Enhancing photosynthesis and root development for better fruit quality, aroma, and lessening of radioactive materials in key lime (Citrus aurantifolia) using Trichoderma harzianum and Bacillus thuringiensis.

The present study was conducted to investigate the effects of Trichoderma harzianum and Bacillus thuringiensis alone or with gradual levels of NPK on photosynthesis, growth, fruit quality, aroma improvement and reduced radionuclides of key lime fruits. The lemon seedlings were treated with (T0) without fertilizers as control, (T1) 100g of NPK at 100%, (T2) 5 g of Trichoderma. harzianum at 50% + 50 g of NPK at 50%, (T3) 5 g of Bacillus thuringiensis at 50% + 50 g of NPK at 50 %, (T4) 7.5 g of Trichoderma harzianum at 75% + 25 g of NPK at 25 %, (T5) 7.5 g of Bacillus thuringiensis at 75% + 25 g of NPK at 25 %, (T6) 10 g of Trichoderma harzianum at 100 % and (T7)10 g of Bacillus thuringiensis at 100 %. The results showed that T2 increased net photosynthetic rate, stomatal conductance, transpiration rate, internal CO2 concentration, fresh and dry root biomass by 209%, 74%, 56%, 376%, 69.4% and 71.6%, while, T5 increased root volume, root length, and root tip number by 27.1%, 167%, and 67%, respectively over the control trees. The microbial treatments developed cortex, vascular cylinder and tracheal elements of the root. Fruit number, length, diameter, weight, pulp thickness, pulp/peel ratio, juice, total soluble solids (TSS), pigment contents and antioxidant activity increased significantly in the T2 treatment. Vitamin C, total phenols, total flavonoids, and total sugar content increased by 1.59-, 1.66-, 1.44- and 2.07- fold in T5 treated fruits compared to the control. The two microbes increased volatile compounds and decreased radionucleotides in the fruit, moreover, 27 identified and 2 (two) unmatched volatile compounds were identified by GCMS analysis. It is concluded that T. harzianum and B. thuringiensis with 25-50 g NPK treatments improved photosynthesis, root structure, fruit growth, fruit quality, aroma and lessened radionuclides in key lime fruits.

An Overview of the History, Pathophysiology, and Pharmacological Interventions of Multiple Sclerosis.

Multiple sclerosis (MS) is an immune-inflammatory disease that attacks and damages myelinated axons in the central nervous system (CNS) and causes nontraumatic neurological impairment in young people. Historically, Lidwina of Schiedam documented the first MS case. After that, Augustus d'Este wrote for years about how his MS symptoms worsened. Age, sex, genetics, environment, smoking, injuries, and infections, including herpes simplex and rabies, are risk factors for MS. According to epidemiology, the average age of onset is between 20 and 40 years. MS is more prevalent in women and is common in Europe and America. As diagnostic methods and criteria change, people with MS may be discovered at earlier and earlier stages of the disease. MS therapy has advanced dramatically due to breakthroughs in our knowledge of the disease's etiology and progression. Therefore, the efficacy and risk of treatment medications increased exponentially. Management goals include reducing lesion activity and avoiding secondary progression. Current treatment approaches focus on managing acute episodes, relieving symptoms, and reducing biological activity. Disease-modifying drugs such as fingolimod, interferon-beta, natalizumab, and dimethyl fumarate are the most widely used treatments for MS. For proof of the efficacy and safety of these medications, investigations in the real world are necessary.

Evaluation of Radiological Health Risks in Popularly Consumed Brands of Sachet Water in Nigeria.

Radiological investigation of 35 brands of most popularly used sachet drinking water in Ondo state, Nigeria has been carried out using a spectrometric method for evaluating the concomitant health risks to the members of the public. Activity concentrations of the investigated radionuclides 40K, 226R, and 228Ra were in the range from 16.35 ± 4.10 to 199.94 ± 38.40 Bq L-1 with an arithmetic mean (AM) of 66.22 ± 54.99 Bq L-1, from 1.35± 0.79 to 17.06 ± 5.13 Bq L-1 with an AM of 6.88 ± 3.66 Bq L-1, and from 1.95 ± 0.08 to 17.22 ± 3.87 Bq L-1 with an AM of 9.49 ± 4.98 Bq L-1, respectively. The determined annual effective doses and the corresponding excess lifetime cancer risks due to 226Ra and 228Ra were found to exceed the acceptable limits of 0.1 mSv y-1 and 10-3 respectively, as suggested by the World Health Organization (WHO). This implies a non-negligible carcinogenic health hazard due to the intake of the surveyed drinking water, especially for the lactating babies (0-1) y and teenagers (12-17) y. The data from this research may form an invaluable component of radiometric values of the database in Nigeria, as well as the world for setting up guidelines and control policies for the use of sachet water.

A Continuously Tunable Full-Color Emission Nitrogen-Doped Carbon Dots and for Ultrasensitive and Highly Selective Detection of Ascorbic Acid.

Nitrogen-doped carbon dots exhibiting excitation-dependent full-color emissions (F-NCDs) were prepared via the one-step hydrothermal method with citric acid and phenylenediamine. Specifically, the emission wavelength of the F-NCDs tuned from 452 nm to 602 nm due to the introduction of new energy levels by C=O and C=N functional groups. We exploited its stability in illumination, ionic strength, and pH, as well as its specificity, sensitivity, especially in ascorbic acid (AA) detection. F-NCDs could measure the AA concentration in the linear ranges of 0~0.1 and 0.1~1 mmol/L with the detection limit (LOD, S/N = 3) as low as 2.6 nmol/L. Additionally, we successfully detected AA in bovine serum with our F-NCDs and obtained the result within 1 min. Because of full-color emission features, we believe our F-NCDs have a great potential in fluorescent sensor detection.

Analysis of 11 years of clinical negligence claims in esophagogastric cancer in England.

In the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. The aim of this study is to identify the size, trends, and causes of litigations claims in relation to esophagogastric (EG) cancer in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) for the period of January 2003 to December 2013. Data were reviewed, categorized clinically, and analyzed in terms of causes and costs behind claims. In this time period, there were 163 claims identified from the NHSLA database. Ninety-five (58.3%) claims were successful with a pay out of £6.25 million. An increasing overall claim frequency and success rate were found over the last few years. Majority of the claims were from gastric cancer 84 (88.4%). The commonest cause of complaint in successful claims was delay or failure in diagnosis (21.1%) and treatment (17.9%). There were only 10.5% successful intraoperative claims, of which 50% were due to unnecessary or additional procedures. The frequency and success rates of malpractice claims in EG cancer are rising. The failure or delay in diagnosing and treatment in EG malignancy are the common cause for successful litigation claims. The findings further reinforce the need to improve early diagnosis.

Theatre time utilisation in elective orthopaedic surgery.

A prospective review of theatre time utilisation of the senior author's elective orthopaedic lists was carried out over a period of 10 weeks. A total of 41 cases were included. Only 54.0% of theatre time was utilised for operating. The anaesthetic time was 12.0%, and 9.3% of theatre time was used for positioning and draping. Delays in starting the list and turnover time accounted for the remaining 25%.

Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery.

BACKGROUND: Oesophagogastric cancer surgery is immunosuppressive. This may be modulated by omega-3 fatty acids (O-3FAs). The aim of this study was to assess the effect of perioperative O-3FAs on clinical outcome and immune function after oesophagogastric cancer surgery. METHODS: Patients undergoing subtotal oesophagectomy and total gastrectomy were recruited and allocated randomly to an O-3FA enteral immunoenhancing diet (IED) or standard enteral nutrition (SEN) for 7 days before and after surgery, or to postoperative supplementation alone (control group). Clinical outcome, fatty acid concentrations, and HLA-DR expression on monocytes and activated T lymphocytes were determined before and after operation. RESULTS: Of 221 patients recruited, 26 were excluded. Groups (IED, 66; SEN, 63; control, 66) were matched for age, malnutrition and co-morbidity. There were no differences in morbidity (P = 0·646), mortality (P = 1·000) or hospital stay (P = 0·701) between the groups. O-3FA concentrations were higher in the IED group after supplementation (P < 0·001). The ratio of omega-6 fatty acid to O-3FA was 1·9:1, 4·1:1 and 4·8:1 on the day before surgery in the IED, SEN and control groups (P < 0·001). There were no differences between the groups in HLA-DR expression in either monocytes (P = 0·538) or activated T lymphocytes (P = 0·204). CONCLUSION: Despite a significant increase in plasma concentrations of O-3FA, immunonutrition with O-3FA did not affect overall HLA-DR expression on leucocytes or clinical outcome following oesophagogastric cancer surgery. REGISTRATION NUMBER: ISRCTN43730758 (http://www.controlled-trials.com).

Unplanned overnight admissions in day-case arthroscopic shoulder surgery.

The majority of arthroscopic shoulder procedures can be safely performed as day-case surgery. However, despite better pain control and preoperative assessment; some patients end with unplanned overnight admission. The aim of this study was to investigate the reasons behind unplanned admissions of patients undergoing day-case arthroscopic shoulder surgery. A retrospective review of 242 consecutive cases of arthroscopic shoulder surgery performed by the senior author over a period of two years (2007-2008) was carried out. Twenty cases were planned admissions and were therefore excluded. 222 cases were included, of which 40 (18%) were unplanned overnight admissions. Documented causes for overnight stay included abnormal post-operative observations, pain and wound ooze. The age of patients who stayed overnight was significantly higher (p = 0.006). The difference in ASA grade between both groups was less marked but still statistically significant (p = 0.031). More complex procedures, such as rotator cuff repair, were more likely to result in unplanned overnight admission (p < 0.001). The experience of the anaesthetist and administration of interscalene nerve block were not significantly different between the two groups. However, patients anesthetised by less experienced anaesthetists were less likely to receive an interscalene nerve block (p = 0.016). In conclusion; higher patient age, higher ASA grade and more complex arthroscopic procedures are significant risk factors for unplanned overnight admissions in day-case arthroscopic shoulder surgery.

The range of the Oxford Shoulder Score in the asymptomatic population: a marker for post-operative improvement.

INTRODUCTION: The Oxford Shoulder Score (OSS) is a validated scoring system used to assess the degree of pain and disability caused by shoulder pathology. To date there is no knowledge of the range of the OSS in the healthy adult population. This study aimed to establish the range in asymptomatic individuals. METHODS: The OSS of 100 asymptomatic volunteers was compared with the pre-operative OSS of 100 symptomatic individuals who had had elective shoulder surgery performed at the Royal Preston hospital. RESULTS: The difference in mean scores in the operated group (36.7) and the asymptomatic group (15.3) was statistically significant (p<0.0001). There was, however, a substantial overlap between the scores of the two groups (operated group range: 19-55, asymptomatic group range: 12-47). Factors such as age, sex, body mass index, co-morbidities and smoking did not have a statistically significant impact on the eventual score in the asymptomatic group. CONCLUSIONS: This study has established the range of OSS in the asymptomatic adult population. Symptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast more accurately.

Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms.

The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature > or = 38.5 degrees C), inability to bear weight, white blood-cell count > 12.0 x 10(9) cells/L and ESR > or = 40 mm/hr; CRP > or = 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.

Endoscopic ultrasonography-detected low-volume ascites as a predictor of inoperability for oesophagogastric cancer.

BACKGROUND: Endoscopic ultrasonography (EUS) can detect low-volume ascites (LVA) not apparent on computed tomography. The aim of this study was to assess the importance of LVA for management of patients with oesophagogastric (OG) cancer. METHODS: Patients with LVA were identified from a prospective OG cancer unit database between January 2002 and January 2006. RESULTS: Of 1118 patients staged with OG cancer, 802 had EUS. The incidence of LVA was 8.4 per cent overall but fell to 6.5 per cent when those with metastases on computed tomography were excluded. Only patients with gastric and OG junction carcinoma had LVA. Staging laparoscopy in the 21 patients with LVA revealed that 11 (52 per cent) were inoperable. The remainder had laparotomy and complete (R0) resection was possible in only five (50 per cent). In 106 patients who had staging laparoscopy after EUS without LVA, 37 (34.9 per cent) were inoperable and 56 of the remaining 69 (81 per cent) had R0 resection. CONCLUSION: The presence of LVA on EUS is uncommon in patients with OG cancer but very important, being indicative of incurable disease in 76 per cent. This information will be helpful in counselling patients regarding management options and the low likelihood of potentially curative treatment.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The effect of warming local anaesthetics on pain of infiltration.

A short cut review was carried out to establish whether warming local anaesthetic solutions reduced the pain on injection. A total of 758 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are presented in table 4. The clinical bottom line is that warming local anaesthetics, either alone or in combination with buffering, significantly reduces pain of local infiltration.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Effect of warming local anaesthetics on pain of infiltration.

A short cut review was carried out to establish whether warming local anaesthetic solution reduced the pain of infiltration. A total of 720 papers were found using the reported searches, of which 11 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are presented in table 2. It is concluded that warmed local anaesthetic solution is less painful than that at room temperature.

Liver transplantation--patient selection and timing.

Liver transplantation has been successfully used in the treatment of a large number of liver diseases. The largest patient group comprises patients with end stage decompensated liver disease. Decompensation is defined as the presence of cirrhosis and one or more of the following: jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome or bleeding oesophageal varices. In general patients in this category should be considered for liver transplantation, if available. Guidelines for liver transplant assessment have been published by both the British Society of Gastroenterology and the American Association for the Study of Liver Disease. These guidelines provide a good basis for patient selection. As new information becomes available the indications for individual diseases may change somewhat. One of the most important changes in recent years was the introduction of the MELD/PELD scoring system. This is the model for end stage liver disease which provides a reasonably robust estimate of prognosis for individual patients. Prior to this patient waiting time on the transplant list was one of the principal determinants of priority for liver allocation. The MELD scoring system has been widely adopted with the aim of allocating the available livers to patients in the greatest clinical need.

Serum fructosamine as a marker of 5-year risk of developing diabetes mellitus in patients exhibiting stress hyperglycaemia.

AIMS: We examined whether the level of random serum glucose (RSG) in subjects exhibiting stress hyperglycaemia is a useful marker of the future risk of developing diabetes mellitus (DM), and whether serum fructosamine is of any additional value. METHODS: All non-diabetic adults attending Accident and Emergency in 1994-1995, who had venesection, were studied. Serum fructosamine and RSG were routinely measured in all such patients. Using the laboratory biochemistry database the number of subjects with stress hyperglycaemia (RSG > 11.1 mmol/l) was determined, and their corresponding fructosamine values were recorded. The number of subjects who developed DM over the following 5 years was determined. RESULTS: Three hundred and seventeen patients had stress hyperglycaemia, and follow-up data were available on 224 patients. Of these patients, 63 (28%) had developed DM over the 5 years follow-up period. RSG and fructosamine levels at baseline of patients subsequently developing DM were (mean +/- sd (range)) 16.7 +/- 7.0 (11.2-55.0) mmol/l and 3.3 +/- 0.6 (1.3-4.5) mmol/l, respectively. The patients who did not develop DM had a similar baseline RSG, 15.9 +/- 3.3 (11.2-30.6) mmol/l; P = 0.170, but lower baseline fructosamine, 2.4 +/- 0.4 (1.6-3.8) mmol/l; P < 0.001. Receiver-operating characteristics showed that a serum fructosamine > or = 2.8 mmol/l was a useful marker of the future risk of DM (75% sensitivity, 74% specificity, 53% positive and 88% negative predictive power). CONCLUSIONS: The level of RSG in stress hyperglycaemia does not predict the future development of DM. Raised serum fructosamine is a more useful marker of future DM risk than RSG alone. Further prospective studies are needed.

Calcified pleuropericardic cysts--2 cases report.

Pleuropericardic cysts represent 5 to 7 per cent of tumours of the mediastinum. Their origin is a defect in development of pericardic coelomic cavities. They are located in the right and cardio-phrenic corner in 70 per cent of cases. They are generally asymptomatic. They are best treated by a thin needle puncture under scanography. Surgery is needed only when the cyst wall is thick. We have treated surgically 2 cases of large cysts, because of their sizes (10 cm and 13 cm of diametres respectively), and, mostly, because of their calcification. Symptomatology was dominated by respiratory signs, such as dyspnea. In one case, there were manifestations of inferior vena cava compression. Diagnosis was done by roentgenography of the thorax. The surgical procedure, using right thoracotomy, revealed a calcified cyst in both cases, with a tough wall, which was resected. In one case, the removal of adhesion to the inferior vena cava injured this vessel which was sutured after partial clamping. Hemorrhage was severe and 2.51 blood transfusion was necessary. The post operative course was uneventful. Clinical signs of compression disappeared in both cases.

Human immunodeficiency virus infection presenting as pancytopenia in an infant.

CASE REPORT: A 14-month-old infant presented with pancytopenia and Mycobacterium avium intracellularae (MAI) as the initial manifestation of acquired immunodeficiency syndrome (AIDS). CONCLUSION: Human immunodeficiency virus (HIV-1) infections should be considered in the differential diagnosis of infants and children with cytopenias.