Numerical investigation of unruptured middle cerebral artery bifurcation aneurysms: influence of aspect ratio.

An aneurysm is a disease condition, which is due to the pathological weakening of an arterial wall. These aneurysms are often found in various branch points and bifurcations of an artery in the cerebral circulation. Most aneurysms come to medical attention, either due to brain hemorrhages caused by rupture or found unruptured. To consider surgically invasive treatment modalities, clinicians need scientific methods such as, hemodynamic analysis to assess rupture risk. The arterial wall loses its structural integrity when wall shear stress (WSS) and other hemodynamic parameters exceed a certain threshold. In the present study, numerical simulations are carried out for unruptured middle cerebral artery (MCA) aneurysms. Three distinct representative sizes are chosen from a larger patient pool of 26 MCA aneurysms. Logically, these aneurysms represent three growth stages of any patient with similar anatomical structure. Simulations are performed to compare the three growth phases (with different aspect ratios) of an aneurysm and correlate their hemodynamic parameters. Simulations with patient specific boundary conditions reveal that, aneurysms with a higher aspect ratio (AR) correspond to an attendant decrease in both time-averaged wall shear stress (TAWSS) and spatial wall shear stress gradients (WSSG). Smaller MCAs were observed to have higher positive wall shear stress divergence (WSSD), exemplifying the tensile nature of arterial wall stretching. Present study identifies positive wall shear stress divergence (PWSSD) to be a potential biomarker for evaluating the growth of an aneurysm.

Ultra-light-weight microwave X-band EMI shielding or RAM material made from sustainable pyrolysed cork templates.

Cork is a renewable and sustainable material, highly porous and lightweight. We valorised waste cork and recycled wine stoppers to make pyrolysed/carbonised solid cork, for use as economic and sustainable microwave (MW) absorbers at the microwave X-band (8-12 GHz), without binder or additives. Although cork is already a very lightweight material (0.16 g cm-3), the pyrolysed cork is five-times less dense at 0.031 g cm-3, was amorphous graphitic carbon, and had an excellent shielding effectiveness (SET) of -18 to -38 dB, depending on thickness, with attenuation of the electromagnetic energy through internal reflection within the cellular cork structure. Furthermore, this ultra-light-weight material has an extremely high MW specific shielding effectiveness or efficiency (SSE), between -640 to -1235 dB g-1 cm3 over the entire X-band range, depending on thickness (3.0-8.6 mm), one of the highest reported for any pure carbon material, this upper value being more than twice that of any previously reported graphite-based foams.

Negative Pressure Wound Therapy in Surgical Site Infections of Sternotomy Wounds - A Case Series Study in Neonates and Infants.

This case series, performed by the department of plastic and reconstructive surgery at our institution, reports the management of sternal wound dehiscence in newborns and children after cardiac surgery with the help of a negative pressure wound therapy treatment system. Three neonatal patients with poststernotomy wound problems were treated with a negative pressure wound therapy (VAC) system. Negative pressure therapy was started with negative pressure at 50 mm Hg, continuously. All children achieved healing of the sternal wound and a subsequent closure after a mean length of treatment of 33 days (range, 21-49 days). In conclusion, negative pressure therapy with pressure adjusted to lower values as compared with adults in combination with radical surgical debridement was found to be safe and effective, as well as being tolerated well in neonatal and infant patients with extensive or localized poststernotomy wound dehiscence.

Cu(I)-azidopyrrolo[3,2-d]pyrimidine Catalyzed Glaser-Hay Reaction under Mild Conditions.

The limitation of the CuAAC "click" reaction with a 2-azidopyridine substrate, owing to its equilibrium with a tetrazole isomer, is exploited herein for its utility in the Glaser-Hay reaction. A catalytic combination of a 2-azidopyridine analogue, 4-azido-5H-pyrrolo[3,2-d]pyrimidine, and CuI afforded homocoupled products of terminal alkynes, without any trace of triazole product, under mild conditions with a broad substrate scope. Emphasis on carbohydrate-based substrates appended to a propargylic group led to 1,3-diynes in good to excellent yields.

Traumatic Pseudoaneurysm of Anterior Tibial Artery Treated by Thrombin Injection.

Traumatic pseudoaneurysm of limb arteries are relatively rare. A 70-year-old gentleman, with history of mechanical aortic valve implantation on warfarin, presented to the emergency department with pain and swelling in the right leg. He had sustained blunt injury to the leg, a week prior to presentation. On examination, the lateral compartment of the leg was swollen, ecchymotic, and tense. Distal pulses were well palpable. An ultrasound Doppler evaluation revealed a large intramuscular hematoma in the lateral compartment with a pseudoaneurysm of a muscular branch of the anterior tibial artery. An ultrasound-guided compression of the pseudoaneurysm was initially attempted for 24 hours, which failed in closing off the pseudoaneurysm. He was subsequently taken up for thrombin injection into the pseudoaneurysm, which resulted in instant thrombosis of the pseudoaneurysm, with an uneventful clinical course thereafter. Thrombin injection is an effective and safe modality to treat pseudoaneurysms of limb arteries.

Giant Cavernomas: Gigantic Propositions for a Lilliputian Problem?

AIM: The aim of this case series is to report two cases of giant cavernomas treated at a tertiary level centre along with a literature review on the differences between giant cavernomas and normal sized cavernomas. METHOD: The first case was that of a 13-year-old male with habitual seizures since one year of age with normal examination findings. His imaging revealed a large parieto-occipital lesion which was excised microsurgically after a parieto-occipital craniotomy and a transcortical approach. The second case was a 26-year-old male who presented with generalised seizures and bilateral visual loss. Imaging was suggestive of a large left lateral ventricular lesion. A left fronto-temporo-parietal craniotomy was done followed by transventricular microsurgical excision. Histopathology of both cases were reported to be cavernomas. The first patient had transient hemiparesis post-operatively which improved within 24 hours. Eventually, both patients had an uneventful follow-up. CONCLUSION: Microsurgical excision remains the treatment of choice for giant cavernomas. In toto excision may be advocated depending upon the location of the cavernoma especially with respect to eloquence and venous anatomy.

MutT Homolog1 has multifaceted role in glioma and is under the apparent orchestration by Hypoxia Inducible factor1 alpha.

AIMS: The study focused on the expression and role of a recent potential cancer therapeutic target protein, MutT Homolog1 (MTH1). MTH1 gets activated in an increased reactive oxygen species (ROS) environment and removes the oxidized nucleotides from the cell. The study aimed to check the role of MTH1 in DNA damage and apoptosis, migration and angiogenesis and also to examine its regulation in glioma. MAIN METHODS: The experiments were carried out in human glioma tissue samples and brain tissues of epilepsy patients (non-tumor control). We used two human glioblastomas cell lines, U87MG and U251MG cells. In order to study the role of MTH1 in glioma and to analyze the relation of MTH1 with Hif1α, we have used MTH1 siRNA and Hif1α siRNA respectively. KEY FINDINGS: We found an increased expression of MTH1 in glioma tissues compared to the non-tumor brain tissues. Correlation analysis revealed that those samples showing reduced expression of MTH1 also had high levels of DNA damage and apoptotic markers, while diminished expression of angiogenesis regulators and levels of migration. MTH1 knockdown in vitro by siRNA in tumor cell lines corroborates the above observation. This justifies the emergence of MTH1 inhibitors as potential first-in-class drugs. Mechanistically, our observations suggest that Hif1α may modulate MTH1 expression. SIGNIFICANCE: We found elevated MTH1 expression in glioma irrespective of their grades, while its inhibition affects multiple tumor progression pathways, and that targeting Hif1α could simulate the same.

Five-year mortality and readmission rates in patients with heart failure in India: Results from the Trivandrum heart failure registry.

INTRODUCTION: Heart failure (HF) has emerged as an important and increasing disease burden in India. We present the 5-year outcomes of patients hospitalized for HF in India. METHODS: The Trivandrum Heart Failure Registry (THFR) recruited consecutive patients admitted for acute HF among 16 hospitals in Trivandrum, Kerala in 2013. Guideline-directed medical therapy (GDMT) was defined as the combination of beta-blockers (BB), renin angiotensin system blockers (RAS), and mineralocorticoid receptor antagonists (MRA) in patients with HF with reduced ejection fraction (HFrEF, EF < 40%) at discharge. We used Cox proportional hazards models and Kaplan-Meier survival plots for analysis. The MAGGIC risk score variables were included as exposure variables. RESULTS: Among 1205 patients [69% male, mean (SD) age = 61.2 (13.7) years], HFrEF constituted 62% of patients and among them, 25% received GDMT. The 5-year mortality rate was 59% (n = 709 deaths), and median survival was 3.1 years. Sudden cardiac death and pump failure caused 46% and 49% of the deaths, respectively. In the multivariate Cox model, components of GDMT associated with lower 5-year mortality risks were discharge prescription of BB, RAS blocker, and MRA. Older age, lower systolic blood pressure, NYHA class III or IV, and higher serum creatinine were also associated with higher 5-year mortality. CONCLUSIONS: Three out of every 5 patients had died during 5-years of follow-up with a median survival of approximately 3 years. Lack of GDMT in patients with HFrEF and frequent readmissions were associated with higher 5-year mortality. Quality improvement programmes with strategies to improve adherence to GDMT and reduction in readmissions may improve HF outcomes in this region.

Oral health care system analysis: A case study from India.

OBJECTIVES: The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions. METHODS: This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment. RESULTS: A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. CONCLUSION: Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases.

Spinal angiolipoma-a rare but reversible cause of paraplegia in a child.

PURPOSE: Spinal angiolipomas are benign spinal epidural tumors consisting of mature fat cells with angiomatous components. These tumors are rare in children and there are no definite management guidelines. METHOD: To the best of our knowledge, only five cases of spinal angiolipomas have been reported in children below 12 years. This article discusses the presentation, diagnostics, and surgical tips for the management of a case of spinal angiolipoma. RESULT: In this paper, we present a one and half-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal angiolipoma and underscore the importance of early surgery in a benign disease for a good outcome. CONCLUSION: Overall neurological recovery and prognosis following timely intervention for spinal angiolipomas are good.

To be Wild or Mutant: Role of Isocitrate Dehydrogenase 1 (IDH1) and 2-Hydroxy Glutarate (2-HG) in Gliomagenesis and Treatment Outcome in Glioma.

Molecular and clinical research based on isocitrate dehydrogenase (IDH) mutations is much sought after in glioma research since a decade of its discovery in 2008. IDH enzyme normally catalyzes isocitrate to α-keto-glutarate (α-KG), but once the gene is mutated it produces an 'oncometabolite', 2-hydroxyglutarate (2-HG). 2-HG is proposed to inhibit α-KG-dependent dioxygenases and also blocks cellular differentiation. Here, we discuss the role of the IDH1 mutation in gliomagenesis. The review also focuses on the effect of 2-HG on glioma epigenetics, the cellular signaling involved in IDH1 mutant glioma cells and the therapeutic response seen in mutant IDH1(mIDH1) harboring glioma patients in comparison to the patients with wild-type IDH1. The review encompasses the debatable impacts of the mutation on immune microenvironment a propos of various mIDH1 inhibitors in practice or in trials. Recent studies revealing the relation of IDH mutation with the immune microenvironment and inflammatory status in untreated versus treated glioblastoma patients are highlighted with respect to prospective therapeutic targets. Also at the molecular level, the association of mIDH1/2-HG with the intracellular components such as mitochondria and other neighboring cells is discussed.

Neem oil-loaded cross-linked biodegradable polymeric capsules: Its larvicidal activity against Culex quinquefasciatuss larvae.

BACKGROUND: Pesticide delivery system has been formulated in the form of emulsifiable concentrates, water solutions, aerosols, or spray formulations. However, such formulations showed health hazards. Encapsulation technique is the more suitable method to reduce health hazard and to deliver and release the pesticides. Natural biopolymers have been widely studied for encapsulation of pesticide compounds, as they are biodegradable, biocompatible, and low toxic to mammalian. Neem oil has been reported for controlling of the mosquitoes and more eco-friendly insecticide than synthetic insecticides. The present study was designed to prepare a cross-linked polymeric network capsules loaded with neem oil as effective controlled release formulation against Culex quinquefasciatus larvae. MATERIALS AND METHODS: Neem oil-loaded chitosan/alginate/gelatin capsules were prepared by cross-linking method. Neem oil-loaded capsules were characterized with respect to their capsule size, scanning electron microscopy (SEM) analysis, and swelling property. In vitro larvicidal activity of neem oil-loaded polymeric capsules was studied against C. quinquefasciatus larvae. RESULTS: The cross-linking method produced spherical shape of neem oil-loaded capsules. Ultraviolet spectroscopy analysis indicated that 10% of neem oil was loaded with capsule. A swelling study indicated that swelling of the loaded capsules tends to be more stable. SEM analysis showed that loading of the neem oil with the capsules fills all pores and capsules were found with good compatibility between chitosan, alginate, and gelatin due to the uniform shape of the capsule. Formulated neem oil-loaded capsules showed potential larvicidal activity (100% of mortality) against C. quinquefasciatus larvae in an in vitro model. CONCLUSION: Formulated neem oil-loaded capsules showed a simple method of preparation and eco-friendly. These polymeric capsule containing neem oil exhibited potential larvicidal activity against C. quinquefasciatus larvae.

A cost-effective colourimetric assay for quantifying hydrogen peroxide in honey.

Honey is a natural product with many beneficial properties including antimicrobial action. Production of hydrogen peroxide (H2O2) in diluted honey is central to this action. Here, we describe an optimized method for measuring levels of H2O2 in honey. This method is based on established methods, with the level of dilution, the time between dilution and reading the assay, and aeration of the samples during the assay identified as critical points for ensuring reliability and reproducibility. The method is cost-effective and easy to perform using common laboratory equipment. Using this method, we quantified the hydrogen peroxide content of five different, unprocessed polyfloral honeys collected in NC, USA. Our results show that H2O2 production by these honeys varies greatly, with some samples producing negligible levels of H2O2. We assessed the effect of colour on the assay by measuring the recovery of spiked H2O2 from light and dark honey and from serially diluted dark corn syrup, and found the amount of H2O2 that could be detected was lower in dark corn syrup and darker honey samples.

Selected aryl thiosemicarbazones as a new class of multi-targeted monoamine oxidase inhibitors.

A series of 13 phenyl substituted thiosemicarbazones (SB1-SB13) were synthesized and evaluated for their inhibitory potential towards human recombinant monoamine oxidase A and B (MAO-A and MAO-B, respectively) and acetylcholinesterase. The solid state structure of SB4 was ascertained by the single X-ray diffraction technique. Compounds SB5 and SB11 were potent for MAO-A (IC50 1.82 ± 0.14) and MAO-B (IC50 0.27 ± 0.015 µM), respectively. Furthermore, SB11 showed a high selectivity index (SI > 37.0) for MAO-B. The effects of fluorine orientation revealed that SB11 (m-fluorine) showed 28.2 times higher inhibitory activity than SB12 (o-fluorine) against MAO-B. Furthermore, inhibitions by SB5 and SB11 against MAO-A and MAO-B, respectively, were recovered to near reference levels in reversibility experiments. Both SB5 and SB11 showed competitive inhibition modes, with K i values of 0.97 ± 0.042 and 0.12 ± 0.006 µM, respectively. These results indicate that SB5 and SB11 are selective, reversible and competitive inhibitors of MAO-A and MAO-B, respectively. Compounds SB5, SB7 and SB11 showed moderate inhibition against acetylcholinesterase with IC50 values of 35.35 ± 0.47, 15.61 ± 0.057 and 26.61 ± 0.338 µM, respectively. Blood-brain barrier (BBB) permeation was studied using the parallel artificial membrane permeation assay (PAMPA) method. Molecular docking studies were carried out using AutoDock 4.2.

Surgical Correction of TMJ Bilateral Dislocation with Eminectomy and Capsulorrhaphy as an Adjuvant: Case Reports.

INTRODUCTION: Anterior excessive movement of the temporomandibular joint (TMJ) is a condition which reduces the quality of life of a person to great extent with the patient always living in the fear of inherent dislocation. Dislocation of the temporomandibular joint represents 3% of all reported joint dislocations. CASE REPORT: In this article, we discuss about two cases where the patients with chronic TMJ dislocation were treated with eminectomy and capsulorrhaphy. Both the patients were reviewed over a period of 1 year and did not show any recurrence of the condition with satisfactory controlled increase in mouth opening. CONCLUSION: The combination has proved to be useful for the better neuromuscular control and psychological aspect, i.e., the fear of dislocation. Future of the technique combination lies in further prospective studies.

Postoperative alar base symmetry in complete unilateral cleft lip and palate:A prospective study.

In the evolution of cleft lip repair, there have been continuous attempts to minimize local trauma and to improve lip and nasal appearances. In order to obtain an aesthetically balanced development of midface, the primary surgical correction of the nasolabial area is of paramount importance. In this study, the importance of a back-cut extending cephalically above the inferior turbinate at the mucocutaneous junction which elevates the nostril floor on the cleft side for the purpose of achieving symmetry of the alar bases are analyzed by pre and postoperative photographic anthropometry. This study comprised of fifty cases of the unilateral complete cleft lip. At the time of surgery, the patient age ranged from 3-9 months. The surgeries, performed by a single surgeon, employed the standard Millard technique, incorporating Mohler modifications of lip repair. Anthropometric analysis revealed that the preoperative mean difference between the normal side and the cleft side was 0.2056 with a standard deviation of 0.133. In the postoperative analysis, the mean difference was reduced to 0.0174 with a standard deviation of 0.141. The paired t-test showed that the p-value is <0.001, indicating high statistical significance. To conclude, in complete unilateral cleft lip and palate, the geometrically placed nasal back-cut incision has a definite role in the correction of the alar base symmetry during primary surgery.

Monoamine oxidase inhibitory activity of methoxy-substituted chalcones.

The MAO-B inhibitory activity of chalcone (1, 3- diphenyl-2-propen-1-one) based compounds arise from its structural similarity with 1, 4-diphenyl-2-butene, a known MAO-B inhibitor. Based on our previous report, the methoxy-substituted with fluorine containing chalcones are promising reversible MAO-B inhibitors, while in the present study, a series of methoxylated chalcones (C1-C9) bearing substitution on the para position of ring B was synthesized and evaluated for their human monoamine oxidase inhibitory activity. With the exception of (2E)-1-(4-methoxyphenyl)-3-(4-nitrophenyl) prop-2-en-1-one (C7), which is a nonselective inhibitor, the chalcones exhibited competitive, selective, and reversible inhibition of hMAO-B. The most potent compound, (2E)-3-[4-(dimethylamino) phenyl]-1-(4-methoxyphenyl) prop-2-en-1-one (C5), showed the best inhibitory activity towards hMAO-B (IC50=0.29±0.011µM;Ki=0.14±0.001µM). The reversibility of MAO-B inhibition by compound C5 was demonstrated by the recovery of enzyme activity after dialysis of mixtures containing enzyme and inhibitor. The reversiblity of C5 was 25.38±1.40 and 92.00±3.87% before and after dialysis, respectively. PAMPA was carried out to evaluate the blood-brain barrier effects of the designated compounds. Moreover, the most potent MAO-B inhibitor, C5, was found to be nontoxic towards cultured hepatic cells at 5 and 25µM, with 97 and 90% viability. Molecular docking study was performed against hMAO-B to observe the binding site interactions of the lead compound.