DNA methylation and expression of stress related genes in PBMC of MDD patients with and without serious suicidal ideation

Stress plays an important role in major depressive disorder (MDD) and is one of the state dependent factors in suicidal behavior. A dysfunctional hypothalamic-pituitary-adrenal axis is a common feature in this disorder. The involvement of environmental factors has added additional complexity to understanding depression or suicidal behavior. In this regard, epigenetic regulation has been considered a mechanistic interface between environmental stress stimuli and altered functioning of underlying gene network that may increase susceptibility to depression or suicidal behavior. The present study examined whether epigenetic modifications of stress related genes are associated with MDD and whether there are differences in these epigenetic marks between depressed individuals with and without serious suicidal ideation. Using MeDIP analysis in genomic DNA isolated from peripheral blood mononuclear cells (PBMC) of healthy controls (n = 20), MDD patients with (n = 14) or without serious suicidal ideation (n = 10), we studied methylation of the stress-associated genes, Brain Derived Neurotrophic Factor (BDNF), Nuclear Receptor Subfamily 3 Group C Member 1 (NR3C1), FK506 Binding Protein 5 (FKBP5), Corticotropin Releasing Hormone Binding Protein (CRHBP), and Corticotropin Releasing Hormone Receptor 1 (CRHR1). In addition, we determined their transcript levels in RNAs isolated from the same PBMC. We found that BDNF, FKBP5, CRHBP, and NR3C1 gene promoters were significantly hypermethylated in MDD patients with and without suicidal ideation. We also found concomitant reductions in expression of BDNF, FKBP5 transcript variants (1, 2 and 3), and NR3C1 genes in these patients, suggesting that promoter hypermethylation in these genes may functionally be associated with their observed downregulation in MDD patients. In a secondary analysis, methylation of these genes was compared between MDD patients with or without serious suicidal ideation and controls. The MDD with serious suicidal ideation were significantly different from controls while the MDD without were not, although MDD with or without suicidal ideation were not different from each other, likely owning to a relatively small sample size. Thus, our findings underline the importance of epigenetic modifications of stress-associated genes in depression and, possibly, suicidal behavior, which, in future, needs to be confirmed in a larger patient population.

Comparison of hospitalization rates in schizophrenic patients on first generation versus second generation antipsychotic depots

Introduction

There is limited data on the efficacy rates between first and second generation antipsychotic depots. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics significantly reduce hospitalizations rates as compared to conventional depots.

Objectives

Comparison of hospitalization rates for patients with schizophrenia on first and second generation antipsychotic depots.

Methods

A retrospective observational study was done by reviewing the records of an antipsychotic depot clinic in Essex, United Kingdom. A list of 47 patients enrolled and receiving depot antipsychotics was obtained. Their records were studied and hospital admission rates calculated.

Results

Of the 47 patients 11 were excluded as they were on depot antipsychotics for non-schizophrenic diagnoses.

Of the 36 patients with schizophrenia, 12 were on second generation and 24 were on first generation depots.

Amongst the 24 patients on first generation depots, 19 were male, 5 female and mean age was 52 years.

Of the 12 patients on second generation depots, 10 were male and 2 female and mean age was 46 years.

When comparing hospital admission rates between the 2 groups, the following data was noted (Table 1).

Conclusions

There is no difference in hospitalization rates between patients on first generation antipsychotic depots as compared to second generation antipsychotic depots.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison of Initial Vasopressors Used for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

BACKGROUND

The main reason for morbidity after aneurysmal subarachnoid hemorrhage (aSAH) is delayed cerebral ischemia (DCI). The mainstay of medical therapy for treating DCI is induced hypertension with vasopressors to restore cerebral perfusion. Both phenylephrine (PE) and norepinephrine (NE) are commonly used for induced hypertension, but the impact of the initial choice of vasopressor on the efficacy, adverse effects, or outcome after hemodynamic therapy for DCI is unknown.

METHODS

Sixty-three patients with aSAH between January 2012 and October 2014, who developed DCI (defined as new focal deficit or decline in Glasgow Coma Score) and in which PE (n = 45) or NE (n = 18) treatment was initiated were evaluated in this retrospective study. Baseline characteristics, adverse effects, the need to change or add vasopressors, the response to therapy, the need for endovascular therapy, new infarct development, discharge disposition, and 3 months modified Rankin score were all compared between pressor groups.

RESULTS

Baseline characteristics (e.g., Hunt Hess and Fisher grades) were similar. There were no differences in the overall rate of complications including arrhythmia, pulmonary edema, or kidney injury. However, those initiated on PE were more likely to be changed to an alternate vasopressor (64 vs. 33%, p = 0.016), mostly for bradycardia or failure to reach therapeutic targets. Patients initially treated with PE were less likely to respond neurologically (71 vs. 94%, p = 0.01) or to be discharged to home or acute rehabilitation facilities (73 vs. 94%, p = 0.02) and were more likely to have a delayed infarct on imaging (62 vs. 33%, p = 0.04).

CONCLUSIONS

Our study suggests that patients with DCI after aSAH initiated on PE are more likely to require treatment change to another vasopressor and are at greater risk for poor clinical outcomes compared to patients started on NE. Larger comparative studies are warranted.

The Life Span Model of Suicide and Its Neurobiological Foundation

The very incomprehensibility of the suicidal act has been occupying the minds of researchers and health professionals for a long time. Several theories of suicide have been proposed since the beginning of the past century, and a myriad of neurobiological studies have been conducted over the past two decades in order to elucidate its pathophysiology. Both neurobiology and psychological theories tend to work in parallel lines that need behavioral and empirical data respectively, to confirm their hypotheses. In this review, we are proposing a "Life Span Model of Suicide" with an attempt to integrate the "Stress-Diathesis Model" and the "Interpersonal Model of Suicide" into a neurobiological narrative and support it by providing a thorough compilation of related genetic, epigenetic, and gene expression findings. This proposed model comprises three layers, forming the capability of suicide: genetic factors as the predisposing Diathesis on one side and Stress, characterized by epigenetic marks on the other side, and in between gene expression and gene function which are thought to be influenced by Diathesis and Stress components. The empirical evidence of this model is yet to be confirmed and further research, specifically epigenetic studies in particular, are needed to support the presence of a life-long, evolving capability of suicide and identify its neurobiological correlates.

Does arthroscopic subacromial decompression improve quality of life

INTRODUCTION

There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner.

METHODS

Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost-utility analysis was performed.

RESULTS

Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4-27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11-15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16-0.30), translating to a minimum cost per QALY of £5,683.

CONCLUSIONS

Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients.

Competing Magnetic Fluctuations in Iron Pnictide Superconductors: Role of Ferromagnetic Spin Correlations Revealed by NMR

In the iron pnictide superconductors, theoretical calculations have consistently shown enhancements of the static magnetic susceptibility at both the stripe-type antiferromagnetic and in-plane ferromagnetic (FM) wave vectors. However, the possible existence of FM fluctuations has not yet been examined from a microscopic point of view. Here, using ^{75}As NMR data, we provide clear evidence for the existence of FM spin correlations in both the hole- and electron-doped BaFe_{2}As_{2} families of iron-pnictide superconductors. These FM fluctuations appear to compete with superconductivity and are thus a crucial ingredient to understanding the variability of T_{c} and the shape of the superconducting dome in these and other iron-pnictide families.

Is energy drink safe? A cross sectional study on the effects of energy drink on medical students from a medical school of Nepal

Background: Energy drinks that contain caffeine, taurine, vitamins, herbal supplements, sugar or sweeteners are marketed to improve energy, weight loss, stamina, athletic performance and concentration. Recently some of energy drink has been banned in different countries like Saudi Arabia. In Nepal none of the studies has been done to report the effect of energy drink on health. The main objective of the study was to find out the effect of energy drink on health of medical students. Materials and Methods:  It was a cross sectional questionnaire based study done at Manipal College of Medical Sciences, Pokhara, Nepal on November 2013. Results: Out of 206 students 202 completed the questionnaire completely and their responses were evaluated which gives an overall response rate of 98.05%%. Out of 202 students, 88 (43.56%) students were found consuming energy drinks. The research finding revealed that most of the students who consumed energy drink were male 58%. Most of the students felt energetic after consuming energy drink. The majority of the students were from the second year 79.5%. The majority of the students, 71.6% consumed < 5 cans/week. Among the CNS manifestations students felt energetic, insomnia, euphoria, anxiety, dizziness, hallucination, headache and seizure disorder. Most of the students suffered from palpitation among the CVS manifestations. Other GIT and CVS Manifestations were discomfort, nausea, vomiting, diarrhoea, abdominal pain, constipation, weight loss and chest pain. ANS and miscellaneous manifestations were also seen among the students among which increased stamina , micturation, dry mouth, sweating, burning sensation in the throat, allergic reactions, breathlessness were noted by the students. Headache and insomnia was found more prevalent in males [OR 1.836 95% (CI 0.458, 7.367)] and [OR 1.214, 95 %(CI 0.517, 2.852)], respectively as compared to female students. However, in the case of GIT manifestations viz. abdominal pain and constipation revealed that it was more prevalent among male students [OR 2.292, 95 %(CI( 0.343, 13.638)] and [OR 1.836, 95 %(CI 0.458, 7.367)]. Conclusion:  It is concluded that energy drink gives energy and increases the stamina but it produces neurologic, psychiatric, cardiovascular and gastrointestinal complications on health. Further studies are required on the same field to find out its effect on health in Nepalese population. 

Belonephobia and finger pricking associated pain in hematology laboratory: A cross sectional study among undergraduate medical students in Nepal

BackgroundNeedle phobia, clinically termed as Belonephobia strongly influences psychological behaviors. Physiological responses include palpitations, shortness of breath, nervousness and fainting. In Nepal, first year MBBS students prick their own finger for hematology practical. They use to suffer from Belonephobia and pain due to finger prick. The main objective of this study was to determine influential fear factors and assessment of pain during hematology practical.Material and Methods:One hundred and forty two first year medical students of basic sciences participated in the study. Standard pricking was performed by blood lancet in the middle and side of the middle finger during hematology practical for the assessment of pain in Young Baker scale and visually rating scale. They also responded to a questionnaire on factors associated with fear of needles and lancets, symptoms etc.Results:Out of 142 students, numbers of males were 76 and females were 66. Belonephobia persisted among 65.2% females and 42.1% males, p<0.01. Watching others during lancing or receiving injection was a significant fear factor. Lateral side pricking was preferred by students for less pain. Mild, moderate, “hurts little bit”, “little more”, “even more” were the maximum response for pain sensation.Conclusion:Positive approaches like separation of lancing area, systematic exposure, behavioral therapy, counseling and administration of anti-anxiety drugs for severely needle phobics, can alleviate fear and anxiety. Female students need more assistance. Development of proper strategies and necessary interventions are required, which will facilitate to overcome this phobia.DOI: http://dx.doi.org/10.3126/nje.v4i5.12024 Nepal Journal of Epidemiology 2014; 4(5):433-40

Nanotopography directs mesenchymal stem cells to osteoblast lineage through regulation of microRNA-SMAD-BMP-2 circuit

The aim of this study was to investigate if chemically produced nanotopography on titanium (Ti) surface induces osteoblast differentiation of cultured human bone marrow mesenchymal stem cells (hMSCs) by regulating the expression of microRNAs (miRs). It was demonstrated that Ti with nanotopography induces osteoblast differentiation of hMSCs as evidenced by upregulation of osteoblast specific markers compared with untreated (control) Ti at day 4. At this time-point, miR-sequencing analysis revealed that 20 miRs were upregulated (>twofold) while 20 miRs were downregulated (>threefold) in hMSCs grown on Ti with nanotopography compared with control Ti. Three miRs, namely miR-4448, -4708, and -4773, which were significantly downregulated (>fivefold) by Ti with nanotopography affect osteoblast differentiation of hMSCs. These miRs directly target SMAD1 and SMAD4, both key transducers of the bone morphogenetic protein 2 (BMP-2) osteogenic signal, which were upregulated by Ti with nanotopography. Overexpression of miR-4448, -4708, and 4773 in MC3T3-E1 pre-osteoblasts noticeably inhibited gene and protein expression of SMAD1 and SMAD4 and therefore repressed the gene expression of key bone markers. Additionally, it was observed that the treatment with BMP-2 displayed a higher osteogenic effect on MC3T3-E1 cells grown on Ti with nanotopography compared with control Ti, suggesting that the BMP-2 signaling pathway was more effective on this surface. Taken together, these results indicate that a complex regulatory network involving a miR-SMAD-BMP-2 circuit governs the osteoblast differentiation induced by Ti with nanotopography. J. Cell. Physiol. 229: 1690-1696, 2014. © 2014 Wiley Periodicals, Inc.

Heritable genome editing with CRISPR/Cas9 in the silkworm, Bombyx mori

We report the establishment of an efficient and heritable gene mutagenesis method in the silkworm Bombyx mori using modified type II clustered regularly interspaced short palindromic repeats (CRISPR) with an associated protein (Cas9) system. Using four loci Bm-ok, BmKMO, BmTH, and Bmtan as candidates, we proved that genome alterations at specific sites could be induced by direct microinjection of specific guide RNA and Cas9-mRNA into silkworm embryos. Mutation frequencies of 16.7-35.0% were observed in the injected generation, and DNA fragments deletions were also noted. Bm-ok mosaic mutants were used to test for mutant heritability due to the easily determined translucent epidermal phenotype of Bm-ok-disrupted cells. Two crossing strategies were used. In the first, injected Bm-ok moths were crossed with wild-type moths, and a 28.6% frequency of germline mutation transmission was observed. In the second strategy, two Bm-ok mosaic mutant moths were crossed with each other, and 93.6% of the offsprings appeared mutations in both alleles of Bm-ok gene (compound heterozygous). In summary, the CRISPR/Cas9 system can act as a highly specific and heritable gene-editing tool in Bombyx mori.

Ethical statement in medical research manuscripts: A Necessary step for quality control

Recently there are several budding medical journals which are coming from developing countries and also there is a large number of publishers. It will foster medical research from these countries. Authors will improve the skill of medical writing because of these journals senior, experienced international/ national editorial and review board. Also this team is responsible for the quality of the journal. Journals primary aim should not be making money and get other benefit to the people who are dealing with it. Journals should produce evidence based new information to the medical science which will benefit to the new generation physicians, scientists and readers.  There is a tremendous increase in the medical research articles in the recent years because most of the institutions, universities and funding agencies consider the publication history of the scientists for their promotion and incentive. It results with good practice and bad practice of research. There are several scientists and teaching faculty members who publish the articles without proper data or they plagiarise other scientist work.  It can be stopped only by the national medical research authorities like Indian Council of Medical Research [India], Nepal Health Research Council [Nepal], etc. for each country level and the Institutional Research and Ethics Committee in  the institutional level. DOI: http://dx.doi.org/10.3126/nje.v4i3.10661Nepal Journal of Epidemiology 2014; 4(3):348-50

Prevalence of Strongyle infections in goat of Maha Koushal region, Madhya Pradesh, India

The coproculture study on Strongyle infection of goats was carried out in small holder farmers kept under semi-intensive management system in Balaghat, Narsinghpur and Chhindwara district, Madhya Pradesh, during the period from July 2011 to February 2012. Copro-culture of the samples positive for Strongyle infection revealed Haemonchus sp., Trichostrongylus sp., Oesophagostomum sp., Strongyloides sp., and Bunostomum sp. in a decreasing order in goats. The larvae of Haemonchus sp. (61.63 %) and Strongyloides sp. (7.50 %) were highest in Balaghat, Trichostrongylus (18.13 %) in Narsinghpur, while Oesophagostomum sp. (10.50 %) and Bunostomum sp. (5.75 %) were in Chhindwara district. The finding of this study indicates that, even though subclinical in nature, Strongyle infection are one of the major problems that could hamper health and productivity and there is need for design a programme to minimize and control Strongyle infection in goats in the study area.

Prevalence of gastro-intestinal parasitic infections in goat of Madhya Pradesh, India

Gastrointestinal (GI) parasitism in animals is one of the major problems in India causing emaciation, anaemia, oedema, weakness, diarrhoea and death. Present study was designed to generate epidemiological data on GI parasitism of goats of Madhya Pradesh, India. During 8 months study period, a total of 960 samples were collected and examined by sedimentation and floatation methods followed by egg per gram out of 960 samples, 907 (94.48 %) were positive for one or more gastrointestinal parasite, wherein coccidia was predominant (82.4 %) followed by strongyles (69.27 %), amphistomes (22.71 %), Strongyloides sp. (9.17 %), Trichuris sp. (3.85 %), Moniezia sp. (3.02 %), Schistosomes sp. (2.29 %) and Fasciola sp. (1.77 %). The seasonal incidence was found highest in monsoon (98.06 %) and lowest in winter (91.67 %). The incidence of gastrointestinal parasitism was found higher in kids (96.25 %) in comparison with adult goats (93.89 %).

Mapping of glycine distributions in gliomas

BACKGROUND AND PURPOSE

Increased glycine concentration in the brain is associated with altered metabolism in cancer and can be detected by using in vivo MR spectroscopy. This has been proposed as a marker for grade IV gliomas; however, little is known about the potential significance and frequency of in vivo glycine observation. The purpose of this study was to examine the rate of occurrence and spatial distribution of glycine observation with respect to other MR imaging parameters.

MATERIALS AND METHODS

Data from volumetric whole-brain MR spectroscopic imaging of 59 subjects with glioma were analyzed with glycine included in the spectral model. The associations of the signal amplitude and spatial distributions of glycine with findings from contrast-enhanced T1, perfusion, and diffusion MR imaging were then examined.

RESULTS

Glycine was detected in 24% of all studies, though with a wide range of signal amplitude and extent of the spatial distributions. While more commonly seen in grade IV tumors (42% of studies), relatively large concentrations were also detected in grade II and III gliomas. Coanalysis with other metabolites indicated a strong association with choline and that glycine was frequently seen to be overlapping with, and adjacent to, areas of high lactate concentration. Increased glycine was always associated with contrast enhancement and areas of increased cerebral blood flow, but without any clear association with other image parameters.

CONCLUSIONS

Detection of increased glycine in gliomas appears to identify a subgroup of tumors and areas of increased proliferation.

Infections in acute leukemia in Indian Children

Aims: In the present study acute leukemic children were studied to determine the incidence and principal site of infection, correlation with absolute neutrophil count, causative organisms and to standardize the initial empirical anti microbial therapy. Materials and methods: A total 40 children in the age group 6 month to 12 year with acute leukemia relapse were included in this study. A total 82 infectious episodes including 61 febrile episodes were investigated for infectious etiology. Results: We found that the frequency of infections increased significantly with the degree of immunocompromisation specially neutropenia (ANC < 500/cmm). The skin and soft tissue was the commonest site of infection (26.83%), followed by respiratory tract (21.95%). Staphylococcus nonhemolytic coagulase-negative (34%), followed by Klebsiella (17%) were the most common organisms isolated from blood. Staphylococcus non-hemolytic coagulase-negative was also the commonest isolate (26%) from other sites of infection. Most strains were sensitive to Cloxacillin, cephalosporin and aminoglycosides. Conclusion: For the treatment of febrile episodes, empirical use of beta-lactamase resistant penicillin e.g. Cloxacillin or cephalosporin combined with an aminoglycosides with a broad spectrum antifungal like fluconazole in selective cases at the first sign of infection is recommended. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 40-47 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9672

DTI correlates of cognition in conventional MRI of normal-appearing brain in patients with clinical features of subacute combined degeneration and biochemically proven vitamin B(12) deficiency

BACKGROUND AND PURPOSE

Vitamin B12 deficiency may cause neural injury that results in cognitive deficits. The main purpose of our study was to evaluate morphometric and microstructural changes in the brain and relate them to cognition in subacute combined degeneration of the spinal cord and patients with biochemically deficient vitamin B12.

MATERIALS AND METHODS

Fifty-one patients were recruited and underwent nerve-conduction velocity tests and routine hematologic examinations. Serum vitamin B12 and homocystine levels were also measured. All patients and 46 age- and sex-matched controls underwent cervical spine and brain MR imaging along with cognition tests. MR imaging included conventional scans and DTI. Voxel-based morphometry was performed for determining the WM and GM volumes, based on T1-weighted images. DTI measures that included fractional anisotropy, ADC, radial diffusivity, and axial diffusivity were determined by using tract-based statistics.

RESULTS

None of the patients showed any abnormality on conventional MR imaging. No significant changes in GM and WM volumes were observed in patients compared with controls. Significant reductions in the fractional anisotropy and an increase in ADC and radial diffusivity values were observed in multiple brain regions in patients compared with controls. These changes were confirmed on the region-of-interest analysis. Neuropsychological scores were significantly different in patients compared with controls and showed significant correlation with fractional anisotropy and radial diffusivity in a few brain regions.

CONCLUSIONS

Microstructural changes are seen in WM regions on DTI in patients with vitamin B12 deficiency and correlate with cognition scores. DTI can be used for objective assessment of microstructural changes in the brain in vitamin B12 deficiency.

Supramolecular nanoparticles that target phosphoinositide-3-kinase overcome insulin resistance and exert pronounced antitumor efficacy

The centrality of phosphoinositide-3-kinase (PI3K) in cancer etiology is well established, but clinical translation of PI3K inhibitors has been limited by feedback signaling, suboptimal intratumoral concentration, and an insulin resistance "class effect." This study was designed to explore the use of supramolecular nanochemistry for targeting PI3K to enhance antitumor efficacy and potentially overcome these limitations. PI3K inhibitor structures were rationally modified using a cholesterol-based derivative, facilitating supramolecular nanoassembly with L-α-phosphatidylcholine and DSPE-PEG [1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[amino(polythylene glycol)]. The supramolecular nanoparticles (SNP) that were assembled were physicochemically characterized and functionally evaluated in vitro. Antitumor efficacy was quantified in vivo using 4T1 breast cancer and K-Ras(LSL/+)/Pten(fl/fl) ovarian cancer models, with effects on glucose homeostasis evaluated using an insulin sensitivity test. The use of PI103 and PI828 as surrogate molecules to engineer the SNPs highlighted the need to keep design principles in perspective; specifically, potency of the active molecule and the linker chemistry were critical principles for efficacy, similar to antibody-drug conjugates. We found that the SNPs exerted a temporally sustained inhibition of phosphorylation of Akt, mTOR, S6K, and 4EBP in vivo. These effects were associated with increased antitumor efficacy and survival as compared with PI103 and PI828. Efficacy was further increased by decorating the nanoparticle surface with tumor-homing peptides. Notably, the use of SNPs abrogated the insulin resistance that has been associated widely with other PI3K inhibitors. This study provides a preclinical foundation for the use of supramolecular nanochemistry to overcome current challenges associated with PI3K inhibitors, offering a paradigm for extension to other molecularly targeted therapeutics being explored for cancer treatment.

Sequential application of a cytotoxic nanoparticle and a PI3K inhibitor enhances antitumor efficacy

Nanomedicines that preferentially deploy cytotoxic agents to tumors and molecular targeted therapeutics that inhibit specific aberrant oncogenic drivers are emerging as the new paradigm for the management of cancer. While combination therapies are a mainstay of cancer chemotherapy, few studies have addressed the combination of nanomedicines and molecular targeted therapeutics. Furthermore, limited knowledge exists on the impact of sequencing of such therapeutics and nanomedicines on the antitumor outcome. Here, we engineered a supramolecular cis-platinum nanoparticle, which induced apoptosis in breast cancer cells but also elicited prosurvival signaling via an EGF receptor/phosphoinositide 3-kinase (PI3K) pathway. A combination of mathematical modeling and in vitro and in vivo validation using a pharmacologic inhibitor of PI3K, PI828, demonstrate that administration of PI828 following treatment with the supramolecular cis-platinum nanoparticle results in enhanced antitumor efficacy in breast cancer as compared with when the sequence is reversed or when the two treatments are administered simultaneously. This study addresses, for the first time, the impact of drug sequencing in the case of a combination of a nanomedicine and a targeted therapeutic. Furthermore, our results indicate that a rational combination of cis-platinum nanoparticles and a PI3K-targeted therapeutic can emerge as a potential therapy for breast cancer.

Plagiarism: Who is responsible author or the journal editors?

I am writing in context to an article recently been published in the Journal of Drug Delivery and Therapeutics, Volume 3, Issue 4, July-August 2013 entitled ‘’Medications For Anxiety: A Drug Utilization Study In Psychiatry Outpatients From A Tertiary Care Centre Of Eastern India’4. http://jddtonline.info/index.php/jddt/article/view/574 I was very shocked to see that the above article is plagiarized from one of my paper which is the most  popular article 53475 views till 21st July 2013 in NJE, ‘’Medications for Anxiety: A Drug Utilization Study In Psychiatry Inpatients From A Tertiary Care Centre of Western Nepal’’5 published in Nepal Journal of Epidemiology on September 2011. http://nepjol.info/index.php/NJE/article/view/5753DOI: http://dx.doi.org/10.3126/nje.v3i3.9190 Nepal Journal of Epidemiology 2013;3(3): 277-278

Patient-reported outcome measures: an on-line system empowering patient choice

An innovative web-based system was developed to allow patient-reported outcome measures (PROMs) to be easily administered. Stakeholders guided the design and implementation. The software gives patients access to their current and previous scores. This pilot study focused on patients undergoing arthroscopic subacromial decompression, evaluated using the Oxford shoulder score (OSS). Patients showing good improvement in their OSS were offered the choice to return for routine follow-up clinic appointments, or continue rehabilitation, reassured by their improved score. Thirty-six of 117 patients were eligible. Thirty of these (83%) were opted to avoid further clinics. PROMs 2.0 can be used for any medical intervention with a validated PROM. Evolution and refinement is ongoing. Funding has been granted for 12 primary and secondary healthcare trusts to implement PROMs 2.0. Further work is needed to assess economic impact, patient views and satisfaction with the process.

Adventitial transduction of lentivirus-shRNA-VEGF-A in arteriovenous fistula reduces venous stenosis formation

Venous neointimal hyperplasia (VNH) causes hemodialysis vascular access failure. Here we tested whether VNH formation occurs in part due to local vessel hypoxia caused by surgical trauma to the vasa vasorum of the outflow vein at the time of arteriovenous fistula placement. Selective targeting of the adventitia of the outflow vein at the time of fistula creation was performed using a lentivirus-delivered small-hairpin RNA that inhibits VEGF-A expression. This resulted in significant increase in mean lumen vessel area, decreased media/adventitia area, and decreased constrictive remodeling with a significant increase in apoptosis (increase in caspase 3 activity and TUNEL staining) accompanied with decreased cellular proliferation and hypoxia-inducible factor-1α at the outflow vein. There was significant decrease in cells staining positive for α-smooth muscle actin (a myofibroblast marker) and VEGFR-1 expression with a decrease in MMP-2 and MMP-9. These results were confirmed in animals that were treated with humanized monoclonal antibody to VEGF-A with similar results. Since hypoxia can cause fibroblast to differentiate into myofibroblasts, we silenced VEGF-A gene expression in fibroblasts and subjected them to hypoxia. This decreased myofibroblast production, cellular proliferation, cell invasion, MMP-2 activity, and increased caspase 3. Thus, VEGF-A reduction at the time of arteriovenous fistula placement results in increased positive vascular remodeling.

Analysis of 3 common polymorphisms in the KCNK18 gene in an Australian Migraine case-control cohort

Migraine is a common neurological disorder characterised by temporary disabling attacks of severe head pain and associated disturbances. There is significant evidence to suggest a genetic aetiology to the disease however few causal mutations have been conclusively linked to the migraine subtypes Migraine with (MA) or without Aura (MO). The Potassium Channel, Subfamily K, member 18 (KCNK18) gene, coding the potassium channel TRESK, is the first gene in which a rare mutation resulting in a non-functional truncated protein has been identified and causally linked to MA in a multigenerational family. In this study, three common polymorphisms in the KCNK18 gene were analysed for genetic variation in an Australian case-control migraine population consisting of 340 migraine cases and 345 controls. No association was observed for the polymorphisms examined with the migraine phenotype or with any haplotypes across the gene. Therefore even though the KCNK18 gene is the only gene to be causally linked to MA our studies indicate that common genetic variation in the gene is not a contributor to MA.

Kearns-Sayre Syndrome: A Rare Mitochondrial Deletion Disorder

A 9 yr girl presented with bilateral ptosis and deafness of gradual onset for the last four years. Associated ophthalmoplegia and pigmentary retinopathy, heart block, raised CSF protein and serum lactate was suggestive of the diagnosis of Kearns-Sayre syndrome (KSS), a rare entity in the spectrum of the mitochondrial deletion syndrome. Search for endocrinopathy revealed no abnormality. DOI: http://dx.doi.org/10.3126/jnps.v33i1.6696 J Nepal Paediatr Soc. 2013;33(1):61-62

Simvastatin reduces venous stenosis formation in a murine hemodialysis vascular access model

Venous neointimal hyperplasia (VNH) is responsible for hemodialysis vascular access malfunction. Here we tested whether VNH formation occurs, in part, due to vascular endothelial growth factor-A (VEGF-A) and matrix metalloproteinase (MMP)-9 gene expression causing adventitial fibroblast transdifferentiation to myofibroblasts (α-SMA-positive cells). These cells have increased proliferative and migratory capacity leading to VNH formation. Simvastatin was used to decrease VEGF-A and MMP-9 gene expression in our murine arteriovenous fistula model created by connecting the right carotid artery to the ipsilateral jugular vein. Compared to fistulae of vehicle-treated mice, the fistulae of simvastatin-treated mice had the expected decrease in VEGF-A and MMP-9 but also showed a significant reduction in MMP-2 expression with a significant decrease in VNH and a significant increase in the mean lumen vessel area. There was an increase in terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining, and decreases in α-SMA density, cell proliferation, and HIF-1α and hypoxyprobe staining. This latter result prompted us to determine the effect of simvastatin on fibroblasts subjected to hypoxia in vitro. Simvastatin-treated fibroblasts had a significant decrease in myofibroblast production along with decreased cellular proliferation, migration, and MMP-9 activity but increased caspase 3 activity suggesting increased apoptosis. Thus, simvastatin results in a significant reduction in VNH, with increase in mean lumen vessel area by decreasing VEGF-A/MMP-9 pathway activity.

Effect of rotating acoustic stimulus on heart rate variability in healthy adults

Acoustic stimulus can modulate the Autonomic Nervous System. However, previous reports on this topic are conflicting and inconclusive. In this study we have shown, how rotating acoustic stimulus, a novel auditory binaural stimulus, can change the autonomic balance of the cardiac system. We have used Heart rate Variability (HRV), an indicator of autonomic modulation of heart, both in time and frequency domain to analyze the effect of stimulus on 31 healthy adults.A decrease in the heart rate accompanied with an increase in SD and RMSSD indices on linear analysis was observed post-stimulation. In the Poincaré Plot, Minor Axis (SD1), Major Axis (SD2) and the ratio SD12 (SD1/SD2) increased after the stimulation. Post stimulus greater increment of SD12 with higher lag numbers of (M) beat to beat intervals, when compared to pre stimulus values, resulted in increased curvilinearity in the SD12 vs. Lag number plot. After stimulation,value of exponent alpha of Dretended Flactuation Analysis of HRV was found to be decreased. From these characteristic responses of the heart after the stimulus, it appears that rotating acoustic stimulus may be beneficial for the sympathovagal balance of the heart.

A reporter promoter assay confirmed the role of a distal promoter NOBOX binding element in enhancing expression of GDF9 gene in buffalo oocytes

Growth differentiation factor 9 is primarily expressed in oocytes and plays a vital role in oocyte cumulus crosstalk. Earlier studies with buffalo oocytes revealed differential expression of this gene under different media stimulation conditions which, in turn, are correlated with the blastocyst yield. In this study, different germ cell specific cis elements including a NOBOX binding elements (NBE) and several E-boxes were identified at the 5' upstream region of buffalo GDF9 gene and their potential role in GDF9 expression was investigated. Transfecting oocytes with GDF9 promoter deletion constructs harbouring the NBE reporter gene revealed a 33% increase in GFP as well as the luciferase signal signifying its role in stimulating the minimal promoter activity of GDF9 in buffalo oocytes. Site directed mutation of core binding nucleotides at NBE at 1.8 kb upstream to TSS further confirmed its role for enhancing the basal transcriptional activity of GDF9 promoter in buffalo oocytes. Current work will provide important leads for understanding the role of GDF9 in oocytes competence and designing a more physiological IVF protocol in case of buffalo.

Abstract 391: Insulin-like Growth Factors Promote Vasculogenesis in Embryonic Stem Cells

The ability of embryonic stem cells to differentiate into endothelium and form functional blood vessels has been well established and can potentially be harnessed for therapeutic angiogenesis. However, after almost two decades of investigation in this field, limited knowledge exists for directing endothelial differentiation. A better understanding of the cellular mechanisms regulating vasculogenesis is required for the development of embryonic stem cell-based models and therapies. In this study, we elucidated the mechanistic role of insulin-like growth factors (IGF1 and 2) and IGF receptors (IGFR1 and 2) in endothelial differentiation using an embryonic stem cell embryoid body model. Both IGF1 and IGF2 predisposed embryonic stem to differentiate towards a mesodermal lineage, the endothelial precursor germ layer, as well as increased the generation of significantly more endothelial cells at later stages. Interestingly, differentiation into other mesoderm lineages was not augmented while endothelial cell differentiation was significantly increased. The percentage of endothelial cells within differentiated embryoid bodies was amplified by greater than 7% in embryoid bodies, a substantial increase compared to other characterized vasculogenic factors like VEGF. Inhibition of IGFR1 signaling using neutralizing antibody or a pharmacological inhibitor, picropodophyllin, significantly reduced IGF-induced mesoderm and endothelial precursor cell formation. We confirmed that IGF-IGFR1 signaling stabilizes HIF1[[Unsupported Character - Symbol Font α]] and leads to up-regulation of VEGF during vasculogenesis in embryoid bodies, which may be one of the critical mechanisms of IGF-induced promotion of vasculogenesis. Understanding the mechanisms that

are critical for vasculogenesis in various models will bring us one step closer to enabling cell based therapies for neovascularization.