Clinical outcomes related to portal pressures before and after embolization of large portosystemic shunts in cirrhosis.

Objectives: Embolization of large portosystemic shunts effectively controls gastric variceal bleeding and prevents hepatic encephalopathy. The significance of dynamic changes in hepatic venous pressure gradient before and after embolization on clinical events and patient outcomes remains unknown. Methods: In this retrospective single-center series, 46 patients with gastric variceal bleeding, hepatic encephalopathy, or both undergoing embolization (January 2018 to October 2020) were included, and dynamic changes in portal pressures were analyzed against patient outcomes. Results: Males predominated. The most common portosystemic shunt syndrome was the lienorenal shunt. In all, 34 patients underwent embolization for hepatic encephalopathy and 11 for gastric variceal bleeding. The proportion of patients surviving at the end of 12 and 32 months was 86.96 and 54.35%, respectively. The hepatic venous pressure gradient before shunt embolization was 13.4 ± 3.2 and 16.9 ± 3.7 mm Hg after occlusion (p < 0.001). Bleeding from varices on overall follow-up was notable in five patients (10.9%), and overt hepatic encephalopathy in four (N = 42, 9.5%) patients at 6-12 months. The development of infections within 100 days and beyond the first year was associated with the risk of dying at the end of 12 and 32 months, respectively. Elevation of hepatic venous pressure gradient by >4 mm Hg from baseline and an absolute increase to >16 mm Hg immediately post-procedure significantly predicted the development of early- and late-onset ascites, respectively. Conclusion: Close monitoring for the development of infections and optimization of beta-blockers and diuretics after shunt embolization may improve clinical outcomes and help identify patients who will benefit from liver transplantation pending prospective validation.

Regenerative Therapy for the Permanent Immature Teeth: A Long Term Study. An Original Research.

Introduction: Endodontics faces several clinical difficulties while treating young necrotic permanent teeth. The use of regenerative endodontic procedures (REPs) enables apical closure, improved canal wall thickness, and root growth. The objective of this study was to assess the effects of these regenerative procedures on immature necrotic permanent teeth. Methods: This prospective clinical study was conducted at the tertiary care hospital for the study period of 2 years. This study includes 30 necrotic permanent immature teeth that were studied in 30 subjects of both genders. A standard REP protocol was used to treat every tooth. A follow-up visit was scheduled for each patient at timely intervals. Various study parameters as well as the demographics were assessed at each visit. To examine various parameters, a calibrated endodontist also performed a radiographic evaluation. Results: Our findings point to excellent rates of survival, clinical success, and apical pathological resolution for 29 teeth. After 2 years, there were significant variations in the root thickness area and the average root length. The apical diameter significantly decreased during the research period, with 30.8% of the instances exhibiting full apical closure. Apical diameter, root length, and thickness changed more frequently in teeth with the level of the immaturity of the root, although the variations were not significant. Conclusions: REP treatment for teeth preceded symptom relief. Increased root thickness, root length, and apical closure were seen at 30 months, even if the clinically meaningful change was not attained in all patients.

Assessment of gamma radiation through agro-morphological characters in camellia sinensis L. (O.) kuntze.

PURPOSE: To study the effects of gamma radiation on tea seed germination, morphological changes, and genetic variation by using gamma radiation. MATERIAL AND METHOD: Fresh Tea seed material were irradiated with twenty different doses of gamma radiation such as 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 40, 50, 60, 70, 80 90, 100, 200, 500 and 1000 Gy from Cobalt 60Co source from Regional Nuclear Agriculture Research Center, Bidhan Chandra Krishi Viswavidyalaya (BCKV), West Bengal, in between 2019 and 2020. RESULT AND CONCLUSION: The growth behavior of tea seedling was recorded under varying levels of gamma radiation and its performance at nursery stages. It was observed seed irradiated with doses from 35 Gy to 100 Gy could germinate but could not survive beyond five (05) months. When treated with higher doses as 200 Gy, 500 Gy and 1000 Gy, no seed germination takes places due to possible damages occur in the DNA structure. Screening of growth characteristics of tea plant generally monitored by the characteristics like plant height, number of leaves, number of primary branches, base diameter, and total leaf area of plants and we found that these characteristics significantly increased with the progress of time and increasing levels of gamma radiation; however, the plant height showed decreasing trend with the increasing levels of gamma radiation, which could be due to the change in chromosomal structure and genetic alteration. After 90 weeks of planting, the plant height, no. of primary branches, the number of leaves, plant base diameter, and total leaf area per plant recorded were 36.42 cm, 1/plant, 7.11/plant, 0.62 c.m, 22.92 cm2/plant respectively under the radiation level 30 Gy, whereas the corresponding figures of the above parameters at the control treatment were 85.32 cm, 1/plant, 18.84/plant, 1.18 c.m and 26.68 cm2/plant, respectively. The total plant height, no. of primary branches, the number of leaves, plant base diameter, and total leaf area per plant were significantly influenced by the rising levels of gamma radiation (up to 100 Gy), finally, after 90 weeks of planting, the maximum no. of branching was observed in the treatment of 8 Gy, 10 Gy and 15 Gy respectively. The study reveals a hitherto open the possibility of using gamma radiation on tea plant for creation of variation in the tea seed planting materials. Further studies on mutation using tea planting materials would give an insight into its mutable gene behavior.

Clinical outcomes and gut microbiota analysis of severe alcohol-associated hepatitis patients undergoing healthy donor fecal transplant or pentoxifylline therapy: single-center experience from Kerala.

Background: Severe alcohol-associated hepatitis (SAH) patients with infections have a high short-term mortality rate. Gut microbiota dysbiosis plays an important role in the pathogenesis of SAH. Preliminary studies have demonstrated long-term benefits with healthy donor fecal microbiota transplantation (FMT). Data on FMT compared with pentoxifylline for SAH and relevant gut microbial changes are lacking in literature. Methods: From January 2019 to February 2021, retrospective analysis of a single hospital's records revealed 47 SAH patients undergoing FMT (100 mL/day via nasoduodenal tube for 7 days) and 25 matched patients receiving pentoxifylline (400 mg/8 h for 28 days). The primary end point was a 6-month survival rate. Secondary end points included incidence of ascites, hepatic encephalopathy, infections, acute kidney injury, and gut microbiota changes between post-therapy groups. Biomarker discovery and network analysis were also performed to identify significant taxa of gut microbiota in post-treatment groups in retrospectively stored stool samples. Results: All were males. The 6-month survival rate was higher in the patients undergoing FMT than in patients receiving pentoxifylline (83.0% vs 56.0%, P = 0.012). At the end of 6-month follow-up, the incidences of clinically significant ascites (56.0% vs 25.5%, P = 0.011), hepatic encephalopathy (40.0% vs 10.6%, P = 0.003), and critical infections (52.0% vs 14.9%, P < 0.001) in patients administered pentoxifylline were significantly higher than those in patients treated with FMT. At 3 months, biomarker analysis revealed a significant abundance of Bifidobacterium and Eggerthella in the FMT group and the pentoxifylline group, respectively. At 6 months, Bifidobacterium in the FMT group and pathogenic Aerococcaceae in the pentoxifylline group were notable. Network analysis showed beneficial taxa (Bifidobacterium) as a central influencer in those undergoing FMT at 6 months. Conclusions: Healthy donor FMT improved survival rate and reduced liver-related complications compared with pentoxifylline. These clinical benefits were associated with favorable modulation of intestinal bacterial communities. Difficult-to-treat SAH patients may be safely bridged to transplantation using FMT. Controlled trials evaluating long-term outcomes are an unmet need.

Transjugular Intrahepatic Portosystemic Shunt in Chronic Portal Vein Thrombosis-From Routine Recommendations to Demanding Scenarios.

Portal vein thrombosis (PVT), particularly the presence of portal cavernoma, was traditionally considered a relative contraindication for transjugular intrahepatic portosystemic shunting (TIPS) due to the technical difficulties in accessing and maneuvering the portal vein and avoiding the high risk for bleeding periportal collaterals. However, the last decade has seen a surge in the number of studies-mostly case reports and small series of patients-demonstrating that TIPS is not only technically feasible in the vast majority of these patients but also provides effective and long-term control of symptoms associated with portal hypertension in cases refractory to the standard line of therapy. The present article aims to provide a concise but exhaustive overview of the role and the standard and technically difficult TIPS placement scenarios in patients with chronic non-malignant PVT and with and without underlying liver disease. The review is strategically punctuated by exemplary instances from the authors' experience.

Physiological and biochemical evaluation of high anthocyanin pigmented tea (Camellia sinensis L. O. Kuntze) germplasm for purple tea production.

Finding promising purple tea germplasm that would target new tea products for diversification and value addition boost the tea industry's economic growth. Accordingly, 10 tea germplasm viz. TRA St. 817, TRA St. 293, TRA St. 400, TRA 177/3, TRA 376/2, TRA 376/3, TRA 427/7, TRA P7, TRA P8, and TV1 were evaluated in terms of gas exchange parameters, multiplication performance, and biochemical markers such as chlorophyll, carotenoids, and anthocyanin content, which are related to the purple tea quality. The investigated gas exchange and biochemical parameters revealed significant differences. Germplasm TRA St.817 was physiologically more efficient (24.7 µmol m-2 s-1), followed by TRA St. 293, exhibiting the highest net photosynthesis, water use efficiency (19.02 µmol mmol-1), carboxylation efficiency (0.73), chlorophyll fluorescence or photochemical efficiency of PSII (0.754) and mesophyll efficiency (ci/gs ratio: 2.54). Net photosynthesis was positively correlated with water use efficiency, carboxylation efficiency, mesophyll efficiency, and photochemical efficiency of PSII (r = 0.965**, 0.937**, 0.857**, 0.867**; P = 0.05), respectively, but negatively correlated with the transpiration ratio (r = -0.878**; P = 0.05) based on Pearson correlation analysis. The total anthocyanin content (4764.19 µg.g-1 fresh leaf weight) and carotenoid content (3.825 mg.g-1 fresh leaf weight) were highest in the TRA St.817 germplasm, followed by germplasm TRA St. 293 (2926.18 µg.g-1 FW). In contrast, total chlorophyll content was significantly low (1.779 mg.g-1 fresh weight), which is very suitable for manufacturing purple tea. The highest carotenoid concentration in TRA St. 817 was 3.825 mg.g-1 FW, followed by TRA P8 (3.475 mg.g-1 FW), favoring the formation of more volatile flavor constituents. The promising germplasm, TRA St 817, has a multiplication success rate of 91.4% through cleft grafting. The outcome reveals that TRA St.817 is a promising germplasm that can be used to make speciality teas, i.e., purple tea.

Applicability of Tanaka-Johnston, Moyers, and Bernabé and Flores-Mir Mixed Dentition Analyses in School-going Children of Sri Ganganagar City, Rajasthan (India): A Cross-sectional Study.

BACKGROUND: The orthodontic diagnosis and treatment planning are the fundamental goals during the mixed dentition period. Numerous methods have been proposed till date such as Nance method, Moyer's method, Staley-Kerber and Tanaka-Johnston's method, and Bernabé and Flores-Mir method. AIM: The aim of the study is to determine the mesiodistal widths of the lower permanent canines and premolars from Tanaka-Johnston, Moyers, and Bernabé E and Flores-Mir C mixed dentition analysis and to determine the correlation coefficients and the new prediction equation for Sri Ganganagar population. SETTING AND DESIGN: A total of 3572 children were clinically examined from the contemporary population of Sri Ganganagar city and Outpatient Department of Pediatric and Preventive Dentistry in Sri Ganganagar, Rajasthan. A total of 150 individuals were randomly selected for the study based on the inclusion and exclusion criteria and were designated as "study samples. MATERIALS AND METHODS: A total of 150 children aged 11-16 years of Sri Ganganagar city were randomly selected. The mesiodistal width of permanent incisors, canines, premolars, and molars was measured with the help of digital vernier caliper with an accuracy of ±0.01 mm. The measurements of canines and premolars were summed up and compared with those derived from Tanaka and Johnston equations, Moyers probability tables, and Bernabé and Flores-Mir equations. STATISTICAL ANALYSIS: The data obtained were subjected to statistical analysis using IBM SPSS Statistics Windows version "20.0" using Student's t-test, Pearson correlation coefficient, and Kruskal-Wallis test. RESULTS: All the three methods overestimated the actual sum of permanent canine and premolars in both the arches in our population. The correlation coefficients and the new regression equations were derived for both maxilla and mandible in males and females for Sri Ganganagar population. CONCLUSION: The predicted values obtained from all the three methods overestimated the actual values.

Adenoid cystic carcinoma of the upper trachea: a rare neoplasm.

Primary malignant tracheal tumors are not common and adenoid cystic carcinoma (ACC) of trachea is rare. We report an extremely rare case of ACC of proximal trachea, which was diagnosed in a 42-year-old male who presents with 6-month history of dyspnea. Lateral skiagram of neck, computed tomography, and magnetic resonance imaging revealed a broad-based polypoidal soft tissue mass arising from posterior wall of the proximal trachea. Biopsy confirmed the diagnosis of ACC. The patient was treated by surgical resection followed by radiotherapy and is on regular follow-up. Follow-up at 18 months post-treatment showed no local recurrence or distant metastases. The literature on tracheal ACC is reviewed. Image findings are briefly discussed.