Growing Skull Fractures; Pathogenesis and Surgical Outcome.

BACKGROUND: We performed a retrospective study of 67 patients and their data for radiological investigations by serial Xrays, computed tomography, magnetic resonance imaging, uniform surgical procedure of craniotomy. The results were analyzed to determine the natural course of the disease, anatomical changes at various intervals following trauma, and outcome of surgical procedure in terms of cranial reconstruction, seizures, and progress in neurological deficit. RESULTS: Among 67 patients, 34 (50.74%) were male and 33 (49.26%) were female patients. About 86.67% of patients sustained the injury before the age of 3 years. Development of seizures in 28 patients (41.80%) is the most common symptom. In our study, 43.28% of patients (29 cases) had a combination of Type I and II of growing skull fracture. The dural defects confirmed in all cases were nearly twice (average 1.42) as large as the bone defects. All patients under the age of 3 years with diastatic skull fracture should be closely followed up and should be examined 2-3 months later to look for evidence of a growing skull fracture. Linear fractures and burst fractures in an infant with a scalp swelling must be corrected early to prevent a growing skull fracture. CONCLUSION: Early management can avoid difficult surgical dissection and progressive neurological sequelae seen with delayed intervention. Surgical correction results in the prevention of brain shift and increase in meningocerebral cicatrices. Meticulous surgery and vigilant postoperative care reduce the morbidity and mortality. In our opinion, the autologous material is the best choice because of its tissue compatibility, convenience, inexpensiveness, and rare rate of infection.

DNA triplex-mediated inhibition of MET leads to cell death and tumor regression in hepatoma.

Mesenchymal epithelial transition factor (MET) is one of the critical cell signaling molecules whose aberrant expression is reported in several human cancers. The aim of the study is to investigate the antigene and antiproliferative effect of short triplex forming oligonucleotides, TFO-1 (part of the positive regulatory element) and TFO-2 (away from the transcription start site) on MET expression. HepG2 cells transfected only with TFO-1 (but not with TFO-2 and non-specific TFO) significantly decreased MET levels, which is accompanied by decrease in antiapoptotic proteins and increase in pro-apoptotic proteins. Phosphoproteome-array analysis of 46 intracellular kinases revealed hypophosphorylation of about 15 kinases including ERK, AKT, Src and MEK, suggesting the growth inhibitory effect of TFO-1. Further, the efficacy of TFO-1 was tested on diethylnitrosamine-induced liver tumors in wistar rats. T2-weighted magnetic resonance imaging showed decrease in liver tumor volume up to 90% after treatment with TFO-1. Decreased MET expression and elevated apoptotic activity further indicate that TFO-1 targeted to c-met leads to cell death and tumor regression in hepatoma. Formation of stable DNA triplex between TFO-1 and targeted gene sequence was confirmed by circular dichroic spectroscopy and gel retardation assay. Therefore, it can be concluded that DNA triplex-based therapeutic approaches hold promise in the treatment of malignancies associated with MET overexpression.

p300 provides a corepressor function by cooperating with YY1 and HDAC3 to repress c-Myc.

We showed earlier that p300/CBP plays an important role in G1 progression by negatively regulating c-Myc and thereby preventing premature G1 exit. Here, we have studied the mechanism by which p300 represses c-Myc and show that in quiescent cells p300 cooperates with histone deacetylase 3 (HDAC3) to repress transcription. p300 and HDAC3 are recruited to the upstream YY1-binding site of the c-Myc promoter resulting in chromatin deacetylation and repression of c-Myc transcription. Consistent with this, ablation of p300, YY1 or HDAC3 expression results in chromatin acetylation and induction of c-Myc. These three proteins exist as a complex in vivo and form a multiprotein complex with the YY1-binding site in vitro. The C-terminal region of p300 is both necessary and sufficient for the repression of c-Myc. These and other results suggest that in quiescent cells the C-terminal region of p300 provides corepressor function and facilitates the recruitment of p300 and HDAC3 to the YY1-binding site and represses the c-Myc promoter. This corepressor function of p300 prevents the inappropriate induction of c-Myc and S phase.

Prices & availability of common medicines at six sites in India using a standard methodology.

BACKGROUND & OBJECTIVE: The price and availability of medicines are key components in determining access to effective treatment. Data on prices and availability of common medicines in public and private sector in different States of India are scarce. Hence, surveys were undertaken in different States of India to evaluate these metrics. METHODS: During October 2004 to January 2005, six surveys were undertaken simultaneously in five States of India to assess medicine prices and availability of essential medicines (n = 21-28) using the World Health Organization and Health Action International methodology. Surveys were conducted at Chennai, Haryana, Karnataka, West Bengal, and at two sites in Maharashtra. For each medicine, data were collected for the Innovator Brand (IB), Most Sold Generic (MSG), and Lowest Priced Generic (LPG) at randomly selected public and private facilities in each site surveyed. Prices were compared to an international reference benchmark (expressed as median price ratio - MPR). RESULTS: The procurement price of medicines in the public sector was 0.27 to 0.48 times the international reference price. However, these medicines were inadequately available and the median availability in the public sector ranged from 0 to 30 per cent. The median prices of medicines in the private sector were less than twice the IRP, although a few innovator brands were more expensive. No difference was observed between the prices of the most sold generic (MSG) and the lowest priced generic (LPG) available at the facilities. Interestingly, price variation was observed among different generic equivalents of ciprofloxacin in each region. The price of LPG diazepam in the private sector was thirty three times its procurement price in the public sector. INTERPRETATION & CONCLUSION: The survey revealed low procurement prices and poor availability in the public sector. Thus, the majority of the population purchased medicines from private pharmacies, where generics were usually available although prices of certain medicines were high. Various policy measures could increase the availability and accessibility of medicines for the population.

Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach.

OBJECTIVES: To explore the feasibility of applying a dorsal free graft to treat urethral stricture by the ventral sagittal urethrotomy approach without mobilizing the urethra. METHODS: Twelve patients with long or multiple strictures of the anterior urethra were treated by a dorsal free full-thickness preputial or buccal mucosa graft. The urethra was not separated from the corporal bodies and was opened in the midline over the stricture. The floor of the urethra was incised, and an elliptical raw area was created over the tunica on which a free full-thickness graft of preputial or buccal mucosa was secured. The urethra was retubularized in one stage. RESULTS: After a follow-up of 8 to 40 months, one recurrence developed and required dilation. CONCLUSIONS: The ventral sagittal urethrotomy approach for dorsal free graft urethroplasty is not only feasible and successful, but is easy to perform.

Spectral light quality affects protein profile of Synechococcus sp. PCC 7942: a comparative 2-dimensional gel electrophoresis (2-DGE) analysis.

We report here a comparative analysis of the effect of blue (450 nm), red (660 nm), and white light (400-700 nm) on the protein profile of cyanobacteria Synechococcus sp. PCC 7942. In vivo labeling of cells with [(35)S] methionine and their subsequent analysis by two-dimensional gel electrophoresis (2-DGE) showed that eight polypeptides were unique to dark adapted cells, ten were blue light specific, and four were specifically induced in red light. The results show that Synechococcus sp. respond to various light treatments rapidly and synthesize new polypeptides in dark and blue/red light.

UVB-induced photodamage to phycobilisomes of Synechococcus sp. PCC 7942.

The effect of UVB irradiation on the phycobilisomes (PBSs) of Synechococcus sp. PCC 7942 cells was studied. The sucrose density-gradient-isolated PBSs from in vivo UVB-treated (280-320 nm) cells showed a strong decrease in beta-phycocyanin (beta PC) and alpha-phycocyanin (alpha PC) polypeptides, in addition to a decrease in the linker polypeptides LCM 75 (linker connecting the core to the thylakoid membranes), LR 33 (linker in the rod structure), LRC 31.5 (linker connecting the rod to the core) and LRC 29. In vitro UVB treatment of gradient-isolated intact PBSs for 1 h had no effect on any of the constituent polypeptides, and only after 2 h was a degradation of LCM 75 and LR 33 and a decrease in beta PC evident. Further investigation of phycobiliproteins (4 h of UVB irradiation) using polyclonal antibody directed against purified whole PBSs revealed that, in vivo, there was a gradual decline in the levels of LCM 75, LR 33, LRC 31.5, LRC 29, beta PC and alpha PC.

Different sites of photodamage in chilling-sensitive (sorghum) and chilling-resistant (barley and wheat) plants.

The electron transport chain was affected to varying degrees by high light intensity at low temperature in different crop plants. The PS II was found to be the sensitive site while PS I showed very little change in its activity. Photoinhibition affected the oxidizing side of PS II in all three plants. However, the site of inhibition was different in chilling-sensitive and chilling-resistant plants. In sorghum, the water splitting reaction was damaged while in barley and wheat the damage occurred in the reaction centre itself. It appears that photoinhibition may affect different sites within the PS II in chilling-resistant and sensitive plants.

Changes in the Activities of Anti-Oxidant Enzymes during Exposure of Intact Wheat Leaves to Strong Visible Light at Different Temperatures in the Presence of Protein Synthesis Inhibitors.

Changes in activities of the enzymes involved in the metabolism of active oxygen species were followed in homogenates prepared from wheat leaves (Triticum aestivum L.) exposed to strong visible light (600 W m-2). The activities of superoxide dismutase (SOD), ascorbate peroxidase, and monodehydroascorbate reductase increased significantly on prolonged illumination of the leaves, indicating an increase in the rate of generation of active oxygen species. This increase was further exacerbated when high light stress was combined with low temperature (8[deg]C). Our results indicate that the increase in activities of SOD and ascorbate peroxidase involved de novo protein synthesis that was sensitive to the nuclear-directed protein synthesis inhibitor cycloheximide. The activity of catalase, on the other hand, decreased on exposure to strong light, which could be due to its photolability, particularly at lower temperatures. Ascorbate and total carotenoid contents also increased on light treatment of the leaves. The induction of the enzymes except for catalase and increase in the levels of ascorbate and total carotenoids in response to the stress conditions indicate that they play an important role in the protection of higher plants from the damaging effects of toxic active species.

Effect of water stress on primary photosynthetic process: interaction with light and temperature.

Effect of water stress alone and in combination with light and temperature on chlorophyll fluorescence and photosynthetic electron transport have been studied in drought-resistant wheat. It was observed that water stress alone-did not modify the amplitude of variable fluorescence in leaf but showed slight decrease in photosynthetic electron transport. However, interaction with light caused significant decrease in the efficiency of photosynthesis. This was greater when photoinhibited at 30 degrees C than at 10 degrees C. Results suggest that water stress alone does not lead to significant damage to the primary photochemistry but photoinhibition causes both inhibition of electron transport activity and chlorophyll fluorescence. The damage was further enhanced by the combination of water stress and high temperature.

Function of Photosynthetic Apparatus of Intact Wheat Leaves under High Light and Heat Stress and Its Relationship with Peroxidation of Thylakoid Lipids.

Effects of high light and temperature stress on the structure and function of the photosynthetic apparatus of wheat (Triticum aestivum) were studied. There was a decrease in the electron transport activity of chloroplasts isolated from photoinhibited and heat-stressed leaves. Chlorophyll fluorescence was measured in photoinhibited and heat-stressed leaves and the decrease in variable fluorescence and variable to maximum fluorescence ratio of the stressed leaves indicated a loss in the quantum yield of photosynthesis. The decrease in electron transport activity was accompanied by an increase in peroxidation of thylakoid lipids. Lipid peroxidation indicated the oxidative degradation of polyunsaturated fatty acyl residues of the thylakoid lipids. A negative correlation was observed between electron transport activity and lipid peroxidation. The electron transport activity was completely lost as the peroxidation level reached a threshold equivalent to 0.6 micromoles malondialdehyde. The threshold of lipid peroxidation for complete loss of activity was the same for both photoinhibition and heat treatment, suggesting that the nature of the environmental stress may be less important with respect to the relationship between electron transport and lipid peroxidation. Thus, it seems likely that lipids are required for sustaining the photosynthetic activity under environmental stress, and a loss in activity is observed as the lipids are degraded either by high light or high temperature stress.

Intestinal perforation in children.

There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris lumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation. Radiological evidence of pneumoperitoneum was seen in 88% of patients. The majority of cases in this study were older than 5 years of age (48%). Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro-organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes. The overall mortality rate was high (19%).

Fusion of phosphatidylcholine liposomes induced by polyethylene glycol.

Fusion of small unilamellar vesicles of L-alpha-phosphatidylcholihne (PC) was carried out in the presence of polyethylene glycol (PEG, Mr 6000-7500). The fusion of liposomes was detected by (i) monitoring the efficiency of energy transfer from chlorophyll b (Chl b) to chlorophyll a (Chl a), (ii) formation of fluorescent complex Tb (DPA)3(3-) between terbium chloride (TbCl3) and dipicolinic acid (DPA), (iii) light scattering at 520 nm and (iv) PMR spectroscopy. The changes in the proton magnetic resonance (PMR) signal intensities and increase in the linewidths of the fatty acyl chain methylenes and terminal methyl group in presence of PEG are discussed in relation to fusion.

Germ cell tumors in Indian children.

The present paper is a retrospective study of one hundred and thirty five germ cell tumors seen in children at the University Hospital, Varanasi during a period of 21 years. These tumors constituted 7.5% of all solid tumors in the pediatric age group. Histologically 89 tumors (65.9%) were benign and 46 (34.1%) were malignant. Eighty percent of ovarian and all the testicular germ cell tumors were malignant. Thirty per cent of the tumors were located in the sacrococcyx. The ovaries were the next common site. There were 80 girls, 53 boys, and 2 cases in which the sex was not recorded. The predominance amongst girls was mainly due to the more frequent involvement of ovaries as compared to the testes. Twenty nine of the children were in the first year of life. The factors probably responsible for the higher incidence of malignancy, the differences in anatomic location, and the sex distribution in comparison to other reports have been examined and discussed.

Urinary mucoprotein in pediatric urolithiasis.

Primary bladder stone is a common pediatric surgical problem in developing countries. Many theories are prevalent. The stone matrix theory is based on increased excretion of its precursor, the uromucoid (the urinary mucoprotein). Uromucoid, studied in urine and stones by the electroimmunodiffusion technique in 49 cases with controls, showed significantly increased excretion in stone cases. Family income and serum protein were the only important influencing factors (negative). Causal relationship between uromucoid excretion, stone matrix, and pediatric bladder stones is discussed. Methylene blue decreased uromucoid excretion but not magnesium oxide, vitamin C or B6 (four common therapeutic drugs for prevention/dissolution of urolithiasis).

Fluorescence polarization of trypsin digested photosystem II membranes.

Fluorescence polarization of photosystem II particles treated with trypsin and incubated with high salt-medium (2M NaCl) was investigated. The presence of atrazine and TMPD in normal and salt-washed particles induced a decrease in the polarization ratios. Similar results were obtained at low concentrations of trypsin. On the basis of our observations we suggest that the presence of these perturbing agents causes a reorganisation of the membrane components and alters pigment-pigment and pigment-protein interactions. The results of fluorescence polarization demonstrate trypsin entry into the membrane after the digestion of the peripheral proteins.

The diagnosis and management of accidental burns and allied conditions in ancient Indian surgery.

Surgery in ancient India was highly advanced, much more than in any other country at that time. Its proof is available in Susruta Samhita, one of the main treatises of Ayurveda, which is presented here.