the second and third decades, male preponderance, nonfamilial, sporadic occurrence, painless asymmetrical wasting and weakness confined to one limb, and absence of involvement of the cranial nerves, cerebrum, brain stem, and sensory system, During the year J997 to 2003, we have registered 7 cases that had been thoroughly investigated and treated as benign monomelic amyotrophy. Their analysis showed possible spread of the disease to other limbs following a period of stabilization in the initially affected limb, familial involvement, and almost equal sex distribution contradictory to the earlier reports. In their rehabilitation programme strengthening exercises upto fatigue stage should be avoided. Early consideration of change in life style is an important step in rehabilitation of such patients