Otoplasty: The Belfast Experience. A 10-Year Review of 2333 Ear Outcomes.

BACKGROUND: "Prominent ear" remains one of the most common referrals to pediatric plastic surgery. The perceived deformity has been corrected using a multitude of techniques for over a century, and significant variation in practice still exists. Recent studies suggesting that cartilage-scoring techniques are associated with more major complications than suture techniques may have led to an adverse international perception of the technique. Thus, waning use of anterior scoring prominent ear correction appears to be occurring. For appropriate cases, the authors have used anterior scoring for over 20 years, with high patient satisfaction and low complication rates. They present a review of all cases and outcomes from 2005 to 2015. The authors believe this is the largest case series of anterior scoring otoplasty published to date. METHODS: All pediatric cases undergoing prominent ear correction from 2005 to 2015 were included in this retrospective case note analysis and follow-up study. Patient demographics, operative details including early and late complications, and postoperative results were analyzed. METHODS: Over a 10-year period, 1199 otoplasties were performed (1134 bilateral, 65 unilateral), for a total of 2333 ear corrections. A total of 1575 ears were corrected using the anterior scoring technique. The remaining cases underwent correction by means of suture only, cartilage reduction, or combination techniques. There was a significantly lower all-cause reoperation rate for anterior scoring compared to suture-only techniques ( P = 0.0039; significant at P < 0.025). There were no reported cases of cartilage necrosis. CONCLUSIONS: This study demonstrates that in appropriately selected patients, anterior scoring otoplasty is a low-morbidity procedure. In the authors' institution, when compared to suture techniques, it was associated with a lower rate of complications and reoperation rate than suture-only techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

In vitro comparative evaluation of Tamarix gallica extracts for antioxidant and antidiabetic activity.

Tamarix gallica known as Jhau is traditionally used as expectorant, liver tonic, laxative, astringent, and antidiarrheal. The current study was proposed to determine the in vitro antioxidant, antidiabetic properties of the methanolic, ethanolic, and aqueous extracts of Tamarix gallica arial part, subsequently the phytochemical evaluation. Hence, Tamarix gallica arial part extracts were extracted with methanol (MthTg), ethanol (EthTg), and distilled water (AqTg). Extracts phytochemical analysis were accomplished to identify the phenolic components (TPC and TFC). Extracts antioxidant property was evaluated by DPPH, FRAP, and ABTS assay. For antidiabetic property, α-amylase and α-glucosidase inhibitory activities were assessed. One Way ANOVA was applied statistically by means of software SPSS Statistics 23 and attained data were definite as mean ± standard deviation. Result revealed that EthTg have the maximum TPC and TFC levels than MthTg and AqTg. Antioxidant property in relations of DPPH (lowest IC50 = 1.309 ± 0.31), FRAP (323.51 ± 2.32), and ABTS (266.97 ± 25.14) assay was also highest in EthTg. EthTg was also exposed highest α-amylase and α-glucosidase inhibition activity with lower IC50 (1.116 ± 0.051; 0.402 ± 0.2, respectively). The extracts antioxidant and antidiabetic activities order was as EthTg > MthTg > AqTg. TFC and TPC also revealed directly proportional correlation with antioxidant, and antidiabetic properties of the Tamarix gallica arial part extracts. Results noticeably stated that the ethanolic extract of Tamarix gallica have the highest antioxidant and antidiabetic properties. Tamarix gallica has competency to reduce the oxidative stress and can be utilized in the management of diabetes.

Efficacy and safety of thermobalancing therapy with Dr Allen's Device for chronic low back pain: A randomised controlled trial.

BACKGROUND: Lumbar disc herniation and non-specific low back pain are common conditions that seriously affect patients' health-related quality of life (HRQoL). Although empirical evidence has demonstrated that novel Thermobalancing therapy and Dr Allen's Device can relieve chronic low back pain, there have been no randomised controlled trials for these indications. AIM: To evaluate the efficacy of Dr Allen's Device in lumbar disc herniation (LDH) and non-specific low back pain (NSLBP). METHODS: A randomised clinical trial was conducted investigating 55 patients with chronic low back pain due to LDH (n = 28) or NSLBP (n = 27), out of which 15 were randomly assigned to the control group and 40 were assigned to the treatment group. The intervention was treatment with Dr Allen's Device for 3 mo. Changes in HRQoL were assessed using the Numerical Pain Rating Scale and the Japanese Orthopedic Association Back Pain Questionnaire. RESULTS: Thermobalancing therapy with Dr Allen's Device showed a significant reduction in pain in the treatment group (P < 0.001), with no recorded adverse effects. Both pain assessment scales showed a significant improvement in patients' perception of pain indicating improvement in HRQoL. CONCLUSION: The out-of-hospital use of Thermobalancing therapy with Dr Allen's Device for Low Back Treatment relieves chronic low back pain significantly and without adverse effects, improves the level of activity and HRQoL among patients with LDH and NSLBP. This study demonstrates the importance of this safe first-line therapy that can be used for effective at-home management of chronic low back pain.

The Hepatoprotective and Anti-Nephrotoxic Potential of Methanolic Extract of a Polyherbal Preparation in CCl4-Induced Liver Injury Model of Wistar Rats.

The liver and kidneys are the vital organs of the body and perform important life-sustaining functions in the body. Synthetic drugs used in the treatment of liver and kidney diseases are sometimes inadequate and can lead to serious side effects. Medicinal herbs and plants were used to combat diseases for a long time and combination therapy is preferred over single plant therapy. In the current study, the Asparagus racemosus, Mucuna pruriens, Anacyclus pyrethrum, and Tribulus terrestris polyherbal preparation (PHP) was selected to evaluate its hepatoprotective, antioxidant, and anti-nephrotoxic potential. The methanolic extract of PHP was prepared following standard protocols. Fifty-six albino rats were divided into 7 groups (n = 8). The negative control (NC) having the healthy rats and the remaining 6 groups were induced liver toxicity by intraperitoneally injecting 0.5 mL/kg of 50% CCl4 in olive oil. Group 2 was positive control and group 3 and 4 received silymarin standard drug at the dose of 100 and 200 mg/kg body weight. Groups 5, 6, and 7 (PHP-1, PHP-2, PHP-3) were the liver-damaged rats receiving the PHP at a dose of 50, 100, and 150 mg/kg body weight. Blood samples were collected at 21 of the trial, to evaluate oxidative stress, hepatoprotective and anti-nephrotoxic potential. Results of liver function tests revealed significant (P < .05) hepatoprotective activities of PHP after intoxication with CCl4 of albino rats as compared to standard groups. Moreover, results of renal functions also showed that PHP has a significant (P < .05) restoring the capacity of blood urea, creatinine, and uric acid in intoxicated rats as compared with the control group. The PHP also reduced the oxidative stress in the treatment groups by increasing the total antioxidant capacity and reducing the total oxidative status. It can be concluded that selected medicinal plants have a potential role in the management of liver and kidney disorders. So, by running the clinical trial on a large scale and by isolating the phytochemical constituents responsible for hepatoprotective and nephroprotective activities, locally prepared drugs could be developed to manage liver and renal disorders.

Phytochemical Screening, Antioxidant, and Inhibition Activity of Picrorhiza kurroa Against α-Amylase and α-Glucosidase.

Picrorhiza kurroa (P.K) usually familiar as kutki is a well-known plant in the Ayurvedic system of medicine due to its reported activities including antidiabetic, antibacterial, antioxidant, antitumor, anti-inflammatory, and hepatoprotective. The current research was intended to evaluate the antioxidant, inhibition activity of the ethanolic, methanolic, and aqueous extracts of P.K roots against α-amylase and α-glucosidase in vitro, after the phytochemical analysis. For this purpose, P.K roots were extracted with ethanol (EthPk), methanol (MthPk), and distilled water (AqPk) and phytochemical study of the extracts were performed to recognize the total phenolic content (TPC) and total flavonoids content (TFC). Antioxidant capability of the extracts was assessed by FRAP, ABTS, and DPPH assay. α-amylase inhibitory and α-glucosidase inhibitory activities were also determined. Software SPSS-23 was used to statistically analyze with One Way ANOVA and results were stated as mean standard deviation. Result of the study showed that MthPk contained the maximum concentration of TPC and TFC than EthPk and AqEh. Antioxidants in terms of DPPH (lowest IC50 = .894 ± .57), FRAP (612.54 ± 11.73) and ABTS (406.42 ± 4.02) assay was also maximum in MthPk. MthPk was also showed maximum inhibition activity against α-amylase and α-glucosidase with lowest IC50 (.39 ± .41; .61 ± .24), respectively. The extracts α-amylase and α-glucosidase inhibitory activities order was as MthPk > EthPk> AqPk. Results clearly specified that the methanolic extract of Picrorhiza kurroa have the maximum antioxidant, α-amylase, and α-glucosidase inhibitory activities. A positive correlation of TPC, TFC with antioxidant, and α-amylase and α-glucosidase inhibition activities of the P.K roots were also shown. The plant has capability to diminish the oxidative stress and can be used to treat diabetes by inhibiting α-amylase and α-glucosidase actions.

In-Vitro Assessment Of The Therapeutic Potential Of Polymyxins And Tigecycline Against Multidrugresistant Acinetobacter Isolates From Infected Wounds.

BACKGROUND: The incidence of multidrug-resistant (MDR), extreme drug resistant (XDR), and pan drug-resistant (PDR) Acinetobacter are increasing throughout the world. The therapeutic management and control of Acinetobacter are difficult due to the emergence of drug resistance and its enduring capacity to survive in the environment. The present study was designed to appraise the efficacy of Polymyxins and Tigecycline against multidrugresistant Acinetobacter isolates from surgical and burn wounds. METHODS: During the study, the specimens were collected from various types of wounds from inpatients and outpatients of the tertiary care hospitals of Lahore, Pakistan in 2017 and 2018. The bacterial pathogens were isolated and identified using standard microbiological procedures and molecular confirmation of Acinetobacter species was examined by PCR using specific primers. The antibiotic susceptibility profiling of Acinetobacter isolates was studied against 18 antibiotics as per Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The Acinetobacter isolates demonstrated extreme resistance especially to ampicillin/sulbactam, piperacillin/tazobactam, cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides. However, the colistin, polymyxin, and tigecycline remained the most effective antimicrobial agents against Acinetobacter isolates. CONCLUSIONS: The results highlight the extent of drug resistance and therapeutic potential of Polymyxins and Tigecycline for wound infections caused by MDR and XDR Acinetobacter species. The wiser use of antimicrobials, incessant surveillance of antimicrobial resistance, and stringent adherence to infection control guidelines are critical to reducing major outbreaks in the future.

An alternative approach to treat obesity with leptogenic polyherbal formulation obesecure: A randomized clinical trial study.

Obesity is a common disease of developing countries, including Pakistan. Obesity is a risk factor for many diseases which can be life threatening or making the person unable to perform daily routine work. In the current study, clinical trials were designed to evaluate the effects of medical intervention by comparing the effects of placebo control drug "Plasicure" with the herbal medicinal formulation "Obesecure". The test drug formulation was designed on the basis of the screening study for Leptogenic drugs. To evaluate the safety of the test drug, the toxicity index and the safety profile of test formulation was assessed on animal models. The drug was found safe for further clinical study. Randomized Controlled Clinical Trials were conducted. The statistical analysis was carried out by the application of Two-Way Repeated Analysis of Variance test. The clinical findings of randomized controlled trial revealed that the test drug was Leptogenic and effective in weight reduction as compared to control drug Plasicure therapy as the p-value deduced was 0.001 in leptin level and 0.000 in case of BMI after the conduction of Two-Way Repeated Analysis of Variance test. Hence it is concluded that obscure therapy is more significant than control drug Plasicure therapy in the management and treatment of obesity.

Microbial profile of burn wound infections and their antibiotic sensitivity patterns at burn unit of allied hospital Faisalabad.

Microbial infection is the most common and serious complication of burn injury, which is a major cause of morbidity and mortality. The aim of this study was to determine the bacteriological profiles and the antibiotic sensitivity patterns in burn unit of Allied Hospital Faisalabad over a period of 1 year. During the study period, 393 samples were collected and cultured by conventional method. Disk diffusion method was used to determine the sensitivity/resistance pattern of the isolates. Results were analyzed using SPPS version 20. Out of 393, 332 (84.5%) cases were found to be culture positive. Microbial contamination of the burn wounds was significantly (p<0.05) higher in males (89.3%) as compared to females (78.1%), and in 3rd degree burns (92.2%) as compared to 2nd degree burns (80.8%). Out of 393 patients, 258 (65.6%) cases were of Staphylococcus aurous followed by 169 (43.0%) of Pseudomonas aeruginosa 79 (20.1%) of Klebsiella pneumoniae and 67 (17.0%) of Escherichia coli. Among 258 cases of S. aurous, 153 (59.3%) were MRSA and 105 (40.7%) were MSSA. A large proportion (92.8%) of MRSA was sensitive to techoplanin and exhibited high-level resistant (96.7%) to fusidic acid whereas, significant proportion (74.4%) of MSSA isolates showed resistant to fusidic acid. A zero resistance was noted in coagulase negative staphylococci to linezolide, vancomycin and teichoplanin.. Pseudomonas aeruginosa exhibited high level resistance to tobramycin (91.7%) and were mostly sensitive (93.5%) to cefipiem. Klebsiella penumoniae was most sensitive to meropenem (100%) and most resistant to tobramycin (63.3%). E. coli showed zero resistance cefipiem and a small proportion of isolates (14.9%) exhibited resistance to tobramycin. In conclusion, S. aurous and P. aeruginosa represented the most common bacterial microbes of burn wounds which exhibited variable antibiotic susceptibility pattern. This study revealed a high potential for multiple microorganism outbreaks and emergence of resistant pathogens in burn patients due to the lack of patient screening and extended empirical use of antibiotics.

Lightning injuries in Northern Ireland.

INTRODUCTION: Lightning injuries are uncommon in Northern Ireland (NI) with scarce reports detailing incidence and local experience. We present a case study of 3 patients involved in a single lightning strike with a review of the incidence of similar injuries in the province. METHODS: Data from TORRO's National Lightning Incidents Database between 1987 and 2016 (30 years) were searched to identify victims of lightning injuries in NI. Information on 3 patients with lightning injuries that were managed in our regional burns and plastic surgery service was collected and examined. A supplementary search in hospital records was conducted over the last 20 years to identify additional data. RESULTS: Prior to our study, 6 victims of lightning injuries were identified of whom 5 survived and 1 died. Our 3 patients comprised of 2 children and 1 accompanying adult. All survived but the adult suffered cardiac arrest and required a prolonged period of cardiopulmonary resuscitation. CONCLUSION: While lightning injuries are rare in NI, this is the first report of more than one person affected by a single lightning incident in the province. In our limited experience, immediate public response and prolonged cardiopulmonary resuscitation efforts facilitated by automated defibrillators result in a favourable outcome.

Anti-coagulant activity of plants: mini review.

Medicinal plants have been used for treatment of human ailments since ancient times. Objective of this study is to document the effect of herbal drugs on anticoagulant therapy. The material for this review was taken mostly from PubMed and the Cochrane database of systematic reviews. Some other relevant references were collected from personal database of papers on anti-coagulant properties of plants. Literature review shows that many plants such as Thymus vulgaris, Cyamopsis tetragonoloba taub, Pulmonaria officinalis and Cinnamomum cassia etc have anti-coagulant activity. This review shows that medicinal plants should be prescribed with care to patients on anticoagulant therapy.

Antiurease and anti-oxidant activity of Vaccinium macrocarpon fruit.

The objective of present study was to evaluate the antiurease and anti-oxidant activity of Vaccinium macrocarpon fruit. The parent extract was ethanolic extract while its sub fractions were prepared in n-hexane, chloroform and n-butanol. The method based on scavenging activity and reduction capability of 1, 1-diphenyl-2-picrylhydrazyl radical (DPPH). N-butanol fraction was the most effective antioxidant with 87.0±1.15 activity but the activity was less than ascorbic acid i.e. 93.74±0.12. Highly significant urease inhibition was shown by crude ethanolic extract (71.00±0.2a) with IC50 (392.66±2.1) followed by aqueous fraction (68.00±0.5e) with IC50 (159.83±2.8). The results of crude ethanolic extract and aqueous extracts were highly significant (p<0.05) than standard Thiourea. Present study showed that Vaccinium macrocarpon exhibits potent antiurease and antioxidant activities.

Antimicrobial susceptibility of Acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management.

INTRODUCTION: The drug resistant Acinetobacter strains are important causes of nosocomial infections that are difficult to control and treat. This study aimed to determine the antimicrobial susceptibility patterns of Acinetobacter strains isolated from different clinical specimens obtained from patients belonging to different age groups. METHODS: In total, 716 non-duplicate Acinetobacter isolates were collected from the infected patients admitted to tertiary-care hospitals at Lahore, Pakistan, over a period of 28 months. The Acinetobacter isolates were identified using API 20E, and antimicrobial susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The isolation rate of Acinetobacter was high from the respiratory specimens, followed by wound samples. Antibiotic susceptibility analyses of the isolates revealed that the resistance to cefotaxime and ceftazidime was the most common, in 710 (99.2%) specimens each, followed by the resistance to gentamicin in 670 (93.6%) isolates, and to imipenem in 651 (90.9%) isolates. However, almost all isolates were susceptible to tigecycline, colistin, and polymyxin B. CONCLUSIONS: The present study showed the alarming trends of resistance of Acinetobacter strains isolated from clinical specimens to the various classes of antimicrobials. The improvement of microbiological techniques for earlier and more accurate identification of bacteria is necessary for the selection of appropriate treatments.

Antimicrobial susceptibility of acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management

Abstract: Introduction: The drug resistant Acinetobacter strains are important causes of nosocomial infections that are difficult to control and treat. This study aimed to determine the antimicrobial susceptibility patterns of Acinetobacter strains isolated from different clinical specimens obtained from patients belonging to different age groups. METHODS: In total, 716 non-duplicate Acinetobacter isolates were collected from the infected patients admitted to tertiary-care hospitals at Lahore, Pakistan, over a period of 28 months. The Acinetobacter isolates were identified using API 20E, and antimicrobial susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The isolation rate of Acinetobacter was high from the respiratory specimens, followed by wound samples. Antibiotic susceptibility analyses of the isolates revealed that the resistance to cefotaxime and ceftazidime was the most common, in 710 (99.2%) specimens each, followed by the resistance to gentamicin in 670 (93.6%) isolates, and to imipenem in 651 (90.9%) isolates. However, almost all isolates were susceptible to tigecycline, colistin, and polymyxin B. CONCLUSIONS: The present study showed the alarming trends of resistance of Acinetobacter strains isolated from clinical specimens to the various classes of antimicrobials. The improvement of microbiological techniques for earlier and more accurate identification of bacteria is necessary for the selection of appropriate treatments.

Differences in Knowledge, Attitude, and Behavior towards HIV/AIDS and Sexually Transmitted Infections between Sexually Active Foreign and Chinese Medical Students.

Although the prevalence of human immunodeficiency virus (HIV) decreased in the last decade worldwide, the number of deaths due to HIV/AIDS and communicable diseases including syphilis, hepatitis, and tuberculosis had dramatically increased in developing countries. Education and behavior are incredibly important factors to prevent these diseases' spread. This study highlights the range of differences in knowledge, attitude, and behavior of 434 sexually active medical students towards HIV/AIDS and sexually transmitted infections (STIs). Because the surveyed population constitutes the forefront of healthcare providers and was originated from different area of the world, this is the first time a study sought to investigate the behavioral attitude of this group of population irrespective of the three levels of their academic and professional knowledge. Several factors including sociodemographic characteristics, sexual behavior, HIV/AIDS, and STIs related patterns play a key role in medical student attitude and behavior towards people infected with HIV/AIDS and STIs. Our findings add consistent value in prior studies which aimed to stop new infections and also imply further investigations on the management of the studied infections by medical students. The present study arouses much interest among participants and provides evidence of reinforcing medical students' education on HIV/AIDS and STIs.

Protection of DNA during oxidative stress and cytotoxic potential of Artemisia absinthium.

Medicinal plants are rich in secondary metabolites (alkoloids, glycosides, coumarins, flavonides, steroids, etc.) and considered to be more effective and a safer alternative source to manage a variety of diseases related to liver, heart and kidney disordered. This study determines in vitro antioxidant and in vivo toxicological profile including hemolytic, brine shrimp lethality and mutagenicity of aerial parts of Artemisia absinthium. DNA protection assay was performed on pUC19 plasmid vector using H(2)O(2) as oxidative agent. Total phenolic and flavonoid content were determined using colorimetric methods. Toxicity of the plant was evaluated by brine shrimp lethality, hemolytic and mutagenic activity. DNA protection assay of the plant showed concentration dependent protective effect and at concentration 10µL/mL revealed complete protective effect against H(2)O(2) induced DNA damage. Highest phenolic and flavonoid content was found to be 167.3 (mg GAE 100g DW(-1)) and 14 (mg CE 100g DW(-1)) respectively. Results showed that A. absinthium is potent against standard toxicological procedures, that indicates the presence of bioactive components in the plant and possess antioxidant activity that protects DNA against H(2)O(2) induced oxidative damage. Thus the results showed/support that A. absinthium provides significant health benefits.

Review-Medicinal plants and management of Diabetes Mellitus: A review.

Diabetes is a metabolic disorder characterized by chronic hyperglycemia and associated with dysfunction and failure of various body organs. Alarming increase in prevalence rate has made this disorder a major health problem globally. The available treatment modalities are not sufficient to combat diabetes and associated complications. A number of medicinal plants have a significant antidiabetic potential against diabetes mellitus. We have listed the use of important medicinal herbs for the treatment and management of diabetes in this review.

Protective effects of activated protein C on neurovascular unit in a rat model of intrauterine infection-induced neonatal white matter injury.

Activated protein C (APC), a natural anticoagulant, has been reported to exert direct vasculoprotective, neural protective, anti-inflammatory, and proneurogenic activities in the central nervous system. This study was aimed to explore the neuroprotective effects and potential mechanisms of APC on the neurovascular unit of neonatal rats with intrauterine infection-induced white matter injury. Intraperitoneal injection of 300 µg/kg lipopolysaccharide (LPS) was administered consecutively to pregnant Sprague-Dawley rats at embryonic days 19 and 20 to establish the rat model of intrauterine infection- induced white matter injury. Control rats were injected with an equivalent amount of sterile saline on the same time. APC at the dosage of 0.2 mg/kg was intraperitoneally injected to neonatal rats immediately after birth. Brain tissues were collected at postnatal day 7 and stained with hematoxylin and eosin (H&E). Immunohistochemistry was used to evaluate myelin basic protein (MBP) expression in the periventricular white matter region. Blood-brain barrier (BBB) permeability and brain water content were measured using Evens Blue dye and wet/dry weight method. Double immunofluorescence staining and real-time quantitative PCR were performed to detect microglial activation and the expression of protease activated receptor 1 (PAR1). Typical pathological changes of white matter injury were observed in rat brains exposed to LPS, and MBP expression in the periventricular region was significantly decreased. BBB was disrupted and the brain water content was increased. Microglia were largely activated and the mRNA and protein levels of PAR1 were elevated. APC administration ameliorated the pathological lesions of the white matter and increased MBP expression. BBB permeability and brain water content were reduced. Microglia activation was inhibited and the PAR1 mRNA and protein expression levels were both down-regulated. Our results suggested that APC exerted neuroprotective effects on multiple components of the neurovascular unit in neonatal rats with intrauterine infection- induced white matter injury, and the underlying mechanisms might involve decreased expression of PAR1.

Subungual Congenital Nevus with Recurrent Nevus Phenomenon.

Melanonychia is uncommon. We report the first case of histopathologic recurrence of a completely excised subungual congenital nevus that presented as congenital melanonychia.

Valproate pretreatment protects pancreatic ß-cells from palmitate-induced ER stress and apoptosis by inhibiting glycogen synthase kinase-3ß.

BACKGROUND: Reduction of pancreatic ß-cells mass, major secondary to increased ß-cells apoptosis, is increasingly recognized as one of the main contributing factors to the pathogenesis of type 2 diabetes (T2D), and saturated free fatty acid palmitate has been shown to induce endoplasmic reticulum (ER) stress that may contribute to promoting ß-cells apoptosis. Recent literature suggests that valproate, a diffusely prescribed drug in the treatment of epilepsy and bipolar disorder, can inhibit glycogen synthase kinase-3ß (GSK-3ß) activity and has cytoprotective effects in neuronal cells and HepG2 cells. Thus, we hypothesized that valproate may protect INS-1 ß-cells from palmitate-induced apoptosis via inhibiting GSK-3ß. RESULTS: Valproate pretreatment remarkable prevented palmitate-mediated cytotoxicity and apoptosis (lipotoxicity) as well as ER distension. Furthermore, palmitate triggered ER stress as evidenced by increased mRNA levels of C/EBP homologous protein (CHOP) and activating transcription factor 4 (ATF4) in a time-dependent fashion. However, valproate not only reduced the mRNA and protein expression of CHOP but also inhibited GSK-3ß and caspase-3 activity induced by palmitate, whereas, the mRNA expression of ATF4 was not affected. Interestingly, TDZD-8, a specific GSK-3ß inhibitor, also showed the similar effect on lipotoxicity and ER stress as valproate in INS-1 cells. Finally, compared with CHOP knockdown, valproate displayed better cytoprotection against palmitate. CONCLUSIONS: Valproate may protect ß-cells from palmitate-induced apoptosis and ER stress via GSK-3ß inhibition, independent of ATF4/CHOP pathway. Besides, GSK-3ß, rather than CHOP, may be a more promising therapeutic target for T2D.