Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern

Objective:

A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant.

Materials and Methods:

A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities.

Results:

Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant.

Discussion and Conclusion:

By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Colon capsule endoscopy

There are multiple indications for luminal imaging of the colon. From assessment of known disease, to diagnosing new pathology; intra-luminal visualisation is the mainstay of gastrointestinal diagnosis. Colonoscopy and radiological imaging are currently the most frequently deployed diagnostic methods. However, both have an associated risk profile, have significant resource pressures and are not universally tolerated. Colon capsule endoscopy (CCE) offers an adjunct to these diagnostic options. In this narrative review the utility of CCE is described. Its current uses, potential benefits and future developments are also discussed.

Possible glass-like random singlet magnetic state in 1T-TaS2

Two-dimensional layered transition-metal-dichalcogenide compound 1T-TaS₂ shows the rare coexistence of charge density wave (CDW) and electron correlation driven Mott transition. In addition, atomic-cluster spins on the triangular lattice of the CDW state of 1T-TaS₂ give rise to the possibility of the exotic spin-singlet state in which quantum fluctuations of spins are strong enough to prevent any long range magnetic ordering down to the temperature absolute zero (0 K). We present here the evidences of a glass-like random singlet magnetic state in 1T-TaS₂ at low temperatures through a study of temperature and time dependence of magnetization. Comparing the experimental results with a representative canonical spin-glass system Au(1.8%Mn), we show that this glass-like state is distinctly different from the well established canonical spin-glass state.

Integrated care for older people (ICOPE): from guidelines to demonstrating feasibility

The World Health Organization (WHO) Global strategy and action plan on ageing and health (1) provides a policy framework to align health systems to the diverse needs of older populations. It promotes person-centred care that strengthen older peoples’ intrinsic capacity (physical and mental capacity) and ability to function where they live, a shift away from specialized medical treatment for each disease or condition. With its endorsement in 2016, WHO Member States recognized a pressing need to develop integrated, community-based approaches to prevent declines in intrinsic capacity. To operationalize ‘intrinsic capacity (IC)’, domains closely associated with care dependency were proposed: mobility, cognition, psychological capacity (depressive symptoms), vitality (malnutrition), and sensory capacity (hearing and vision) (2).

Approach to dyspnoea in pregnancy in the COVID-19 era

IMPORTANCE

Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount.

OBJECTIVE

To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise.

DESIGN, SETTING AND PARTICIPANTS

Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic.

RESULTS

Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

An oxygen-rich atmosphere or systemic fluoxetine extend the time to respiratory arrest in a rat model of obstructive apnea

Audiogenic seizure-prone mice can be protected from seizure-associated death by exposure to an oxygen atmosphere or treatment with selective serotonergic reuptake inhibitors (SSRIs). We have shown previously in a rat model that epileptic seizure activity can spread through brainstem areas to cause sufficient laryngospasm for obstructive apnea and that the period of seizure-associated obstructive apnea can last long enough for respiratory arrest to occur. We hypothesized that both the oxygen-rich atmosphere and SSRIs function by prolonging the time to respiratory arrest, thus ensuring that seizure activity stops before the point of respiratory arrest to allow recovery of respiratory function. To test this hypothesis, we evaluated each preventative treatment in a rat model of controlled airway occlusion where the times to respiratory arrest can be measured. Adult male Sprague Dawley rats (median age = 66 days) were studied in the absence of any seizure activity. By directly studying responses to controlled airway occlusion, rather than airway occlusion secondary to seizure activity, we could isolate the effects of manipulations that might prolong respiratory arrest from the effects of those manipulations on seizure intensity. All group sizes were ≥ 8 animals per group. We found that both oxygen exposure and fluoxetine significantly increased the time to respiratory arrest by up to 65% (p < .0001 for 5 min oxygen exposure; p = .031 for 25 mg/kg fluoxetine tested 60 min after injection) and, given that neither treatment has been shown to significantly alter seizure duration, these increases can account for the protection of either manipulation against death in sudden death models. Importantly, we found that 30 s of exposure to oxygen produced nearly the same protection as 5 min exposure suggesting that oxygen exposure could start after a seizure starts (p = .0012 for 30 s oxygen exposure). Experiments with 50% oxygen/50% air mixtures indicate that the oxygen concentration needs to be above about 60% to ensure that times to respiratory arrest will always be longer than a period of seizure-induced airway occlusion. Selective serotonin reuptake inhibitors, while instructive with regard to mechanism, require impractical dosing and may carry additional risk in the form of greater challenges for resuscitation. We conclude that oxygen exposure or SSRI treatment prevent seizure associated death by sufficiently prolonging the time to respiratory arrest so that respiratory function can recover after the seizure abates and eliminates the stimulus for seizure-induced apnea.

A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum in Dental Caries

OBJECTIVE

To determine the difference in level of dental caries in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG or use alternatives such as lozenges, candies, rinses, tablets, and other nonchewing controls.

METHODS

Systematic review of published literature.

RESULTS

Twelve studies of interventions of SFG for dental caries outcomes were included. SFGs were found to significantly reduce caries increment, giving a preventative fraction (PF) of 28% (95% CI, 7% to 48%). Including the 8 trials that used xylitol gum only as the basis of the intervention, the PF was 33% (95% CI, 4% to 61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included.

CONCLUSION

The findings of this review provide tentative evidence that chewing SFG reduces caries increment in comparison to nonchewing controls. However, there is a considerable degree of variability in the effect and the trials included were generally of moderate quality. There is a need for future research to explore the acceptability and feasibility of the use of SFG as a public health intervention (PROSPERO 2018 CRD42018094676).

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians when deciding how best to implement dental caries prevention regimes for their patients. With consideration of cost and patient preference, this information could help to develop national policy directives on caries prevention and dictate the direction of future clinical research.

Characterization of beta-lactamase and biofilm producing Enterobacteriaceae isolated from organized and backyard farm ducks

This study was undertaken to detect the occurrence of beta-lactamase and biofilm producing Enterobacteriaceae in healthy ducks. A total 202 cloacal swabs were collected from ducks kept in organized (n = 92) and backyard (n = 110) farms in West Bengal (India). The ducks had no history of antibiotic intake. Among the 87 phenotypically beta-lactamase producing Escherichia coli, 19 (17·43%), 6 (5·05%) and 15 (13·76%) isolates possessed bla_TEM , bla_SHV and bla_CTX-M respectively. Whereas, 5 (38·46%) Salmonella isolates were found to harbour bla_CTX-M . In K. pneumoniae 10 (33·33%), 3 (13·33%), 4 (13·33%) isolates possessed bla_TEM , bla_SHV and bla_CTX-M respectively. The sequences of selected PCR products were found 98% cognate with bla_CTX-M-9, bla_SHV-12 and bla_TEM-1 . Beta-lactamase producing E. coli isolates belonged to 14 different serogroups such as O1, O2, O3, O5, O7, O8, O35, O83, O84, O88, O119, O128, O145 and O157. Moreover, 87 E. coli (79·82%), six Samonella (46·15%) and 13 K. pneumoniae (43·33%) isolates were detected as AmpC producers possessing bla_AmpC . Majority of E. coli (46·79%), Salmonella (46·15%) and K. pneumoniae (70%) isolates were detected as biofilm producers and possessed the associated genes (csgA, sdiA, rcsA, rpoS). Significantly higher occurrence of beta-lactamase and biofilm producing Enterobacteriaceae isolates was detected in backyard ducks than organized farms. SIGNIFICANCE AND IMPACT OF THE STUDY: Consumption of antibiotic through feed or during therapy is considered as potential reason for generation of antimicrobial resistant bacteria in birds. This study provides valuable evidence that exposure to contaminated environment may be an additional source for generation of antimicrobial resistant bacteria in backyard ducks. The backyard ducks are reared by marginal farmers in India who cannot offer antibiotics to them either through feed or during therapy due to high cost. The study also reveals a significant correlation between biofilm formation and possession of antimicrobial resistance genes in the bacterial isolates from the ducks.

P5705Machine learning for phenotyping and risk prediction in cardiovascular diseases: a systematic review

Introduction

Heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation (AF) are among the commonest cardiovascular diseases (CVD), frequently co-exist and share pathophysiology. Definitions of diagnosis and prognosis are suboptimal. Machine learning (ML) is increasingly used in subtype definition and risk prediction, but the design, methods and results of studies have not been appraised.

Purpose

To conduct a systematic review of ML for discovery of new subtypes and risk prediction in HF, ACS and AF.

Methods

PubMed, MEDLINE, and Web of Science databases were searched (January 2000-August 2018) for English language publications with agreed search terms pertaining to machine learning, clustering, CVD, subtype and risk prediction. The baseline characteristics of the study population, the method of ML, covariates and results were extracted for each study.

Results

Of 5012 identified studies, 43 met inclusion criteria. Of the 33 studies of unsupervised ML for disease clustering (mean n=2354; min 117, max 44886), there were 22 in HF, 9 in ACS and 2 in AF. 22/33 studies involved <1000 individuals and 24 were based in North America. Across diseases, 27 studies were in outpatients, and 5 used trial data. The mean number of covariates used was 26; most commonly demographic and symptom variables. The ML methods used were partitional (n=12), hierarchical (n=4), self-organising map (n=1) and hidden Markov model (n=1). Most studies used only one ML method (n=25). Only 15 studies validated or replicated findings. 20/33 studies found 2 or 3 disease clusters, Most studies found 2–3 clusters (20/33) and most clusters were based on physical or physiological characteristics (30/33).

Of the 10 studies of supervised ML for risk prediction (mean n=43003; min 228, max 378256), 4 were in HF, 5 in ACS and 1 in AF. 2/11 studies involved <1000 individuals and most were from North America (n=6). All studies had an observational design, used at least 2 ML methods and validated or replicated findings. The setting was varied: primary care (n=2), emergency department (n=2), inpatient (n=4) and mixed (n=2). The mean number of covariates was 102. The commonest ML methods were neural networks (n=5), random forest (n=4) and support vector machine (n=4). All studies showed positive finding, i.e. ML approaches improved risk prediction.

Conclusions

Studies to-date of ML in HF, ACS and AF have focused on North America (68.2%), and 50% included less than 1000 individuals. Moreover, there is heterogeneity in clinical setting, study designs for data collection and ML methods used. Comparison between methods of ML and validation are common to studies of risk prediction but not disease clustering. There is likely to be a publication bias of ML studies in HF, AF and ACS. ML may improve data-driven characterisation of CVD but consensus guidelines for reporting of research using ML are urgently needed to ensure the internal and external validity and applicability of study findings.

Acknowledgement/Funding

Innovative Medicines Initiative (European Union)

P4436Impaired myocardial healing in patients with diabetes after ST-Elevation Myocardial Infarction

Background

Diabetes mellitus (DM) significantly increases mortality following myocardial infarction (MI). The underlying mechanism explaining this adverse prognosis is not completely understood.

Purpose

This study sought to investigate the characteristics of myocardial healing after MI in DM patients.

Methods

62 recruited ST-elevation myocardial infarction (STEMI) patients (21 with DM and 41 controls) underwent acute (1–3 days post-STEMI) and 6 months (6M) follow-up cardiac magnetic resonance scans (CMR). Control cases were matched for the peak troponin levels and area at risk on the acute CMR scans. Blood samples were obtained 6, 24, 48 hours and 6 months after STEMI.

Results

Despite similar severity of the initial ischaemic injury, DM patients had lower myocardial salvage index (MSI) and as a result larger final infarct size at 6 months. Further segment-based analysis of the acute CMR scans showed significantly prolonged T1-mapping values in all segments including non-ischaemic myocardium in DM patients and poorer recovery of the late gadolinium enhancement (LGE) of the infarcted segments in that group. Additionally, DM patients had higher monocyte counts 24 hours post-MI (1.2±0.4x109/μl DM vs 0.88±0.3 x109/μl control, p=0.001). We found that HbA1C correlated with monocyte count measured 24 hours after STEMI (r=0.577, p=0.006, n=21). HbA1C also predicted myocardial salvage index (MSI) at 6M post STEMI in the DM patients (r=0.891, p=0.017, n=13).

Conclusions

DM patients presenting with STEMI have increased peripheral blood monocytosis and larger final infarct size compared with STEMI patients without DM. Poorly controlled DM predisposes to adverse cardiac remodelling after STEMI.

Acknowledgement/Funding

OHSRC Research Grant, National Institute for Health Research (NIHR), British Heart Foundation Centre of Excellence Oxford

2379Endothelial cell derived extracellular vesicles mediate immune cell deployment from the spleen and transcriptional programming following acute myocardial infarction

Background

Acute myocardial infarction (AMI) induces transcriptional activation of monocyte en route to the injured myocardium, possibly through interactions involving plasma liberated extracellular vesicles (EVs), which are enriched for proteins and microRNAs (miRNAs) post-AMI. Neutrophils are the first immune cells to arrive at sites of injury and mediate further damage to the ischaemic myocardium. Here, we describe neutrophil-deployment from the spleen in AMI and by endothelial cell (EC) derived-EVs.

Methods

Patients presenting AMI provided informed consent as part of the Oxford Acute Myocardial Infarction Study (OxAMI). Plasma EV were isolated by differential ultra-centrifugation (120,000g, 2 hours) followed by washing and characterised for: morphology using transmission electron microscopy (TEM), size and concentration profiling by Nanoparticle Tracking Analysis, EV markers (TSG101, ALIX, CD9, HSP70) by western blot, and miRNAs by RT-qPCR. Mouse and human EC were used in vitro to derive EC-EV under control conditions or after inflammatory stimulation with tumour necrosis factor-alpha (TNF-α) (10ng/mL) and from CRISPR-edited miRNA-126 knock-out ECs. EC-EVs were tail vein injected into wild-type mice or exposed to primary human peripheral blood neutrophils in vitro.

Results

Patients presenting with AMI (N=15) have significantly more plasma EV at time of injury vs a 6-month follow-up measurement (2.2-fold more, P=0.008). Plasma EVs at the time of AMI presentation correlate significantly with the extent of ischaemic injury (R=0.046, P=0.006) and plasma neutrophils (R=0.37, P=0.017). Experimental AMI in wild-type mice induced a significant increase in peripheral blood neutrophils and a simultaneous reduction in splenic-neutrophils, suggesting splenic-neutrophil deployment (P=0.004). Human plasma EV are enriched for vascular cell adhesion molecule-1 (VCAM-1) and EC-associated miR-126 post-AMI (Akbar et al 2017). miRNA-126-mRNA targets are significantly over represented when compared to neutrophil Gene Ontology terms for: degranulation (P<0.001), activation (P<0.001), chemotaxis (P=0.008) and migration (P=0.008). Human and mouse EC release more EV after inflammatory stimulation and show enrichment for miRNA-126. CRISPR-edited miRNA-126 deficient human EC express more VCAM-1 (P<0.001) and release more EC-EVs (P<0.001). EC-EV exposure to primary human neutrophils alters inflammatory gene expression (IL-6 (P<0.05), CCL7 (P<0.001) and CCL18 (P<0.001)). EC-EV tail vein injected into wild-type mice mobilise splenic-neutrophils to peripheral blood (P<0.001).

Conclusions

Neutrophil deployment from the spleen is a novel finding in acute injury and interactions with EC-EV may mediate their splenic liberation and transcriptional programming following AMI, en route to the injured myocardium. The splenic neutrophil reserve may be a novel therapeutic target in AMI to modulate the inflammatory response before recruitment of cells to sites of injury.

Acknowledgement/Funding

British Heart Foundation Project Grant and Centre for Research Excellence Awards (RE/13/1/30181), Nuffield Benefaction for Medicine and ISSF

Candidate screening of blast resistance donors for rice breeding

Rice blast is one of the most serious diseases in the world. The use of resistant cultivars is the most preferred means to control this disease. Resistance often breaks down due to emergence of new races; hence identification of novel resistance donors is indispensable. In this study, a panel of 80 released varieties from National Rice Research Institute, Cuttack was genotyped with 36 molecular markers that were linked to 36 different blast resistance genes, to investigate the varietal genetic diversity and molecular marker-trait association with blast resistance. The polymorphism information content of 36 loci varied from 0.11 to 0.37 with an average of 0.34. The cluster analysis and population structure categorized the 80 National Rice Research Institute released varieties (NRVs) into three major genetic groups. The principal co-ordinate analysis displays the distribution of resistant and moderately resistant NRVs into different groups. Analysis of molecular variance result demonstrated maximum (97%) diversity within populations and minimum (3%) diversity between populations. Among tested markers, two markers (RM7364 and pi21_79-3) corresponding to the blast resistance genes (Pi56(t) and pi21) were significantly associated and explained a phenotypic variance of 4.9 to 5.1% with the blast resistance. These associated genes could be introgressed through marker-assisted to develop durable blast resistant rice varieties. The selected resistant NRVs could be good donors for the blast resistance in rice crop improvement research.

A crossover comparative study to assess efficacy of competency based medical education (CBME) and the traditional structured (TS) method in selected competencies of living anatomy of first year MBBS curriculum: A pilot study

BACKGROUND

Competency based medical education (CBME) is outcome based teaching methodology where a student learns a set of measurable competencies for early clinical exposure. Inspite of ample resources on CBME, there are limited studies on its implementation. This study will try to demonstrate improvement in the performance of students using CBME as a teaching tool over the traditional structured method (TS).

METHODS

Forty student volunteers were chosen and divided into two groups. The crossover design exposed the group of students to CBME and TS spread over two periods with a wash out period in between. The intervention group was exposed to selected list of competencies in living Anatomy with feedbacks and formative assessments. The summative assessments were held at the end of each period.

RESULTS

The mean scores of CBME and TS in group 1 is 130.625 and 113.65 while in group 2 is 139.425 and 112.075 respectively. The treatment and period effect is significant. Estimate of treatment effect is 22.1625. The average improvement in treatment scores is by 11%. Two tailed paired sample T test reveals significant improvement in the scores post intervention.

CONCLUSION

CBME method produces better performance of the students in the competencies of living anatomy.

In vitro expression of vital virulent genes of clinical and environmental isolates of Cryptococcus neoformans/gattii in endothelial cells of human blood-brain barrier

BACKGROUND

Evaluation of the pathogenesis of clinical and environmental cryptococcal isolates to the central nervous system is necessary for understanding the risk. This study was designed to determine the in vitro expression of six important virulent genes of Cryptococcus neoformans/gattii in Human Brain Microvascular Endothelial cells (hBMEC).

METHODS

The hBMEC were infected with Cryptococcus to determine invasion and survival rate at 3, 12 and 24hours by subsequent colony count of internalized yeasts. The whole RNA of the intracellular Cryptococcus was extracted to quantify the expression of CAP10, PLB1, ENA1, URE1, LAC1, and MATα genes by real-time quantitative PCR for 3 and 12hours of infection.

RESULTS

Invasion and survival rates were higher in clinical and standard strains of C. neoformans. A significant difference was observed among the clinical and environmental isolates for the expression of CAP10, ENA1, LAC1, MATα and URE1 at 3hours, and ENA1, LAC1, MATα, PLB1 and URE1 at 12hours. Clinical isolates showed significant upregulation of all the genes except PLB1, which was higher in environmental isolates. Relative expressions at the two time-points showed statistically significant (P=0.043) changes for the clinical isolates and no significance (P=0.063) for environmental isolates.

CONCLUSION

The C. gattii (VGI) isolates showed significantly lower invasion and survival than C. neoformans (VNI, and VNII) irrespective of their sources. Clinical isolates exhibited higher expression for the majority of the virulent genes until 12hours of infection, probably due to their better adaptation in the host system and enhanced pathogenicity than the environmental counterparts.

Hierarchical process using Brier Score Metrics for lower leg injury risk curves in vertical impact

INTRODUCTION

Parametric survival models are used to develop injury risk curves (IRCs) from impact tests using postmortem human surrogates (PMHS). Through the consideration of different output variables, input parameters and censoring, different IRCs could be created. The purpose of this study was to demonstrate the feasibility of the Brier Score Metric (BSM) to determine the optimal IRCs and derive them from lower leg impact tests.

METHODS

Two series of tests of axial impacts to PMHS foot-ankle complex were used in the study. The first series used the metrics of force, time and rate, and covariates of age, posture, stature, device and presence of a boot. Also demonstrated were different censoring schemes: right and exact/uncensored (RC-UC) or right and uncensored/left (RC-UC-LC). The second series involved only one metric, force, and covariates age, sex and weight. It contained interval censored (IC) data demonstrating different censoring schemes: RC-IC-UC, RC-IC-LC and RC-IC-UC-LC.

RESULTS

For each test set combination, optimal IRCs were chosen based on metric-covariate combination that had the lowest BSM value. These optimal IRCs are shown along with 95% CIs and other measures of interval quality. Forces were greater for UC than LC data sets, at the same risk levels (10% used in North Atlantic Treaty Organisation (NATO)). All data and IRCs are presented.

CONCLUSIONS

This study demonstrates a novel approach to examining which metrics and covariates create the best parametric survival analysis-based IRCs to describe human tolerance, the first step in describing lower leg injury criteria under axial loading to the plantar surface of the foot.

Management of Acute Admissions of Heart Failure Patients with Kidney Disease

Acute heart failure (HF) admissions are common. They are often associated with prolonged hospitalisations and poor outcomes. One-third of chronic HF patients also suffer from chronic kidney disease (CKD). Hence, acute admissions of HF with CKD are common and are associated with longer length of stay and increased mortality. Hyperkalaemia and acute on chronic renal impairment are important challenges in the management of these cases. Cautious introduction of high-dose diuretic therapy, followed by the re-commencement of renin-angiotensin-aldosterone (RAAS) inhibitors, improves length of stay, quality of life, and prognosis. During an admission on to the medical assessment unit careful monitoring and management of the patient's clinical condition and biochemistry is essential.

Microvascular complications in orthokeratology (Ortho-K): A real-time study on the microvasculature of the bulbar conjunctiva in Ortho-K treatment

Orthokeratology (Ortho-K) is an over-night hard contact lens therapy, which physically reshapes the corneal curvature in order to stabilize or temporally eliminate myopia in patients. We hypothesize that the prolonged physical contact and mechanical pressure induced by the Ortho-K lenses may create lasting inadvertent effects and damages (microangiopathy), and may bring about unwanted changes in the microvasculature of the bulbar conjunctiva. Computer-assisted intravital microscopy (CAIM) was used to view, document (via videotaping) and objectively quantify (via computer-assisted image analysis) the real-time dynamic and morphometric characteristics of the conjunctival microcirculation in long-term (at least over one year) Ortho-K patients (n = 11) and matched non-user control subjects (n = 8). Ortho-K patients were instructed to wear their lenses overnight following standard protocol. During the study, the conjunctival microcirculation of the left eye of all Ortho-K lens users was viewed, frequently re-focused and videotaped, without and with the lens in place, as outlined in Methods. The matched control subjects (non-lens wearing) were videotaped and studied in like manner. The dynamic and morphometric characteristics of each user and control subject were analyzed, quantified and summated as a severity index (SI) collectively for comparison. SI of Ortho-K lens users (4.18±1.08) differed significantly from SI of control subjects (1.75±1.39, p≤0.05). In addition, changes in the conjunctival microcirculation (e.g., flow velocity, vessel diameter, shape change, etc) were viewed and videotaped immediately after the myopic patients put on the Ortho-K lenses. Eight of the 11 Ortho-K lens users displayed significant percentage changes (p≤0.05) in flow velocity and 10 of 11 displayed significant percentage changes (p≤0.05) in vessel diameter, without and with the Ortho-K lenses. The results clearly indicated that significant microvascular changes via tissue remodeling occurred, and were caused directly by the physical presence of the Ortho-K lenses.

Erratum: Observation of D^{0} Meson Nuclear Modifications in Au+Au Collisions at sqrt[s_{NN}]=200 GeV [Phys. Rev. Lett. 113, 142301 (2014)]

This corrects the article DOI: 10.1103/PhysRevLett.113.142301.

AA Homozygous Genotype of GSTP1 I105V Polymorphism in Oral Cancer: In Silico Screening, Molecular Dynamics Simulation and Activity Studies of Wild and Mutant GSTP1

Background: Highest incidence of oral squamous cell carcinoma (OSCC) has been reported in north-eastern India and causal association between cancer and raw areca-nut (RAN) consumption are well evident. Earlier studies revealed that monitoring the occurrence of precocious anaphase and expression of securin in blood lymphocytes can be a good biomarkers for cancer risk in RAN+lime chewers. Glutathione S-transferases (GSTs) are considered an important cellular detoxification system that provide protection against the effects of toxins and determine individual's cancer susceptibility. Aim: Although GST gene family has been extensively studied, its role as susceptibility factor in oral cancer risk in the RAN chewing population in Meghalaya state, India has not been explored. The association of polymorphisms in GSTP1 (Ile105Val) gene with OSCC risk in Meghalaya, India, was evaluated. Earlier both AA reference and the GG/AG mutant genotype of GSTP1 gene showed an association with different types of cancers. Methods: Genetic polymorphism was evaluated by genotyping 129 cases and 156 controls using PCR-RFLP method and validated by Sanger sequencing in a hospital-based case-control study. GSTP1's interaction status with c-Jun Kinase (JNK) was evaluated through protein-protein docking analysis and this was also validated experimentally by immunohistochemistry and qRT-PCR. Results: Individuals with AA allele of GSTP1 showed significant association with the risk of OSCC compared with individuals with AG/GG mutant genotypes in habit-matched “RAN-only” and “RAN+Tobacco” group. The binding geometry between JNK and GSTP1 was disrupted in mutant combinations. It was demonstrated that AA homozygous genotype of oral epithelial cells showed reduced c-Jun-phosphorylation and proapoptotic genes expression than AG/GG genotypes. In silico docking revealed that homodimeric GSTP1 with AA genotype showed weak catalytic activity in detoxification of RAN and tobacco toxins compared with the AG/GG mutant proteins. Interestingly, the quantitation of 8-Oxo-2´-deoxyguanosine in DNA digests by ELISA-kit showed no differences in these genotypes, however the frequency of sister-chromatid exchanges was significantly higher in individuals with GSTP1 AA genotype than GG genotype. Conclusion: Thus in this population, specific traditional habit along with GSTP1 AA genotype play a significant role in predisposition to oral cancer risk by showing higher DNA-lesions, might be caused by some specific RAN/tobacco metabolites, and lower c-Jun phosphorylation which may inhibit apoptosis.

Minimally invasive direct restorations: a practical guide

The primary objectives of minimum intervention dentistry (MID) are to prevent or arrest active disease using non-operative management techniques. However, patients commonly present with cavitated caries lesions or failed restorations that are in need of operative intervention. Although much of clinical practice is devoted to preventing and managing the effects of caries and subsequent failure of the tooth-restoration complex, the clinical survival of restorations is often poor and becomes significantly worse as they increase in size and complexity. Minimally invasive (MI) restorative techniques present a range of well-documented advantages over more tissue-destructive traditional restorations by minimising unnecessary tooth tissue loss, insult to the dentine-pulp complex and reducing the risk of iatrogenic damage to adjacent hard and soft tissues. They also maximise the strength of the residual tooth structure by use of optimal adhesive restorative materials designed to restore function and aesthetics with durable, long-lasting restorations that are easy for the patient to maintain. In contemporary oral healthcare practice, if patients are to give valid consent for operative interventions, minimally invasive options must be offered, and may be expected to be the first choice of fully informed patients. This paper describes concepts of MID and provides an update of the latest materials, equipment and clinical techniques that are available for the minimally invasive restoration of anterior and posterior teeth with direct restorations.

Caries risk/susceptibility assessment: its value in minimum intervention oral healthcare

This narrative review describes the intimate connection between minimum intervention (MI) oral healthcare and caries risk/susceptibility assessment (CRA). Indeed CRA is the corner stone of an MI care plan, allowing the determination of the appropriate interventions (non-invasive as well as invasive [restorative]) and recall consultation strategies. Various CRA protocols/models have been developed to assist the oral healthcare practitioner/team in a logical systematic approach to synthesising information about a disease that has a multifactorial aetiology. Despite the criticisms toward the lack of clear-cut validation of the proposed protocols/models, CRA still has great potential to enhance patient care by allowing the oral healthcare practitioner/team and the patient to understand the specific reasons for their caries activity and to tailor their care plans and recall intervals accordingly.

The robust, readily available cobalt(iii) trication [Co(NH2CHPhCHPhNH2)3]3+ is a progenitor of broadly applicable chirality and prochirality sensing agents

When NMR spectra of chiral racemic organic molecules containing a Lewis basic functional group are recorded in the presence of air and water stable salts of the cobalt(iii) trication [Co((S,S)-NH2CHPhCHPhNH2)3]3+ (23+), separate signals are usually observed for the enantiomers (28 diverse examples, >12 functional groups). Several chiral molecules can be simultaneously analyzed, and enantiotopic groups in prochiral molecules differentiated (16 examples). Particularly effective are the mixed bis(halide)/tetraarylborate salts Λ-23+ 2X-BArf- (X = Cl, I; BArf = B(3,5-C6H3(CF3)2)4), which are applied in CD2Cl2 or CDCl3 at 1-100 mol% (avg 34 and 14 mol%). Job plots establish 1 : 1 binding for Λ-23+ 2Cl-BArf- and 1-phenylethyl acetate (4) or 1-phenylethanol (10), and ca. 1 : 2 binding with DMSO (CD2Cl2). Selected binding constants are determined, which range from 7.60-2.73 M-1 for the enantiomers of 10 to 28.1-22.6 M-1 for the enantiomers of 4. The NH moieties of the C2 faces of the trication are believed to hydrogen bond to the Lewis basic functional groups, as seen in the crystal structure of a hexakis(DMSO) solvate of Λ-23+ 3I-. These salts rank with the most broadly applicable chirality sensing agents discovered to date.

Case report: Postpartum pneumomediastinum and subcutaneous emphysema

Postpartum pneumomediastinum is a rare complication of labour and delivery, where air leaks into the mediastinum following rupture of marginal alveoli. It follows prolonged and forceful Valsalva manoeuvres that increase intra-thoracic pressure. Subcutaneous emphysema may also develop. A chest radiograph can confirm the diagnosis, however a computed tomography thorax maybe required. Treatment is conservative as it is usually self-limiting. We present a case of postpartum pneumomediastinum following a delay in the second stage of labour and subsequent instrumental delivery. She developed chest pain and dyspnea 40 min post-delivery, and subcutaneous emphysema was palpable. Supplementary nasal flow oxygen was administered for 24 h prior to discharge. There is sparse evidence or guidance as to the management of postpartum pneumomediastinum, but consensus appears to be supplemental oxygen for 24 h. More data are needed on the type and duration of oxygen therapy, need for repeat imaging and management of subsequent pregnancies.

Systematic review of benefits or harms of routine anaesthetist-inserted throat packs in adults: practice recommendations for inserting and counting throat packs: An evidence-based consensus statement by the Difficult Airway Society (DAS), the British Association of Oral and Maxillofacial Surgery (BAOMS) and the British Association of Otorhinolaryngology, Head and Neck Surgery (ENT-UK)

Throat packs are commonly inserted by anaesthetists after induction of anaesthesia for dental, maxillofacial, nasal or upper airway surgery. However, the evidence supporting this practice as routine is unclear, especially in the light of accidentally retained throat packs which constitute 'Never Events' as defined by NHS England. On behalf of three relevant national organisations, we therefore conducted a systematic review and literature search to assess the evidence base for benefit, and also the extent and severity of complications associated with throat pack use. Other than descriptions of how to insert throat packs in many standard texts, we could find no study that sought to assess the benefit of their insertion by anaesthetists. Instead, there were many reports of minor and major complications (the latter including serious postoperative airway obstruction and at least one death), and many descriptions of how to avoid complications. As a result of these findings, the three national organisations no longer recommend the routine insertion of throat packs by anaesthetists but advise caution and careful consideration. Two protocols for pack insertion are presented, should their use be judged necessary.

Destabilization of Magnetic Order in a Dilute Kitaev Spin Liquid Candidate

The insulating honeycomb magnet α-RuCl_{3} exhibits fractionalized excitations that signal its proximity to a Kitaev quantum spin liquid state; however, at T=0, fragile long-range magnetic order arises from non-Kitaev terms in the Hamiltonian. Spin vacancies in the form of Ir^{3+} substituted for Ru are found to destabilize this long-range order. Neutron diffraction and bulk characterization of Ru_{1-x}Ir_{x}Cl_{3} show that the magnetic ordering temperature is suppressed with increasing x, and evidence of zizag magnetic order is absent for x>0.3. Inelastic neutron scattering demonstrates that the signature of fractionalized excitations is maintained over the full range of x investigated. The depleted lattice without magnetic order thus hosts a spin-liquid-like ground state that may indicate the relevance of Kitaev physics in the magnetically dilute limit of RuCl_{3}.

Antiferromagnetic Resonance and Terahertz Continuum in α-RuCl_{3}

We report measurements of optical absorption in the zigzag antiferromagnet α-RuCl_{3} as a function of temperature T, magnetic field B, and photon energy ℏω in the range ∼0.3-8.3 meV, using time-domain terahertz spectroscopy. Polarized measurements show that threefold rotational symmetry is broken in the honeycomb plane from 2 to 300 K. We find a sharp absorption peak at 2.56 meV upon cooling below the Néel temperature of 7 K at B=0 that we identify as the magnetic-dipole excitation of a zero-wave-vector magnon, or antiferromagnetic resonance (AFMR). With the application of B, the AFMR broadens and shifts to a lower frequency as long-range magnetic order is lost in a manner consistent with transitioning to a spin-disordered phase. From a direct, internally calibrated measurement of the AFMR spectral weight, we place an upper bound on the contribution to the dc susceptibility from a magnetic excitation continuum.

Current trends in etiology, prognosis and therapeutic aspects of Parkinson's disease: a review

Parkinson's disease (PD) is a movement disorder, mainly affecting population consisting of the aged. PD occurs chiefly due to progressive loss of dopaminergic neurons in nigrostriatal pathway. Largely, PD patients suffer from non-motor symptoms, such as depression, anxiety, fatigue, and sleep disorders, that needs further investigation and addressing during PD research. Depression in PD is a predominant and complex symptom, and its pathology exists extrinsic to the nigrostriatal system. This disease can  ultimately be managed by a combination of regular physiotherapy and proper medication. Taking together the present scenario of PD, including the nature of disease, characteristics, treatment, diagnosis of the patients with PD, these outcomes were reviewed to be explored along with many speech-based solutions to PD in this study. This neurodegenerative disorder needs advancement in  research and development which  can help patients with PD to lead a normal life.

Managing Carious Lesions: Consensus Recommendations on Terminology

Variation in the terminology used to describe clinical management of carious lesions has contributed to a lack of clarity in the scientific literature and beyond. In this article, the International Caries Consensus Collaboration presents 1) issues around terminology, a scoping review of current words used in the literature for caries removal techniques, and 2) agreed terms and definitions, explaining how these were decided.Dental cariesis the name of the disease, and thecarious lesionis the consequence and manifestation of the disease-the signs or symptoms of the disease. The termdental caries managementshould be limited to situations involving control of the disease through preventive and noninvasive means at a patient level, whereascarious lesion managementcontrols the disease symptoms at the tooth level. While it is not possible to directly relate the visual appearance of carious lesions' clinical manifestations to the histopathology, we have based the terminology around the clinical consequences of disease (soft, leathery, firm, and hard dentine). Approaches to carious tissue removal are defined: 1)selective removal of carious tissue-includingselective removal to soft dentineandselective removal to firm dentine; 2)stepwise removal-including stage 1,selective removal to soft dentine, and stage 2,selective removal to firm dentine6 to 12 mo later; and 3)nonselective removal to hard dentine-formerly known ascomplete caries removal(technique no longer recommended). Adoption of these terms, around managing dental caries and its sequelae, will facilitate improved understanding and communication among researchers and within dental educators and the wider clinical dentistry community.

Vegetation dynamics in Bishrampur collieries of northern Chhattisgarh, India: eco-restoration and management perspectives

Phytosociological study in and around reclaimed coal mine site is an essential requirement for judging restoration impact on a disturbed site. Various studies have been aimed towards assessing the impact of different restoration practices on coal mine wastelands. Plantation scheme in a scientific way is the most suitable approach in this context. During the present investigation, an effort have been made to assess the vegetation dynamics through structure, composition, diversity, and forest floor biomass analysis in and around Bishrampur collieries, Sarguja division, northern Chhattisgarh, India. We have tried to develop strategies for eco-restoration and habitat management of the concerned study sites. Four sites were randomly selected in different directions of the study area. We classified the vegetation community of the study sites into various strata on the basis of height. Two hundred forty quadrats were laid down in various directions of the study area to quantify vegetation under different strata. During our investigation, we found eight different tree species representing four families in the different study sites. The density of the various tree species ranged between 40 and 160 individuals ha^-1. The density of sapling, seedling, shrub, and herb ranged between 740 and 1620; 2000 and 6000; 1200 and 2000; and 484,000 and 612,000 individuals ha^-1, respectively, in different directions. The diversity indices of the tree reflected highest Shannon index value of 1.91. Simpsons index ranged between 0.28 and 0.50, species richness ranged between 0.27 and 0.61, equitability up to 1.44, and Beta diversity ranged between 2.00 and 4.00. Total forest floor biomass ranged between 4.20 and 5.65 t/ha among the study sites. Highest forest floor biomass occurred in the south direction and lowest at east direction. Total forest floor biomass declined by 6.19% in west, 13.10% in north, and 25.66% in east direction, respectively. The mining activities resulted significant damage to natural vegetation and its dynamics. The study indicated that Acacia mangium, Cassia siamea, and Dalbergia sissoo can be recommended for effective eco-restoration of the concerned sites due to cosmopolitan distribution, high regeneration potential, as well as existence in the form of various girth classes with stable population structure.

Adeno-associated viral serotypes differentially transduce inhibitory neurons within the rat amygdala

Recombinant adeno-associated viruses (AAV) are frequently used to make localized genetic manipulations within the rodent brain. It is accepted that the different viral serotypes possess differing affinities for particular cell types, but it is not clear how these properties affect their ability to transduce specific neuronal cell sub-types. Here, we examined ten AAV serotypes for their ability to transduce neurons within the rat basal and lateral nuclei of the amygdala (BLA) and the central nucleus of the amygdala (CeA). AAV2 based viral genomes designed to express either green fluorescent protein (GFP) from a glutamate decarboxylase (GAD65) promoter or the far-red fluorescent protein (E2-Crimson) from a phosphate-activated glutaminase (PAG) promoter were created and pseudotyped as AAV2/1, AAV2/4, AAV2/5, AAV2/6, AAV2/7, AAV 2/8, AAV2/9, AAV2/rh10, AAV2/DJ and AAV2/DJ8. These viruses were infused into the BLA and CeA at equal titers and twenty-one days later tissue within the amygdala was examined for viral transduction efficiency. These serotypes transduced neurons with similar efficiency, except for AAV4 and AAV5, which exhibited significantly less efficient neuronal transduction. Notably, AAV4 and AAV5 possess the most divergent capsid protein sequences compared to the other commonly available serotypes. We found that the Gad65-GFP virus did not exclusively express GFP within inhibitory neurons, as assessed by fluorescent in situ hybridization (FISH), but when this virus was used to transduce CeA neurons, the majority of the neurons that expressed GFP were in fact inhibitory neurons and this was likely due to the fact that this nucleus contains a very high percentage of inhibitory neurons.

An ethical dilemma: malignant melanoma in a 51-year-old patient awaiting simultaneous kidney and pancreas transplantation for type 1 diabetes

Malignant melanoma is a high-risk skin cancer that, in potential transplant recipients, is considered a substantial contraindication to solid organ transplantation due to significant risk of recurrence with immunosuppression. Current guidelines stipulate waiting between 3 and 10 years after melanoma diagnosis. However, in young patients with end-stage organ failure and malignant melanoma, complex ethical and moral issues arise. Assessment of the true risk associated with transplantation in these patients is difficult due to lack of prospective data, but an autonomous patient can make a decision that clinicians may perceive to be high risk. The national and worldwide shortage of available organs also has to be incorporated into the decision to maximize the net benefit and minimize the risk of graft failure and mortality. The incidence of malignant melanoma worldwide is increasing faster than that of any other cancer and continues to pose ethically challenging decisions for transplant specialists evaluating recipients for solid organ transplantation.

Band Structure of Topological Insulator BiSbTe1.25Se1.75

We present our angle resolved photoelectron spectroscopy (ARPES) and density functional theory results on quaternary topological insulator (TI) BiSbTe_1.25Se_1.75 (BSTS) confirming the non-trivial topology of the surface state bands (SSBs) in this compound. We find that the SSBs, which are are sensitive to the atomic composition of the terminating surface have a partial 3D character. Our detailed study of the band bending (BB) effects shows that in BSTS the Dirac point (DP) shifts by more than two times compared to that in Bi₂Se₃ to reach the saturation. The stronger BB in BSTS could be due to the difference in screening of the surface charges. From momentum density curves (MDCs) of the ARPES data we obtained an energy dispersion relation showing the warping strength of the Fermi surface in BSTS to be intermediate between those found in Bi₂Se₃ and Bi₂Te₃ and also to be tunable by controlling the ratio of chalcogen/pnictogen atoms. Our experiments also reveal that the nature of the BB effects are highly sensitive to the exposure of the fresh surface to various gas species. These findings have important implications in the tuning of DP in TIs for technological applications.