Time-domain heart rate dynamics in the prognosis of progressive atherosclerosis.

BACKGROUND AND AIM: The regular uptake of a high-fat diet (HFD) with changing lifestyle causes atherosclerosis leading to cardiovascular diseases and autonomic dysfunction. Therefore, the current study aimed to investigate the correlation of autonomic activity to lipid and atherosclerosis markers. Further, the study proposes a support vector machine (SVM) based model in the prediction of atherosclerosis severity. METHODS AND RESULTS: The Lead-II electrocardiogram and blood markers were measured from both the control and the experiment subjects each week for nine consecutive weeks. The time-domain heart rate variability (HRV) parameters were derived, and the significance level was tested using a one-way Analysis of Variance. The correlation analysis was performed to determine the relation between autonomic parameters and lipid and atherosclerosis markers. The statistically significant time-domain values were used as features of the SVM. The observed results demonstrated the reduced time domain HRV parameters with the increase in lipid and atherosclerosis index markers with the progressive atherosclerosis severity. The correlation analysis revealed a negative association between time-domain HRV parameters with lipid and atherosclerosis parameters. The percentage accuracy increases from 86.58% to 98.71% with the increase in atherosclerosis severity with regular consumption of HFD. CONCLUSIONS: Atherosclerosis causes autonomic dysfunction with reduced HRV. The negative correlation between autonomic parameters and lipid profile and atherosclerosis indexes marker revealed the potential role of vagal activity in the prognosis of atherosclerosis progression. The support vector machine presented a respectable accuracy in the prediction of atherosclerosis severity from the control group.

Laparoscopic Management of Median Arcuate Ligament Syndrome: A Case Report.

Median arcuate ligament syndrome (MALS) is an uncommon disorder characterized by postprandial abdominal pain, vomiting, anorexia, and weight loss. The symptoms are due to the MAL compressing the celiac artery and irritating the celiac plexus/ganglion. We report the case of one patient who presented with chronic abdominal pain, bloating, vomiting, and weight loss. Computed tomography angiography led to the diagnosis of MALS. The patient was treated surgically by laparoscopic division of the MLA and excision of the celiac plexus. He was discharged on day two without complications. On one-month follow-up, he was symptom-free, eating well, and had gained weight. He is on regular follow-up.

A Single-Center Experience With Gynecomastia Treatment Using Liposuction, Complete Gland Removal, and Nipple Areola Complex Lifting Plaster Technique: A Review of 448 Patients.

Background: Gynecomastia is defined as a benign enlargement of male breast glandular tissue. It is the most common breast condition in male, and the prevalence ranges from 32% to 72%. No standardized treatment exists for gynecomastia. Objectives: The authors treat gynecomastia patient with liposuction and complete gland excision through periareolar incision without skin excision. In case of skin redundancy, the authors use their special technique called nipple areola complex (NAC) plaster lift technique. Methods: The authors conducted the retrospective analysis of patient who underwent gynecomastia surgery between January 2020 and December 2021 at Chennai Plastic Surgery. All patients were treated with liposuction, gland excision, and NAC lifting plaster when required. The follow-up period ranges from 6 to 14 months. Results: A total of 448 patients (896 breasts) were included in our study with average age of 26.6 years. Grade II gynecomastia was most common in our study. The average BMI of the patients was 27.31 kg/m2. One hundred and sixteen patients (25.9%) experienced some form of complication. Seroma was most common complications in our study followed by superficial skin necrosis. Patient satisfaction rate was high in our study. Conclusions: Gynecomastia surgery is safe and highly rewarding procedure for surgeons. Various technologies and methods like liposuction, complete gland excision, and NAC lifting plaster technique should be adopted in gynecomastia treatment to give a better patient satisfaction. Complications are common in gynecomastia surgery but easily manageable.

Andrographolide: A Herbal-Chemosynthetic Approach for Enhancing Immunity, Combating Viral Infections, and Its Implication on Human Health.

Plants consistently synthesize and accumulate medically valuable secondary metabolites which can be isolated and clinically tested under in vitro conditions. An advancement with such important phytochemical production has been recognized and utilized as herbal drugs. Bioactive andrographolide (AGL; C20H30O5) isolated from Andrographis paniculate (AP) (Kalmegh) is a diterpenoid lactones having multifunctional medicinal properties including anti-manic, anti-inflammatory, liver, and lung protective. AGL is known for its immunostimulant activity against a variety of microbial infections thereby, regulating classical and alternative macrophage activation, Ag-specific antibody production during immune disorder therapy. In vitro studies with AGL found it to be effective against multiple tumors, neuronal disorders, diabetes, pneumonia, fibrosis, and other diverse therapeutic misadventures. Generally, virus-based diseases like ZIKA, influenza A virus subtype (H1NI), Ebola (EBOV), Dengue (DENV), and coronavirus (COVID-19) epidemics have greatly increased scientific interest and demands to develop more effective and economical immunomodulating drugs with minimal side effects. Trials and in vitro pharmacological studies with AGL and medicinally beneficial herbs might contribute to benefit the human population without using chemical-based synthetic drugs. In this review, we have discussed the possible role of AGL as a promising herbal-chemo remedy during human diseases, viral infections and as an immunity booster.

Heart rate variability time domain features in automated prediction of diabetes in rat.

Diabetes is a very common occurring disease, diagnosed by hyperglycemia. The established mode of diagnosis is the analysis of blood glucose level with the help of a hand-held glucometer. Nowadays, it is also known for affecting multi-organ functions, particularly the microvasculature of the cardiovascular system. In this work, an alternative diagnostic system based on the heart rate variability (HRV) analysis and artificial neural network (ANN) and support vector machine (SVM) have been proposed. The experiment and data recording has been performed on male Wister rats of 10-12 week of age and 200 ± 20 gm of weight. The digital lead-I electrocardiogram (ECG) data are recorded from control (n = 5) and Streptozotocin-induced diabetic rats (n = 5). Nine time-domain linear HRV parameters are computed from 60 s of ECG data epochs and used for the training and testing of backpropagation ANN and SVM. Total 526 (334 Control and 192 diabetics) such datasets are computed for the testing of ANN for the identification of the diabetic conditions. The ANN has been optimized for architecture 9:5:1 (Input: hidden: output neurons, respectively) with the optimized learning rate parameter at 0.02. With this network, a very good classification accuracy of 96.2% is achieved. While similar accuracy of 95.2% is attained using SVM. Owing to the successful implementation of HRV parameters based automated classifiers for diabetic conditions, a non-invasive, ECG based online prognostic system can be developed for accurate and non-invasive prediction of the diabetic condition.

Assessing the impacts of historical and future land use and climate change on the streamflow and sediment yield of a tropical mountainous river basin in South India.

In this study, the impacts of land use/land cover (LULC) and climate change on the streamflow and sediment yield were investigated for the Payaswani River Basin, Western Ghats, India. The LULC was determined using Landsat images, and climate data were procured from five general circulation models for representative concentration pathway (RCP) 4.5 (moderate emission) and 8.5 (high emission). The land change modeler was used to derive the future LULC and its changes from 1988 (historical) to 2030 (future) by using the transition matrix method. The SWAT model was used to assess the impacts of LULC and climate change for the streamflow and sediment yield. The results showed that decrease in forests and grasslands and increase in plantation, agricultural, and urban areas from 1988 to 2030 would lead to an increase in the mean streamflow (11.23%) and sediment yield (17.41%). Under RCP 4.5, climate change would decrease the streamflow by 2.38% in 2030. However, under RCP 8.5, climate change would increase the streamflow by 0.12% in 2030. The sediment yield under RCP 4.5 and 8.5 would increase by 1.23% and 3.33%, respectively. In comparison with the baseline condition, by 2030 future changes in the LULC and climate would increase the streamflow by 7.05% and 11.71% under RCP 4.5 and 8.5, respectively. The sediment yield would increase by 7.92% and 27.11% under RCP 4.5 and 8.5, respectively. The streamflow and sediment yield were predicted to increase in the summer and winter but decrease in the monsoon season.

Systematic review and meta-analysis: does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?

BACKGROUND: Colonic mural thickening (MT) is often reported on standard CT examinations of the abdomen and pelvis. It often presents a dilemma for the clinician on whether any further evaluation is needed, especially in the absence of any set guidelines. OBJECTIVE: To evaluate the significance of colonic MT and to assess its correlation with colonoscopy. METHODS: The search strategy was initially developed in Medline and adapted for use in Embase, Medline, NHS Evidence and TRIP. Studies were included if they had reported colonic MT and subsequent colonoscopy in adults. RESULTS: A total of 9 cohort studies examining 1252 patients were selected having undergone both CT and colonoscopy. Of the 1252 patients with MT, 950 had an abnormal colonoscopy. In the presence of MT, the pooled positive predictive value (PPV) of having any abnormal findings at colonoscopy was 0.73 (95% CI 0.60 to 0.84). The pooled PPV for colorectal cancer, in the presence of MT reporting suspicion of cancer, was 0.63 (95% CI 0.49 to 0.75), and MT suggestive of inflammation confirmed at colonoscopy was 0.97. CONCLUSION: The probability of having an abnormal colonoscopy in the presence of MT identified on CT is high, especially for inflammation. Asymptomatic cancers may also be detected; hence, further endoscopic confirmation is reasonable when a finding of MT is demonstrated on CT examinations. Small sample sizes of the available studies and lack of data on the description of MT detected are the main limiting factors in this review. TRIAL REGISTRATION NUMBER: CRD42016039378.

A Retrospective Comparative Analysis of 2D Versus 3D Laparoscopy in Total Laparoscopic Hysterectomy for Large Uteri (≥ 500g).

STUDY OBJECTIVE: To evaluate the outcomes of total laparoscopic hysterectomy using 3D vision in comparison with 2D vision in women with large uteri (≥500g). DESIGN: Retrospective analytical study Design Classification: Canadian Task Force II-1 Setting: Tertiary referral center for advanced gynecological surgery. PATIENTS: Five hundred forty six women who underwent total laparoscopic hysterectomy over a period of 13 years were studied: 301 under 2D vision and 245 under 3D vision. INTERVENTIONS: Total laparoscopic hysterectomy Measurements: Surgical time, blood loss and complications were recorded for every case in both groups. MAIN RESULTS: The duration of surgery for hysterectomy in the 3D laparoscopy group (88.01?36.95 min) was significantly shorter than that in the 2D group (112.61?42.59 min, p=.0001). Blood loss in the 500-1000g group was significantly less in the 3D group (p=.005). The total complication rates for 3D surgery (3.37 %) and 2D surgery (6.64%) were comparable (p=.25). CONCLUSION: Three-dimensional laparoscopy provides stereoscopic vision and increases precision and safety. The availability of depth perception adds to the ease of surgery, especially in cases of large uteri, leading to reductions in both the duration of surgery and blood loss, which improves patient outcomes.

Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition.

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

Zinner syndrome: an unusual cause of bladder outflow obstruction.

Zinner syndrome is a rare condition comprising a triad of unilateral renal agenesis, ipsilateral seminal vesicle obstruction and ipsilateral ejaculatory duct obstruction. The mutual embryological origins of the seminal vesicle and the ureteral bud result in both anomalous genital and urinary tracts. We present the case of a 39-year-old patient where the initial presentation of this condition was bladder outflow obstruction. In this paper, we discuss the embryological origin of this condition, the range of imaging tools used to diagnose Zinner syndrome and the inherent benefits and shortcomings of each modality.

Three-dimensional laparoscopy: Principles and practice.

The largest challenge for laparoscopic surgeons is the eye-hand coordination within a three-dimensional (3D) scene observed on a 2D display. The 2D view on flat screen laparoscopy is cerebrally intensive. The loss of binocular vision on a 2D display causes visual misperceptions, mainly loss of depth perception and adds to the surgeon's fatigue. This compromises the safety of laparoscopy. The 3D high-definition view with great depth perception and tactile feedback makes laparoscopic surgery more acceptable, safe and cost-effective. It improves surgical precision and hand-eye coordination, conventional and all straight stick instruments can be used, capital expenditure is less and recurring cost and annual maintenance cost are less. In this article, we have discussed the physics of 3D laparoscopy, principles of depth perception, and the different kinds of 3D systems available for laparoscopy. We have also discussed our experience of using 3D laparoscopy in over 2000 surgeries in the last 4 years.

Colonic thickening on computed tomography-does it correlate with endoscopic findings? A protocol for systematic review.

BACKGROUND: Colonic mural thickening is often a finding in standard computed tomography (CT) scans of the abdomen. It often presents clinician with a dilemma on when a further endoscopic evaluation is needed, especially in the absence of guidelines. The aim of this systematic review is to evaluate the significance of bowel wall thickening and to assess its correlation with endoscopy. METHODS: This systematic review will be reported in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. The search strategy will initially be developed in MEDLINE and adapted for use in EMBASE, MEDLINE, NHS evidence and TRIP. Two reviewers will independently conduct a study selection, data extraction and risk of bias assessment for the screened studies. Data synthesis will be conducted using Review Manager software 5.3. The outcome of any dichotomous data will be presented as relative risk with confidence intervals. DISCUSSION: It is extremely useful for the practising clinician to know which patients need further endoscopic evaluation. Even though there are several studies on this issue, none of them have attempted to produce a systematic review. We hope this systematic review will provide a substantiate evidence for future clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039378.

Bcl-2△21 and Ac-DEVD-CHO Inhibit Death of Wheat Microspores.

Microspore cell death and low green plant production efficiency are an integral obstacle in the development of doubled haploid production in wheat. The aim of the current study was to determine the effect of anti-apoptotic recombinant human B-cell lymphoma-2 (Bcl-2△21) and caspase-3-inhibitor (Ac-DEVD-CHO) in microspore cell death in bread wheat cultivars AC Fielder and AC Andrew. Induction medium containing Bcl-2△21 and Ac-DEVD-CHO yielded a significantly higher number of viable microspores, embryo-like structures and total green plants in wheat cultivars AC Fielder and AC Andrew. Total peroxidase activity was lower in Bcl-2△21 treated microspore cultures at 96 h of treatment compared to control and Ac-DEVD-CHO. Electron paramagnetic resonance study of total microspore protein showed a different scavenging activity for Bcl-2△21 and Ac-DEVD-CHO. Bcl-2△21 scavenged approximately 50% hydroxyl radical (HO•) formed, whereas Ac-DEVD-CHO scavenged approximately 20% of HO•. Conversely, reduced caspase-3-like activities were detected in the presence of Bcl-2△21 and Ac-DEVD-CHO, supporting the involvement of Bcl-2△21 and Ac-DEVD-CHO in increasing microspore viability by reducing oxidative stress and caspase-3-like activity. Our results indicate that Bcl-2△21 and Ac-DEVD-CHO protects cells from cell death following different pathways. Bcl-2△21 prevents cell damage by detoxifying HO• and suppressing caspase-3-like activity, while Ac-DEVD-CHO inhibits the cell death pathways by modulating caspase-like activity.

Acute scrotal swelling following perforated rectal carcinoma with abscess formation.

A 59-year-old cachectic male was referred to the surgical outpatient department with intermittent haematochezia and a longstanding change in bowel habit with associated weight loss and anaemia. Following investigation, he was diagnosed with a large rectal tumour with multiple metastases. 7 days later, the patient presented again with fevers, bilious vomiting, abdominal pain and distension. On examination, he had a generally tender abdomen,= although no peritonism, but an enlarged, extremely tender hemiscrotum with no cough reflex. Imaging revealed a perforated rectum and subsequent abscess formation, which tracked via an unusual anatomical route to present as scrotal swelling.

(E)-ß-farnesene gene reduces Lipaphis erysimi colonization in transgenic Brassica juncea lines.

Aphids are the major concern that significantly reduces the yield of crops. (E)-ß-farnesene (Eßf) is the principal component of the alarm pheromone of many aphids. The results of current research support the direct defense response of (E)-ß-farnesene (Eßf) against aphid Lipaphis erysimi (L.) Kaltenbach in Brassica juncea. Eßf gene was isolated from Mentha arvensis and transformed into B. juncea, showed direct repellent against aphid colonization. The seasonal mean population (SMP) recorded under field condition showed significantly higher aphid colonization in wild type in comparison to most of the transgenic lines, and shows positive correlation with the repellency of transgenic plant expressing (E)-ß-farnesene. The current research investigation provides direct evidence for aphid control in B. juncea using Eßf, a non-toxic mode of action.

Classification of Two Class Motor Imagery Tasks Using Hybrid GA-PSO Based K-Means Clustering.

Transferring the brain computer interface (BCI) from laboratory condition to meet the real world application needs BCI to be applied asynchronously without any time constraint. High level of dynamism in the electroencephalogram (EEG) signal reasons us to look toward evolutionary algorithm (EA). Motivated by these two facts, in this work a hybrid GA-PSO based K-means clustering technique has been used to distinguish two class motor imagery (MI) tasks. The proposed hybrid GA-PSO based K-means clustering is found to outperform genetic algorithm (GA) and particle swarm optimization (PSO) based K-means clustering techniques in terms of both accuracy and execution time. The lesser execution time of hybrid GA-PSO technique makes it suitable for real time BCI application. Time frequency representation (TFR) techniques have been used to extract the feature of the signal under investigation. TFRs based features are extracted and relying on the concept of event related synchronization (ERD) and desynchronization (ERD) feature vector is formed.

Support vector machine and fuzzy C-mean clustering-based comparative evaluation of changes in motor cortex electroencephalogram under chronic alcoholism.

In this study, the magnitude and spatial distribution of frequency spectrum in the resting electroencephalogram (EEG) were examined to address the problem of detecting alcoholism in the cerebral motor cortex. The EEG signals were recorded from chronic alcoholic conditions (n = 20) and the control group (n = 20). Data were taken from motor cortex region and divided into five sub-bands (delta, theta, alpha, beta-1 and beta-2). Three methodologies were adopted for feature extraction: (1) absolute power, (2) relative power and (3) peak power frequency. The dimension of the extracted features is reduced by linear discrimination analysis and classified by support vector machine (SVM) and fuzzy C-mean clustering. The maximum classification accuracy (88 %) with SVM clustering was achieved with the EEG spectral features with absolute power frequency on F4 channel. Among the bands, relatively higher classification accuracy was found over theta band and beta-2 band in most of the channels when computed with the EEG features of relative power. Electrodes wise CZ, C3 and P4 were having more alteration. Considering the good classification accuracy obtained by SVM with relative band power features in most of the EEG channels of motor cortex, it can be suggested that the noninvasive automated online diagnostic system for the chronic alcoholic condition can be developed with the help of EEG signals.

Jasmonate-induced biosynthesis of andrographolide in Andrographis paniculata.

Andrographolide is a prominent secondary metabolite found in Andrographis paniculata that exhibits enormous pharmacological effects. In spite of immense value, the normal biosynthesis of andrographolide results in low amount of the metabolite. To induce the biosynthesis of andrographolide, we attempted elicitor-induced activation of andrographolide biosynthesis in cell cultures of A. paniculata. This was carried out by using methyl jasmonate (MeJA) as an elicitor. Among the various concentrations of MeJA tested at different time periods, 5 µM MeJA yielded 5.25 times more andrographolide content after 24 h of treatment. The accumulation of andrographolide was correlated with the expression level of known regulatory genes (hmgs, hmgr, dxs, dxr, isph and ggps) of mevalonic acid (MVA) and 2-C-methyl-d-erythritol-4-phosphate (MEP) pathways. These results established the involvement of MeJA in andrographolide biosynthesis by inducing the transcription of its biosynthetic pathways genes. The coordination of isph, ggps and hmgs expression highly influenced the andrographolide biosynthesis.

Small-intestinal length measurement on MR enterography: comparison with in vivo surgical measurement.

OBJECTIVE: The purpose of this study is to assess the feasibility and accuracy of small-bowel length measurement on MR enterography examinations compared with surgical in vivo measurements. SUBJECTS AND METHODS: Thirty-one consecutive patients who were undergoing elective laparotomy for Crohn disease were included in the study. These patients underwent a prior MR enterography examination, and true fast imaging with steady-state precession MR enterography images from the examinations were used to measure small-intestinal length. The MR enterography measurement was compared with a surgical measurement to assess accuracy and correlation. RESULTS: MR enterography measurements had a significant positive correlation with surgical measurements (r(2) = 0.98; p < 0.001) irrespective of bowel length. The average (± SD) percentage difference between MR enterography and surgical intestinal length measurement was 4.59% ± 0.44%. An average time of 36.5 ± 2.8 minutes was required for bowel length measurement on MR enterography. A significantly longer time was required for measurement of bowel length greater than 300 cm versus shorter bowel length. CONCLUSION: Small-bowel length measurements on MR enterography are accurate compared with anatomic measurements. MR enterography can provide an effective noninvasive investigation in planning surgical and nutritional intervention in patients with compromised bowel length.