Assessment of Trachyspermum ammi essential oil against Aspergillus flavus, aflatoxin B1 contamination, and post-harvest quality of Sorghum bicolor

The present investigation explored the antifungal effectiveness of Trachyspermum ammi essential oil (TAEO) against Aspergillus flavus, aflatoxin B1 (AFB1) contamination, and its mechanism of action using biochemical and computational approaches. The GC-MS result revealed the chemical diversity of TAEO with the highest percentage of γ-terpinene (39 %). The TAEO exhibited minimum inhibitory concentration against A. flavus growth (0.5 µL/mL) and AFB1 (0.4 µL/mL) with radical scavenging activity (IC50 = 2.13 µL/mL). The mechanism of action of TAEO was associated with the alteration in plasma membrane functioning, antioxidative defense, and carbon source catabolism. The molecular dynamic result shows the multi-regime binding of γ-terpinene with the target proteins (Nor1, Omt1, and Vbs) of AFB1 biosynthesis. Furthermore, TAEO exhibited remarkable in-situ protection of Sorghum bicolor seed samples against A. flavus and AFB1 contamination and protected the nutritional deterioration. Hence, the study recommends TAEO as a natural antifungal agent for food protection against A. flavus mediated biodeterioration.

Impact and torsional behavior of additive layer-manufactured biopolymer: An advancement for orthopedic applications

Distal ulna locking bone plates (DLBPs) are commonly employed in the treatment of distal ulna fractures. However, commercially available metallic bone plates experience stress shielding and lack corrosion resistance. Poly lactic acid (PLA) is highly favored biopolymer due to its biocompatible and bioabsorbable nature with human tissues. The use of additive layer manufacturing (ALM) is gaining attention for creating customized implants with intricate structures tailored to patient autonomy. ALM-based PLA bone plates must provide high resistance against impact and torsional forces, necessitating the adjustment of printing process parameters. This study focuses on examining the influence of key printing parameters, on the impact strength and torque-withstanding capability of DLBPs. Experimental results, along with microscopic images, reveal that an increase in infill density (IF) and wall thickness imparts strong resistance to layers against crack propagation under impact and torsional loads. On the contrary, an increase in layer height and printing speed leads to delamination and early fracture of layers during impact and torsional testing. IF significantly contributes to improving the impact strength and torque-withstanding capability of DLBPs by 70.53% and 80.65%, respectively. The study highlights the potential of the ALM technique in developing DLBPs with sufficient mechanical strength for biomedical applications.

Experimental investigation on punch shear strength of poly lactic acid specimens for biomedical applications

The designed biomedical implants require excellent shear strength primarily for mechanical stability against forces in human body. However, metallic implants undergo stress shielding with release of toxic ions in the body. Thus, Fused Deposition Modeling (FDM) has made significant progress in the biomedical field through the production of customized implants. The mechanical behavior is highly dependent on printing parameters, however, the effect of these parameters on punch shear strength of ASTM D732-02 standard specimens has not been explored. Thus, in the current study, the effect of infill density (IFD), printing speed (PTS), wall thickness (WLT), and layer thickness (LYT) has been investigated on the punch shear strength using Response Surface Methodology. The Analysis of Variance (ANOVA) has been performed for predicting statistical model with 95% confidence interval. During the statistical analysis, the terms with p-value lower than 0.05 were considered significant and the influence of process parameters has been examined using microscopic images. The surface plots have been used for discussing the effect of interactions between printing parameters. The statistical results revealed IFD as the most significant contributing factor, followed by PTS, LYT, and WLT. The study concluded by optimization of printing parameters for obtaining the highest punch shear strength.

'Substantial clinical benefit' and 'substantial clinical worsening' cut-off of Vitiligo Impact Scale (VIS)-22 change scores

Patient-centric outcome measures focus on clinically meaningful change in various aspects of disease, including severity, quality-of-life, and psychological distress. The minimal important change (MIC) is a commonly used threshold of patient-reported outcome measures, representing the smallest difference that is considered significant by the patient and/or physician. However, it has been suggested that MIC is too low a bar for determining treatment success, and alternative thresholds such as substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) may be preferred.

Upfront boost to gross disease followed by elective pelvic radiation improves compliance to radiation therapy delivery metrics in locally advanced vulvar cancer

Locally advanced cancer of the vulva (LACV) is commonly diagnosed in older women (>65 years), and is treated using combined multimodality therapy (CMT) that includes radiation therapy (RT). Compliance to optimal RT metrics, including completion of > 20 fractions, overall treatment duration of < 8 weeks (56 days), and < 1 week intra-treatment break is associated with better disease outcomes. However, published results note that a significant number of patients with LACV do not adhere to these metrics. The aim of our study is to evaluate whether a modified sequence of RT delivery, treating the localized boost volume upfront followed by the larger elective nodal volume is associated with improved compliance to optimal RT delivery metrics.

Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma

Purpose

For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy.

Methods and Materials

We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival.

Results

The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention.

Conclusions

Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.

Experimental investigation of ultrasonic assisted coating on three-point bending behavior of 3D printed polymeric bone plates for biomedical applications

3D printed Poly Lactic Acid (PLA) bone plates exhibit limited three-point bending strength, restricting their viability in biomedical applications. The application of polydopamine (PDM) enhances the three-point bending strength by undergoing covalent interactions with PLA molecular structure. However, the heavy nature of PDM particles leads to settling at the container base at higher coating solution concentrations. This study investigates the impact of ultrasonic-assisted coating parameters on the three-point bending strength. Utilizing Response Surface Methodology (RSM) for statistical modeling, the study examines the influence of ultrasonic vibration power (UP), coating solution concentration (CC), and submersion time (TIME). RSM optimization recommended 100 % UP, 6 mg/ml CC, and 150 min TIME, resulting in maximum three-point bending strength of 83.295 MPa. Microscopic images from the comparative analysis revealed non-uniform coating deposition with mean thickness of 6.153 µm under normal coating. In contrast, ultrasonic-assisted coating promoted uniform deposition with mean thickness of 18.05 µm. The results demonstrate that ultrasonic-assisted coating induces PDM particle collision, preventing settling at the container base, and enhances three-point bending strength by 7.27 % to 23.24 % compared to the normal coating condition. This study emphasizes on the potential of ultrasonic-assisted coating to overcome the limitations of direct immersion coating technique.

Risk-Tailoring Radiotherapy for Endometrial Cancer: A Narrative Review

Endometrial cancer is the most common gynecologic cancer in the United States and it contributes to the second most gynecologic cancer-related deaths. With upfront surgery, the specific characteristics of both the patient and tumor allow for risk-tailored treatment algorithms including adjuvant radiotherapy and systemic therapy. In this narrative review, we discuss the current radiation treatment paradigm for endometrial cancer with an emphasis on various radiotherapy modalities, techniques, and dosing regimens. We then elaborate on how to tailor radiotherapy treatment courses in combination with other cancer-directed treatments, including chemotherapy and immunotherapy. In conclusion, this review summarizes ongoing research that aims to further individualize radiotherapy regimens for individuals in an attempt to improve patient outcomes.

Clinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort study

Background Paradoxical flare of pemphigus following rituximab infusion has been reported previously, however, its incidence or risk factors have not been studied in detail. Objectives To evaluate the clinical and immunological predictors associated with post-rituximab paradoxical pemphigus flare. Materials and Methods This was a prospective cohort study including adult patients with pemphigus vulgaris or foliaceus who were treated with rituximab. Patients were administered 1000 mg of intravenous rituximab on days 0 and 14 (Rheumatoid arthritis (RA) protocol), with or without oral prednisolone and/or conventional immunosuppressive agents. Baseline clinical and immunological predictors of post-rituximab pemphigus flares were assessed. Results Fifty patients (mean age 40.44 ± 12.36 years) with a mean pemphigus disease area index (PDAI) score of 27.8 ± 15.48 were administered rituximab. Post-rituximab flare occurred in 10 (20%) patients after a mean of 14.1 ± 4.33 days after the first rituximab infusion. The mean baseline PDAI score (36.4 ± 11.7 vs. 25.6 ± 15.7, P = 0.02) and serum anti-Dsg1 levels (1216.8 ± 850.1 vs. 592 ± 562.12 RU/mL, P = 0.03) were statistically significantly higher in patients experiencing a flare. Using ROC-curve analysis, a PDAI score of 328 (OR 8.3, 95% CI 1.5-44.7) was 80% sensitive and 67.5% specific in predicting post-rituximab flare, while serum anti-Dsg1 level of 31137.78 RU/ml had a sensitivity of 60% and specificity of 85%. There was no significant difference in terms of affected body surface area, type of pemphigus, starting prednisolone dose, oral immunosuppressive adjuvant, serum anti-Dsg3, serum anti-AchRM3, and peripheral CD19+ B cell population. Limitations Our study is limited by a relatively small sample size. Immunological factors were not evaluated at the time of pemphigus flare. Though these unexpected pemphigus flares are likely to be associated with rituximab infusion, the possibility of spontaneous disease exacerbation cannot be entirely excluded. Conclusions Patients with more severe pemphigus or high serum anti-Dsg1 are at risk of post-rituximab paradoxical flare, and may benefit from rituximab administration under close monitoring.

Chronic sexually acquired reactive arthritis secondary to Chlamydiatrachomatis

Reactive arthritis is included in the spectrum of seronegative spondyloarthritides, occurring secondary to triggers of genitourinary and gastrointestinal tract infections. We describe two cases of sexually acquired reactive arthritis secondary to genital infection by Chlamydia trachomatis, diagnosed by in-house polymerase chain reaction performed on the first void urine. Both patients were managed with a combined approach of short course antibiotics, immunosuppressive agents, biologicals and surgical intervention.

Diversity in morpho-pomological attributes and biochemical profiling of bael (Aegle marmelos (L.) Correa) genotypes of North-Western India

Bael is a medicinal cum fruit tree with multipurpose utility and propagated mostly through seeds. The present study aimed to assess and analyse the morpho-pomological and biochemical traits of eighty seedlings grown bael genotypes comparison with two commercial cultivars (NB-5 and NB-9) of bael. The significant differences were detected among the genotypes based on the measured morpho-pomological and biochemical traits. The morpho-pomological and biochemical traits of bael exhibited variation ranging from 6.17% to 133.65%. Trunk girth ranged from 29.50 to 63.40 cm and tree spread (N-S) varied 1.00-6.30 m. Fruit length ranged from 4.60 to 12.05 cm and fruit width ranged from 4.64 to 11.72 cm. Moreover, fruit weight ranged from 56.33 to 917.65 g and pulp percentage varied from 58.64 to 81.38%. Soluble Solid Content ranged from 25.90 to 36.77 0brix and ascorbic acid varied from 14.38 to 25.45 mg/100 g. Fruit length was positively correlated with fruit width, fruit weight, pulp percentage, seed length, seed diameter and number of seeds per fruit, while it was negatively correlated with fruit surface and total number of fruit per plant. Principal component analysis showed that 76.66% of the variability observed was explained by the 13 components. Ward cluster analysis using Euclidean distance classified the genotypes into two main clusters. These findings contribute to a better understanding of the diversity and relationships among the studied genotypes, aiding future breeding and selection programs for improved bael cultivation.

Response surface methodology and machine learning based tensile strength prediction in ultrasonic assisted coating of poly lactic acid bone plates manufactured using fused deposition modeling

Poly Lactic Acid (PLA) based bone plates fabricated using Fused Deposition Modeling have poor mechanical strength which can be improved by biocompatible polydopamine (PDM) coating. However, PDM particles, being heavy in nature, settle at the container bottom with increase in coating solution concentration at the time of bone plate coating using dip coating technique. Thus, the present work aims to witness the effect of ultrasonic assisted coating parameters on tensile strength of coated bone plates. The coating parameters involving power of ultrasonic vibrations, coating solution concentration and immersion time were varied. The standard Response Surface Methodology (RSM) was applied and experimental trials were performed for obtaining tensile strength of bone plates under varied coating parameters. The objective of the present study was to compare the values of tensile strength predicted using RSM and machine learning (ML) models. Based on the obtained experimental values, gradient boosting regression (GBReg), linear regression (LReg) and random forest regression (RFReg) were trained and tested for predicting tensile strength of bone plates. The accuracy and prediction errors corresponding to RSM and ML based models were compared with respect to R2, Mean Squared Error (MSE), Mean Absolute Error (MAE) and Root Mean Squared Error (RMSE). The findings revealed that GBReg exhibited R2, MSE, RMSE and MAE values as 0.9312, 1.7142, 1.2877 and 1.0861 respectively, while RSM showed R2, MSE, RMSE and MAE values as 0.882, 2.13, 1.4595 and 1.258 respectively. RSM model has shown minimum accuracy with high prediction errors amongst the four models. GBReg has outperformed other ML models in terms of their accuracy and error metrics. The present study therefore suggests the application of GBReg based ML model for predicting tensile strength of PDM coated bone plates in response to its accurate and robust prediction performance.

Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic

The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.

A Novel Method for Prediction of Raised Intracranial Pressure Through Automated ONSD and ETD Ratio Measurement From Ocular Ultrasound

The paper presents a novel framework for the prediction of the raised Intracranial Pressure (ICP) from ocular ultrasound images of traumatic patients through automated measurement of Optic Nerve Sheath Diameter (ONSD) and Eyeball Transverse Diameter (ETD). The measurement of ONSD using an ocular ultrasound scan is non-invasive and correlates with the raised ICP. However, the existing studies suggested that the ONSD value alone is insufficient to indicate the ICP condition. Since the ONSD and ETD values may vary among patients belonging to different ethnicity/origins, there is a need for developing an independent global biomarker for predicting raised ICP condition. The proposed work develops an automated framework for the prediction of raised ICP by developing algorithms for the automated measurement of ONSD and ETD values. It is established that the ONSD and ETD ratio (OER) is a potential biomarker for ICP prediction independent of ethnicity and origin. The OER threshold value is determined by performing statistical analysis on the data of 57 trauma patients obtained from the AIIMS, New Delhi. The automated OER is computed and compared with the conventionally measured ICP by determining suitable correlation coefficients. It is found that there is a significant correlation of OER with ICP (r = .81, p ≤ .01), whereas the correlation of ONSD alone with ICP is relatively less (r = .69, p = .004). These correlation values indicate that OER is a better parameter for the prediction of ICP. Further, the threshold value of OER is found to be 0.21 for predicting raised ICP conditions in this study. Scatter plot and Heat map analysis of OER and corresponding ICP reveal that patients with OER ≥ 0.21, have ICP in the range of 17 to 35 mm Hg. In the data available for this research work, OER ranges from 0.17 to 0.35.

Essential oils as green promising alternatives to chemical preservatives for agri-food products: New insight into molecular mechanism, toxicity assessment, and safety profile

Microbial food spoilage caused by food-borne bacteria, molds, and associated toxic chemicals significantly alters the nutritional quality of food products and makes them unpalatable to the consumer. In view of potential adverse effects (resistance development, residual toxicity, and negative effects on consumer health) of some of the currently used preservative agents and consumer preferences towards safe, minimally processed, and chemical-free products, food industries are looking for natural alternatives to the chemical preservatives. In this context, essential oils (EOs) showed broad-range antimicrobial effectiveness, low toxicity, and diverse mechanisms of action, and could be considered promising natural plant-based antimicrobials. The existing technical barriers related to the screening of plants, extraction methods, characterization, dose optimization, and unpredicted mechanism of toxicity in the food system, could be overcome using recent scientific and technological advancements, especially bioinformatics, nanotechnology, and mathematical approaches. The review focused on the potential antimicrobial efficacy of EOs against food-borne microbes and the role of recent scientific technology and social networking platform in addressing the major obstacles with EOs-based antimicrobial agents. In addition, a detailed mechanistic understanding of the antimicrobial efficacy of EOs, safety profile, and risk assessment using bioinformatics approaches are summarized to explore their potential application as food preservatives.

Dose and fractionation regimen for brachytherapy boost in cervical cancer in the US

PURPOSE

Curative-intent radiotherapy for locally advanced and select early stage cervical cancer in the US includes external beam radiotherapy (EBRT) with brachytherapy. Although there are guidelines for brachytherapy dose and fractionation regimens, there are limited data on practice patterns. This study aims to evaluate the contemporary utilization of cervical cancer brachytherapy in the US and its association with patient demographics and facility characteristics.

METHODS

We retrospectively analyzed clinical covariates of cervical cancer patients diagnosed and treated in 2018-2020 with curative-intent radiotherapy from the 2020 National Cancer Database. Associations between patient and institutional factors with the number of brachytherapy fractions were identified with logistic regression. Factors with association (p < 0.10) were then included in a multivariable logistic regression model. All tests were two-sided with significance <0.05 unless specified otherwise.

RESULTS

Among the eligible 2517 patients, 97.3% received HDR or LDR and is further analyzed. More patients received HDR than LDR brachytherapy (98.9% vs 1.1%) and intracavitary than interstitial brachytherapy (86.4% vs 13.6%). The most common number of HDR fractions prescribed were 5 (51.0%), 4 (32.9%), and 3 (8.6%). After adjusting for the other variables in the model, ethnicity, private insurance status, overall insurance status, and facility type were the only factors that were significantly associated with the number of brachytherapy factions (p < 0.0001, p = 0.028, p = 0.001, and p < 0.0001, respectively, n = 2184).

CONCLUSIONS

In the US, various HDR brachytherapy regimens are utilized depending on patient and institutional factors. Future research may optimize cervical cancer brachytherapy by correlating specific dose and fractionation regimens with patient outcomes.

Enrichment of Native and Recombinant Extracellular Vesicles of Mycobacteria

Most bacteria, including mycobacteria, generate extracellular vesicles (EVs). Since bacterial EVs (bEVs) contain a subset of cellular components, including metabolites, lipids, proteins, and nucleic acids, several groups have evaluated either the native or recombinant versions of bEVs for their protective potency as subunit vaccine candidates. Unlike native EVs, recombinant EVs are molecularly engineered to contain one or more immunogens of interest. Over the last decade, different groups have explored diverse approaches for generating recombinant bEVs. However, here, we report the design, construction, and enrichment of recombinant mycobacterial EVs (mEVs) in mycobacteria. Towards that, we use Mycobacterium smegmatis (Msm), an avirulent soil mycobacterium as the model system. We first describe the generation and enrichment of native EVs of Msm. Then, we describe the design and construction of recombinant mEVs that contain either mCherry, a red fluorescent reporter protein, or EsxA (Esat-6), a prominent immunogen of Mycobacterium tuberculosis. We achieve this by separately fusing mCherry and EsxA N-termini with the C-terminus of a small Msm protein Cfp-29. Cfp-29 is one of the few abundantly present proteins of MsmEVs. The protocol to generate and enrich recombinant mEVs from Msm remains identical to the generation and enrichment of native EVs of Msm.

WATCHMEN: a case report highlighting the closure of a bilobed left atrial appendage using two WATCHMAN-FLX devices

Background

Left atrial appendage occlusion (LAAO) performed percutaneously has emerged as a widely accepted method for stroke prevention, offering a viable alternative to anticoagulation. Numerous studies have demonstrated the effectiveness and safety of this procedure. However, in certain cases, the use of a single LAAO device may not adequately achieve optimal closure due to variations in the anatomy of the left atrial appendage (LAA).

Case summary

In this manuscript, we highlight the successful closure of a bilobed LAA with a large ostium utilizing two WATCHMAN™ FLX devices and using the double sheath technique. The aim was to achieve optimal closure and address the unique anatomical characteristics of the patient's LAA.

Discussion

The utilization of two LAAO devices in bilobed appendage anatomy, where a single device may not be sufficient, is possible, although it poses a challenge because of the lack of technical expertise and limited published evidence. Transoesophageal imaging can serve as a valuable tool for assessing the precise anatomy of the LAA and guide the selection and placement of the occlusion devices.

3D printing for spine pathologies: a state-of-the-art review

Three-Dimensional Printing has advanced throughout the years in the field of biomedical science with applications, especially in spine surgeries. 3D printing has the ability of fabricating highly complex structures with ease and high dimensional accuracy. The complexity of the spine's architecture and the inherent dangers of spinal surgery bring the evaluation of 3D printed models into consideration. This article summarizes the benefits of 3D printing based models for application in spine pathology. 3D printing technique is extensively used for fabrication of anatomical models, surgical guides and patient specific implants (PSI). The 3D printing based anatomical models assist in preoperative planning and training of students. Furthermore, 3D printed models can be used for improved communication and understanding of patients about the spinal disorders. The use of 3D printed surgical guides help in the stabilization of the spine during surgery, improving post procedural outcomes. Improved surgical results can be achieved by using PSIs that are tailored for patient specific needs. Finally, this review discusses the limitations and potential future scope of 3D printing in spine pathologies. 3D printing is still in its infancy, and further research would provide better understanding of the technology's true potential in spinal procedures.