Probabilistic classification of the severity classes of unhealthy air pollution events.

Air pollution events can be categorized as extreme or non-extreme on the basis of their magnitude of severity. High-risk extreme air pollution events will exert a disastrous effect on the environment. Therefore, public health and policy-making authorities must be able to determine the characteristics of these events. This study proposes a probabilistic machine learning technique for predicting the classification of extreme and non-extreme events on the basis of data features to address the above issue. The use of the naïve Bayes model in the prediction of air pollution classes is proposed to leverage its simplicity as well as high accuracy and efficiency. A case study was conducted on the air pollution index data of Klang, Malaysia, for the period of January 01, 1997, to August 31, 2020. The trained naïve Bayes model achieves high accuracy, sensitivity, and specificity on the training and test datasets. Therefore, the naïve Bayes model can be easily applied in air pollution analysis while providing a promising solution for the accurate and efficient prediction of extreme or non-extreme air pollution events. The findings of this study provide reliable information to public authorities for monitoring and managing sustainable air quality over time.

Computational Insights into Chromene/pyran Derivatives: Molecular Docking, ADMET Studies, DFT Calculations, and MD Simulations as Promising Candidates for Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative condition characterized by both motor and non-motor symptoms. Although PD is commonly associated with a decline of dopaminergic neurons in the substantia nigra, other diagnostic criteria and biomarkers also exist. In the search for novel therapeutic agents, chromene and pyran derivatives have shown potential due to their diverse pharmacological activities. This study utilizes a comprehensive computational approach to investigate the viability of chromene/pyran compounds as potential treatments for PD. The drug-likeness characteristics of these molecules were analyzed using ADMET (Absorption, Distribution, Metabolism, Excretion, and Toxicity) studies. Molecular docking was performed against PDB ID: 2V5Z. The best three molecules chosen were compound 7, compound 24, and compound 67 have a binding energy of -6.7, -8.6, and -10.9 kcal/mol. Molecules demonstrating positive blood-brain barrier permeability, good solubility, and favorable binding affinity were further evaluated using Density Functional Theory (DFT) calculations and Molecular Dynamics (MD) simulations to assess their electronic structure and stability. DFT calculations indicated that molecule 82 has a dipole moment of 15.70 D. RMSD and RMSF results confirmed the stability of the complexes over a 100 ns simulation, with a maximum of 3 hydrogen bonds formed.

Outcome of Scaphoid Nonunion Using Open Reduction and Internal Fixation With Iliac Crest Bone Graft (Fisk-Fernandez Technique).

Introduction The scaphoid is the most common carpal bone to be fractured and has a high propensity for nonunion. Restoration of scaphoid length mitigates the chances of long-term complications. The aim of this study was to assess the functional outcome of the Fisk-Fernandez technique for the treatment of scaphoid nonunion by using open reduction and internal fixation with trapezoidal iliac crest bone graft.  Materials and methods Fisk-Fernandez technique was used to manage scaphoid nonunion in 31 patients at a tertiary care hospital with follow-up at six weeks, 12 weeks, and 24 weeks. An objective assessment of the outcome was done using a comparison of the pre- and postoperative scaphoid score, QuickDASH, and visual analog score. Discussion The scaphoid is one of the most common carpal bones to get fractured. Anatomical factors, late presentation, and delay in diagnosis render it to usually land in nonunion. A comparison of the preoperative scaphoid, QuickDASH, and VAS scores with six-week, 12-week, and 24-week postoperative scores was made and was found to be statistically significant (p<0.001). Ninety-three percent of patients subjectively reported satisfaction after treatment. Though revascularization was not assessed, the bony union was observed in all the patients. Conclusion The operative technique proposed by Fisk-Fernandez is effective in correcting deformity of the scaphoid as well as providing satisfactory functional outcomes in patients with scaphoid nonunion.

TCF7L2 gene associated postprandial triglyceride dysmetabolism- a novel mechanism for diabetes risk among Asian Indians.

Aim: TCF7L2 gene is believed to increase the risk of T2DM by its effects on insulin secretion. However, the exact mechanism of this enhanced risk is not clearly known. While TCF7L2 gene has been shown to affect lipid metabolism, these effects have remained largely unexplored in the context of diabetes risk. Methods: Postprandial lipid responses to a standardized fat challenge test were performed in 620 Asian Indian subjects (310 with NGT and 310 with T2DM/prediabetes) and compared between the risk and wild genotypes of the rs7903146 TCF7L2 gene. In 30 subjects scheduled to undergo abdominal surgery (10 each with NGT, Prediabetes and T2DM), adipocyte TCF7L2 gene expression was also performed by real time qPCR and confirmed by protein expression in western blot. Results: T allele of rs7903146 TCF7L2 gene was confirmed as the risk allele for T2DM (OR=1.8(1.2-2.74), p=0.005). TT+CT genotypes of rs7903146 TCF7L2 gene showed significantly higher 4hrTg (p<0.01), TgAUC (p<0.01), peakTg (p<0.01) as well as higher postprandial plasma glucose (p=.006) levels and HOMA-IR (p=0.03) and significantly lower adiponectin levels (p=0.02) as compared to CC genotype. The expression of TCF7L2 gene in VAT was 11-fold higher in prediabetes group as compared to NGT (P<0.01) and 5.7-fold higher in T2DM group as compared to NGT group(P=0.003) and was significantly associated with PPTg and glucose levels. Conclusion: There is significant PPTg dysmetabolism associated with the risk allele of rs7903146 polymorphism as well as adipocyte expression of TCF7L2 gene. Significant upregulation of TCF7L2 gene expression in VAT that correlates with PPTg and glycaemia is also seen in Asian Indians with glucose intolerance. Modulation of PPTg metabolism by TCF7L2 gene and the resultant PPHTg may be a novel mechanism that contributes to its diabetes risk in them.

Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft Versus Hamstring Tendons Autograft: A Retrospective Analysis.

AIM:  The purpose of this retrospective study was to examine the clinical outcomes of anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using a free quadriceps (QUADRI) tendon or a quadrupled hamstring (HAM) autograft. MATERIAL AND METHOD: The retrospective analysis (Level III, Therapeutic Study) included consecutive patients who underwent ACL reconstruction between April 2017 and April 2020 using either a free quadriceps tendon autograft or a hamstring tendon autograft. All patients underwent ACL reconstruction to treat isolated ACL injuries. The Tegner-Lysholm knee scoring system and the modified Cincinnati knee score were used for evaluation before surgery, and at six weeks, six months, and one-year follow-up time. RESULTS:  In the present study, 35 people underwent quadriceps (QUADRI) grafts and 35 underwent hamstring (HAM) grafts. The demographic data for the groups were extremely comparable. The mean follow-up length for the HAM group was 11.96±0.28 months, while the QUADRI group had a mean follow-up period of 11.25±0.43 months. No significant variations in the Cincinnati score were observed between the two groups during any of the treatment's follow-up periods. Similarly, the Tegner Lysholm Score revealed no statistically significant differences between clinical outcomes in the HAM and QUADRI groups at all follow-up visits, except for the sixth week. CONCLUSION:  Clinical outcomes are comparable in terms of stability and subjective assessments following ACL reconstruction using a free quadriceps or hamstring tendon autograft.

Mixed POT-BM Approach for Modeling Unhealthy Air Pollution Events.

This article proposes a novel data selection technique called the mixed peak-over-threshold-block-maxima (POT-BM) approach for modeling unhealthy air pollution events. The POT technique is employed to obtain a group of blocks containing data points satisfying extreme-event criteria that are greater than a particular threshold u. The selected groups are defined as POT blocks. In parallel with that, a declustering technique is used to overcome the problem of dependency behaviors that occurs among adjacent POT blocks. Finally, the BM concept is integrated to determine the maximum data points for each POT block. Results show that the extreme data points determined by the mixed POT-BM approach satisfy the independent properties of extreme events, with satisfactory fitted model precision results. Overall, this study concludes that the mixed POT-BM approach provides a balanced tradeoff between bias and variance in the statistical modeling of extreme-value events. A case study was conducted by modeling an extreme event based on unhealthy air pollution events with a threshold u > 100 in Klang, Malaysia.

Use of thopaz in patients of empyema thoracis undergoing decortication.

INTRODUCTION: The management of empyema thoracis has evolved over the years. After all lung surgeries chest drain is required, however they suffer from inter observer variability and impair mobility of the patient. However, the newer digital thoracic drain system are portable and have alarms for various situations, furthermore they eliminate inter-observer variability. One such device is Thopaz™ (Medela inc, Switzerland). We wanted to compare efficacy of Thopaz™ with our conventional intercostal chest tube drain in patients undergoing decortications for empyema thoracis. MATERIALS AND METHODS: One hundred patients were enrolled in study and were randomized into conventional and thopaz group with 50 patients in each group with help of opaque envelopes. RESULTS: Both the groups were comparable in demographic parameters. Majority of the patients in our study were children and young adults. Majority of empyema thoracis involved right side with nontubercular empyema thoracis being the most common cause of decorticartion. Patients managed with Thopaz had a significantly shorter air leak duration, shorter duration of postdecortication chest tube placement and shorter postoperative hospital stay. All postoperative complications were less in Thopaz group. CONCLUSIONS: Patients with empyema thoracis undergoing open decortications when managed with digital chest drainage system (Thopaz) experienced faster reduction in air leak, a shorter duration of chest tube placement and in hospital stay. Thopaz usage is also associated with reduction in rate of postoperative complications. We recommend that this digital chest tube drainage system is a very useful tool in armamentarium of thoracic surgeon after lung surgeries.

Modeling the transition behaviors of PM10 pollution index.

Modeling and evaluating the behavior of particulate matter (PM10) is an important step in obtaining valuable information that can serve as a basis for environmental risk management, planning, and controlling the adverse effects of air pollution. This study proposes the use of a Markov chain model as an alternative approach for deriving relevant insights and understanding of PM10 data. Using first- and higher-order Markov chains, we analyzed daily PM10 index data for the city of Klang, Malaysia and found the Markov chain model to fit the PM10 data well. Based on the fitted model, we comprehensively describe the stochastic behaviors in the PM10 index based on the properties of the Markov chain, including its states classification, ergodic properties, long-term behaviors, and mean return times. Overall, this study concludes that the Markov chain model provides a good alternative technique for obtaining valuable information from different perspectives for the analysis of PM10 data.

Immunogenicity and lot-to-lot consistency of a ready to use liquid bovine-human reassortant pentavalent rotavirus vaccine (ROTASIIL - Liquid) in Indian infants.

BACKGROUND: A lyophilized bovine-human rotavirus reassortant pentavalent vaccine (BRV-PV, Rotasiil®) was licensed in 2016. A liquid formulation of this vaccine (LBRV-PV, Rotasiil - Liquid) was subsequently developed and was tested for non-inferiority to Rotasiil® and for lot-to-lot consistency. METHODS: This Phase II/III, open label, randomized study was conducted at seven sites across India from November 2017 to June 2018. Participants were randomized into four arms; Lots A, B, and C of LBRV-PV and Rotasiil® in 1:1:1:1 ratio. Three doses of study vaccines were given at 6, 10, and 14 weeks of age. Blood samples were collected four weeks after the third dose to assess rotavirus IgA antibody levels. Non-inferiority of LBRV-PV to Rotasiil was proven if the lower limit two-sided 95% confidence interval (CI) of geometric mean concentration (GMC) ratio was at least 0.5. Lot-to-lot consistency was proven if 95% CI of the GMC ratios of three lots were between 0.5 and 2. Solicited reactions were collected by using diary cards. RESULTS: Of the 1500 randomized infants, 1436 infants completed the study. The IgA GMC ratio of LBRV-PV to Rotasiil® was 1.19 (95% CI 0.96, 1.48). The corresponding IgA seropositivity rates were 60.41% (57.41, 63.35) and 52.75% (47.48, 57.97). The IgA GMC ratios among the three LBRV-PV lots were: Lot A versus Lot B: 1.34 (1.03, 1.75); Lot A versus Lot C: 1.22 (0.93, 1.60); and Lot B versus Lot C: 0.91 (0.69, 1.19). The 95% CIs for the GMC ratios were between 0.69 and 1.75. The incidence of solicited reactions was comparable across the four arms. Only one serious adverse event of gastroenteritis event in the Rotasiil® group was causally related. CONCLUSION: The immunological non-inferiority of LBRV-PV against Rotasiil® as well as lot-to-lot consistency of LBRV-PV was demonstrated. LBRV-PV had safety profile similar to Rotasiil®. TRIAL REGISTRATION NUMBER: Clinical Trials.Gov [NCT03474055] and Clinical Trial Registry of India [CTRI/2017/10/010104].

Clinical and Laboratory Profile of Dengue Fever in a North Indian Tertiary Hospital.

Objectives: The present study was done to ascertain the presentations of dengue fever in a North Indian tertiary care Hospital, and to compare the clinical and laboratory features among patients with and without warning signs in dengue fever. Methods: A total of 600 patients of dengue admitted to medical wards were included in the study. A detailed history as well as a general and systemic clinical examination were carried out. Haematological profiles and biochemical investigations were done at the time of admission and were followed daily or at times twice a day. Signs of plasma leakage were assessed by chest radiograph and abdominal ultrasonography, serum albumin etc. Patients were classified as dengue fever without warning signs and with warning signs and laboratory diagnosis of dengue was established by demonstration of NS1 antigen and specific antibodies to dengue in serum. Results: Of the 600 dengue positive patients, 421 (70.2%) were males and 179 (29.8%) were females. Mean age of the patients was 27.35±11.43 years. Among all patients of dengue, 21 (3.5%) presented with bleeding from any site. Out of these, only 7 of those presenting without warning signs had bleeding episodes whereas, 22 (34.3%) of patients presenting with warning signs had bleeding and this difference was statistically significant (p=0.01). Haematocrit was an important factor to predict severity of dengue. Whereas the mean haematocrit among all patients was 39.79±3.23%, it was 39.49±4.25% among those without warning signs and 42.22±3.54% among those with warning signs of dengue, and this was significant statistically, with a p-value of 0.002. Conclusion: Early diagnosis, monitoring and prompt supportive management can reduce mortality in dengue. In the present study, it was found that newer signs and symptoms are emerging and may cause delay in the diagnosis. It was found that the mortality rate was significantly higher in patients of dengue with warning sign.

Giant Primary Sinonasal Mucosal Melanoma: A Rare Malignancy.

It is extremely rare to find a case of primary sinonasal mucosal melanoma, which is more aggressive and have poorer outcome than its cutaneous counterpart. This tumour is refractory to the treatment which includes wide surgical excision with or without adjuvant postoperative radiotherapy. We are reporting a case of 60 year old female who presented with right sided nasal mass and facial deformity, in whom the diagnosis of mucosal melanoma was made on histopathological examination and confirmed by immunohistochemistry.

Glycaemic status in patients of acute myocardial infarction: A detailed analysis.

AIMS: Diabetes mellitus (DM) is considered to be one of the important risk factors for cardiac diseases. Frank diabetes is usually preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. The hypothesis that diabetic patients have greater risk and worse prognosis of Acute Myocardial Infarction (AMI) than pre-diabetics is controversial. Considering that India has been declared as a diabetic capital of the world, the study aimed to assess the load of pre diabetics, diabetics and non-diabetics landing in myocardial infarction. MATERIALS AND METHODS: The study consisted of through physiological and biochemical evaluation of 200 patients of newly diagnosed AMI and evaluating the load of non-diabetics, pre-diabetics and diabetics among them. RESULT: It was found that the total non-diabetic population (normoglycaemic and pre-diabetic) formed the bulk of AMI patient (69%) in our study. The degree of biochemical alterations seen among the three groups suggests that abnormal glucose homeostasis is not the sole determinant of the severity of AMI. The study data also suggests that glycaemic status, which poses a risk for AMI, differs in male and female individuals. Males even with normal glucose level are at increased risk to develop MI. CONCLUSION: The study concludes that both males and females with their blood glucose in pre-diabetic range are seen to be vulnerable to develop AMI. Thus all individuals irrespective of their glycaemic status around the age of forty should be screened and individuals with fasting sugar in pre-diabetic range should take extra precaution in terms of healthy diet, life style and regular check up.

Safety and efficacy of Qurse-e-istisqua in chronic hepatitis C infection: an exploratory study.

BACKGROUND: Qurse-e-istisqua (Q-e-I), an Unani medicine commonly prescribed to treat liver disorders. OBJECTIVES: To study efficacy and safety of Q-e-I in hepatitis C virus (HCV) infection. METHODS: In this randomized double-blind exploratory study, 60 naive patients of HCV infection were assigned to receive either interferonα2a (IFNα2a) (3 mIU, subcutaneous, thrice weekly), ribavirin (RBV) (1000 mg, orally, twice daily in divided doses) and placebo (n = 30) or IFNα2a, RBV and Q-e-I (5 g, orally, thrice daily in divided doses) (n = 30). HCV RNA levels, serum hyaluronic acid (SHA), ultrasound image scoring for fibrosis, liver and renal function test, prothrombin time, were done at the baseline and thereafter periodically. RESULTS: Early virologic response (EVR), end of treatment response (ETR) and sustained virologic response (SVR) were 90%, 96.6% and 90% in the control group and 86.6%, 90.0% and 83.3% in the treatment group. SHA level was lower in the treatment group at the end of the treatment as compared to the control group. Mean end of follow-up ultrasound image scoring for fibrosis in the control and the treatment group was 1.37 ± 0.07 and 1.22 ± 0.06 respectively. Aspartate aminotransferase (AST) levels were significantly lower in the treatment group than the control group at 1-month. Commonly observed adverse drug reactions included fever, hair fall, fatigue, anemia, and diarrhea. CONCLUSION: Q-e-I was well tolerated and showed anti-fibrotic activity. EVR, ETR and SVR suggested that Q-e-I do not have any anti-HCV activity. Early recovery in AST and inhibition of progress of fibrosis in Q-e-I group was probably due to the anti-inflammatory and antioxidant activity of its ingredients.

ECG changes in a case of attempted partial hanging.

This is a case of attempted partial hanging that behaved like a cerebrovascular accident. The serial electrocardiograms (ECGs) showed the characteristic ST and T-wave changes, QT prolongation and U waves later reverting to normal over a period of one month.

Type-2 diabetes mellitus and auditory brainstem response.

OBJECTIVE: Diabetes mellitus (DM) causes pathophysiological changes at multiple organ system. With evoked potential techniques, the brain stem auditory response represents a simple procedure to detect both acoustic nerve and central nervous system pathway damage. The objective was to find the evidence of central neuropathy in diabetes patients by analyzing brainstem audiometry electric response obtained by auditory evoked potentials, quantify the characteristic of auditory brain response in long standing diabetes and to study the utility of auditory evoked potential in detecting the type, site, and nature of lesions. DESIGN: A total of 25 Type-2 DM [13 (52%) males and 12 (48%) females] with duration of diabetes over 5 years and aged over 30 years. The brainstem evoked response audiometry (BERA) was performed by universal smart box manual version 2.0 at 70, 80, and 90 dB. The wave latency pattern and interpeak latencies were estimated. This was compared with 25 healthy controls (17 [68%] males and 8 [32%] females). RESULT: In Type-2 DM, BERA study revealed that wave-III representing superior olivary complex at 80 dB had wave latency of (3.99 ± 0.24) ms P < 0.001, at 90 dB (3.92 ± 0.28) ms P < 0.001 compared with control. The latency of wave III was delayed by 0.39, 0.42, and 0.42 ms at 70, 80, and 90 dB, respectively. The absolute latency of wave V representing inferior colliculus at 70 dB (6.05 ± 0.27) ms P < 0.001, at 80 dB (5.98 ± 0.27) P < 0.001, and at 90 dB (6.02 ± 0.30) ms P < 0.002 compared with control. The latency of wave-V was delayed by 0.48, 0.47, and 0.50 ms at 70, 80, and 90 dB, respectively. Interlatencies I-III at 70 dB (2.33 ± 0.22) ms P < 0.001, at 80 dB (2.39 ± 0.26) ms P < 0.001, while at 90 dB (2.47 ± 0.25) ms P < 0.001 when compared with control. Interlatencies I-V at 70 dB (4.45 ± 0.29) ms P < 0.001 at 80 dB (4.39 ± 0.34) ms P < 0.001, and at 90 dB (4.57 ± 0.31) ms P < 0.001 compared with control. Out of 25 Type-2 DM, 13 (52%) had diabetic neuropathy, of which 12 (92%) showed abnormal BERA. In nonneuropathic [12 (48%)] only 6 (50%) showed abnormal BERA. CONCLUSION: Delay in absolute latencies and interpeak latencies by BERA demonstrates defect at level of brainstem and midbrain in long standing Type-2 diabetes subjects, which is more pronounced in those with neuropathy.

Extract of Ferula foetida regel reverses gentamicin-induced nephrotoxicity in rats.

Natural products and dietary components have earlier been proven as potential chemoprotective agents, and continuous efforts are in progress to search for such new products. Gentamicin, an aminoglycoside antibiotic, is widely used for treating the infections caused by many gram negative bacteria. However, besides other unwanted effects, the drug causes tubular cell necrosis in the proximal convoluted tubules of nephrons. Unavailability of any remedial measures in the modern medicine for such ailments therefore makes it imperative to screen for natural products that are nephroprotective against such renal impairment. Here in the undertaken study, we have tested nephroprotective effects of Hing (Ferula foetida) extracts on gentamicin-treated rats. As expected, subcutaneous administration of rats with Gentamicin (100 mg/kg) showed significant increase in blood urea nitrogen (BUN), serum creatinine and thiobarbituric acid reacting substances (TBARS), as an indication of renal disorder. However, co-administration of methanol soluble and insoluble fractions of Ferula foetida (Hing), to the Gentamicin-treated rats almost showed a complete reversal of the above effects, indicating nephroprotective properties of the herbal drug. This may be an important addition to the list of studies where natural products have been discovered to be chemoprotective.

Type -2 diabetes mellitus and auditory brainstem responses-a hospital based study.

INTRODUCTION: Diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia. The metabolic dysregulation associated with DM causes secondary patho-physiological changes in multiple organ systems. The brainstem auditory electric responses represent a useful, non invasive and simple procedure to detect both acoustic nerve and CNS damage. MATERIAL #ENTITYSTARTX00026; METHODS: The study was carried out in the department of ENT, JNMC from 2008 -2010. The study included two groups, (i) diabetic group (n=25) (ii) Control group (n = 25). Diabetic group included patients attending Endocrinology OPD and ward. The equipment used for recording evoked response audiometry is IHS-BERA. Model number TH72312HT. Year of manufacture 2006. RESULTS: Mean age of control group was 45.7 years. In the study group 13 (52%) were males where as 12 (48%) were females. Mean age of study group was 46.8 years. There is no significant difference between age groups of controls and cases. Significant difference was found in latencies of wave III and interpeak III-V while highly significant difference was found in latencies of wave V and interpeak I-III, I-V between control and study group at 70 dB. Highly significant difference was found in latencies of wave III, V and interpeak I-III and I-V while significant difference was found in interwave III-V between control and study group at 80 dB. Significant difference was found in latencies of wave V and interpeak III-V while highly significant difference was found in wave III and interpeak I-III, I-V between control and study group at 90 dB. CONCLUSION: BERA is a simple, non-invasive procedure to detect early impairment of acoustic nerve, and CNS pathways, even in the absence of specific symptoms. This study suggests that if BERA is carried out in diabetic patients; involvement of central neuronal axis can be detected earlier.

Analysis of the SRY gene in two sex-reversed XY sisters identifies two new novel point mutations in the high mobility group box domain.

OBJECTIVE: To determine mutations in the SRY gene in two sisters with 46, XY karyotype. DESIGN: Case report. SETTING: Jamia Millia Islamia, New Delhi, and CSIRO Human Nutrition, Adelaide, Australia. PATIENT(S): Two sisters aged 23 and 27 years old with primary amenorrhea. INTERVENTION(S): Endocrine, mutations in the SRY gene, and DNA binding ability. MAIN OUTCOME MEASURE(S): LH, FSH, and testosterone levels, DNA sequence findings. RESULT(S): We found a new point mutation in the SRY gene in patient 1 at position +275 (A>T), which results in amino acid change (K92M). In patient 2, we found a double mutation in the SRY gene at two different loci. The first mutation is a substitution of C at +352, resulting in a change of amino acid (A118P), and second is deletion of T, resulting in a frame shift within a highly conserved DNA-binding motif-high mobility group box at +379 (T127IfsX179). Electrophoretic mobility shift assay showed that mutant K92M and A118P show reduced and greatly reduced binding ability, respectively. These mutations have the potential to interfere with protein-DNA binding activity and nuclear localization necessary for interactions of these proteins with DNA. CONCLUSION(S): Our results suggest involvement of the SRY gene in sex reversal, which supports the relationship between SRY alterations, gonadal dysgenesis, and/or primary infertility, and provides further evidence of a high-mobility group box significance in DNA-binding/-bending properties.