The endothelial transcription factor ERG mediates Angiopoietin-1-dependent control of Notch signalling and vascular stability.

Notch and Angiopoietin-1 (Ang1)/Tie2 pathways are crucial for vascular maturation and stability. Here we identify the transcription factor ERG as a key regulator of endothelial Notch signalling. We show that ERG controls the balance between Notch ligands by driving Delta-like ligand 4 (Dll4) while repressing Jagged1 (Jag1) expression. In vivo, this regulation occurs selectively in the maturing plexus of the mouse developing retina, where Ang1/Tie2 signalling is active. We find that ERG mediates Ang1-dependent regulation of Notch ligands and is required for the stabilizing effects of Ang1 in vivo. We show that Ang1 induces ERG phosphorylation in a phosphoinositide 3-kinase (PI3K)/Akt-dependent manner, resulting in ERG enrichment at Dll4 promoter and multiple enhancers. Finally, we demonstrate that ERG directly interacts with Notch intracellular domain (NICD) and ß-catenin and is required for Ang1-dependent ß-catenin recruitment at the Dll4 locus. We propose that ERG coordinates Ang1, ß-catenin and Notch signalling to promote vascular stability.

Appendix as a biliary conduit for choledochal cysts in children.

Biliary conduits are constructed in operations for choledochal cysts. A wide variety of options are available for biliary tract reconstruction. We present our experience of treating six children with choledochal cysts by using the appendix as a biliary conduit. After mobilizing the appendix on its vascular pedicle, nonrefluxing, tunneled anastomosis was made with the 2nd part of the duodenum and the appendix. The operative procedure was simple and less time-consuming. Postoperative evaluation was done with the help of HIDA scan and ultrasound examination. Postoperative cholangitis was conspicuously absent in the two years of follow-up. One child has been lost to follow-up. From our preliminary experience, the operation seems simple and satisfying. Though the long-term efficacy still remains to be proven, the appendix should prove durable as a functional conduit.

Laparoscopic gastropexy in a neonate for acute gastric volvulus.

A 26-day-old male neonate presented with an acute gastric volvulus which was reduced with a nasogastric catheter. The patient was then subjected to laparoscopic anterior gastropexy. Six months after the procedure, the child is thriving and completely free of symptoms. We present this case as the first wherein a laparoscopic gastropexy has been done for gastric volvulus in a neonate. We have found the procedure acceptable for the treatment of neonates with gastric volvulus.

Clinical evaluation of irradiated, freeze-dried dura mater allograft as a collagen-based barrier in periodontal osseous defects.

The objective of this study was to clinically evaluate freeze-dried dura mater allograft (FDDMA) provided by the Tata Memorial Hospital Tissue Bank, in various periodontal osseous defects and to observe any unwanted healing pattern or adverse reaction.Eleven systemically healthy patients with one infrabony/furcation defect and at least 6 mm or more loss of attachment at selected sites, were scheduled for surgery. At base-line, patients had a good maintenance regime, minimal gingival inflammation and mobility not more than 1 mm in the buccolingual plane (grade 2). The measurements taken were probing pocket depth, clinical attachment level, intrasurgical level of bone and radiographic level of bone. Instead of surgical re-entry, transgingival probing was performed after 12 months of surgery. After debridement the defects were filled with demineralised freeze-dried bone allograft and covered with FDDMA barrier. The results after 12 months were satisfactory (mean gain of attachment 4.33 mm and mean defect fill 3.91 mm). No adverse reaction, infection or delayed wound healing was noted throughout the study.

Evaluation of Freeze-Dried Dura Mater Allograft as a Collagen Based Barrier (an experimental animal study).

Freeze-dried dura mater allograft (FDDMA) was evaluated as a cost-effective collagenous barrier using an experimental animal model to determine its biocompatibility and 'cell-occlusivity' potential. The FDDMA was processed at the Civil Hospital Ahmedabad, in accordance with the guidelines provided by the South-Eastern Organ Procurement Foundation, U.S.A. Fifteen Charles Foster rats were selected for a study period of 9 weeks. The 1st set graft procedure was performed in an abdominal pouch and after 1 week bilateral mandibular defects were created. One defect was covered by the FDDMA barrier (2nd set graft procedure) and the other defect served as the control. The post operative autopsy and morphological and histological assessments were carried out at 2 and 4 weeks for the 1st set graft, and 3, 6 and 9 weeks for the 2nd set graft procedure. There was acceptance of the 2nd set graft in a pre-exposed animal and no significant inflammatory response. The processed FDDMA demonstrated optimal 'cell-occlusivity' potential for guided bone regeneration to take place in Charles Foster rats.

Conformations of large cycloalkanes: cyclooctadecane, cyclononadecane and cycloicosane.

The conformations of cyclooctadecane, cyclononadecane, and cycloicosane were generated by a stochastic program that works in conjunction with MM2. The shapes of the rings are analyzed in terms of previous work by Dale and others, and in terms of distributions of energies, torsion angle distributions, and torsion angle sequences. A new shape element called the 'nick' has been discovered, and it seems to be increasingly important with 18-membered and larger rings. Previously suggested relationships between ring size and energy distribution were observed, and a geometrical explanation is provided for the relative distributions of stable conformations in 16-, 18-, and 20-membered rings.

Effect of sublingual isosorbide dinitrate in portal hypertension.

Nitrates decrease portal pressure by decreasing portal venous inflow and resistance. We studied over 20 minutes the effect of 10 mg isosorbide dinitrate sublingual on intrasplenic pulp pressure, mean arterial pressure and heart rate, in 13 patients with cirrhotic or non-cirrhotic portal hypertension. The pulp pressure fell progressively over 20 minutes, from mean 43.6 +/- 2.4 (SEM) to 35.6 +/- 1.8 cm H2O (p less than 0.001). This was accompanied initially by a significant fall in mean arterial pressure (85.8 +/- 1.9 to 80.4 +/- 2.7 mmHg at 4 minutes; p less than 0.01) and rise in heart rate (92.5 +/- 5.0 to 102.6 +/- 5.9 per minute at 6 minutes; p less than 0.02), following which these parameters remained stable. One patient developed giddiness due to hypotension at 15 minutes. We conclude that sublingual isosorbide dinitrate decreases pulp pressure in cirrhotic and non-cirrhotic portal hypertensives, but this is initially accompanied by significant hemodynamic changes.

Psychiatric factors in ulcerative colitis.

Controlled study on 20 patients of ulcerative colitis was conducted at Gastroenterology Department of Civil Hospital, Ahmedabad. It has been observed that in three fourth of the cases, age of onset is before 40 years; & male, female ratio 4:1. No significant trend emerged in marital status, type of family, birth order, dietary habit and parental profile. The disease is common in lower socio-economic status. Ulcerative colitis patients are particularly exposed to stressful life situations and more prone to develop illness.

Emotional factors in bronchial asthma.

Controlled study on 30 patients of bronchial asthma was conducted at General Medicine Dept. of Civil Hospital, Ahmedabad. It has been observed that parental loss or deprivation in childhood per se is a significantly important factor in asthmatics. Asthmatics are found to be reserved, detached, affected by feelings, emotionally less stable, mild, accommodating, shy, timid, tender-minded, dependent, tense and frustrated in comparison to the control cases.

Prevalence of psychiatric disorders in ahmedabad (an epidemiological study).

A psychiatric survey was carried out in an urban area of Ahmedabad which consisted mainly of middle class population. 461 families were surveyed which consisted of a total number of 2712 persons.The data was collected in a predetermined form. The index cases were individually evaluated in detail with the help of a structured Psychiatric proforma, case work and psychiatric examination by a consultant for psychiatric diagnosis. Out of the total of 2712 persons surveyed, 128 were found to be suffering from psychiatric disorders, the prevalance rate being 4.7% (47.2 per thousand).