A New Insight of Herbal Promises Against Ocular Disorders: An Occuloinformatics Approach

Ocular biology is a prominent area of research and advancement, as eyes are the most precious for us to see this beautiful world. Though we have overcome many ocular problems, but still challenges, no doubt exist in the path of the journey. Many ocular disorders still either have surgery or symptomatic drugs as a treatment. If we could get a better preventive way or single drug with many and more potential effects, will definitely be a boon for our society. Keeping the way we tried to focus on the impending effects of phytochemicals on some important ocular disorders. Our study promised with virtual screening based on important insilico protocols that can be a landmark for better futuristic approach towards novel drug development. As a selection Eales' Disease, Diabetic Retinopathy, Uveitis, Age related Macular Disorder, CRVO were taken. Causative Protein identification is the basic of study and further advance Insilico approaches were based on this target in respective disorders. Retinol Binding protein-3 and Retinal S antigen protein in case of Eales, Erythropoietin in the case of Diabetic Retinopathy, Nucleotide-binding oligomerization domain-containing protein-2 in case of Uveitis, Hemicentin-1 in case of Age related Macular Disorder, Coagulation Factor-V in case of CRVO were identified. Insilico characterization, Secondary and Tertiary structure prediction makes the study more prominent towards virtual screening. Virtual Screening was based on the parameters of docking, which reflects the potentiality of Ginkgolide, D-pinitol, Gugglesterones, Berberine and Curcumin herbal molecules against above mentioned ocular disorders respectively. Study signifies about the spectacular vision of herbal uses just to limit the vast side effects of synthetic chemicals used as ocular drugs.

MP2: PATHOPHYSIOLOGY AND METABOLIC PHENOTYPE OF LOW BODY MASS INDEX DIABETES

Purpose of Study

Millions of individuals with low body mass index (BMI) globally have diabetes of unclear etiology. These include patients with Fibrocalculous Pancreatic Diabetes (FCPD) and Lean Diabetes (LD), defined by the presence or absence of pancreatic calcifications on ultrasound. We present the first studies using gold-standard methodologies to assess their metabolic phenotype.

Methods Used

Stepped euglycemic-hyperinsulinemic (∼30 and 80 mU/m2/min) clamp studies were performed in n=8 Indian males with LD (age 38±3 y, BMI 18.4±0.1 kg/m2, HbA1c 11.0±0.8%) and n=22 with FCPD (age 30±1 y, BMI 19.7±0.6 kg/m2, HbA1c 10.2±0.6%), compared with n=12 type 2 diabetes subjects (T2DM, BMI 25.7±0.3 kg/m2, HbA1c 9.7±0.6%) and n=12 age and BMI matched non-diabetic (ND) subjects and n=16 with type 1 diabetes (T1DM, HbA1c 9.1±0.3%). Therapeutic regimens were intensified for two weeks to correct glucose toxicity in all groups. Lean body mass was determined for all subjects from percentage of total body fat as assessed by DXA.

Summary of Results

Peripheral insulin sensitivity (Rd, mg/kg lean body weight/min), was markedly impaired in T2DM (2.3±0.6; p<0.01) compared to LD (9.2±1.6) and FCPD (5.8±0.7). Rd did not differ between T1DM (5.8±0.7), LD and FCPD groups (figure 1).

Conclusions

Thus, these comprehensive studies suggest patients with LD and FCPD are only mildly insulin resistant once hyperglycemia is corrected. This promotes a paradigm shift in our understanding of low body mass index diabetes and could have profound therapeutic implications for millions of people.

Abstract MP2 Figure 1

13: LOW BODY MASS INDEX DIABETES IS CHARACTERIZED BY IMPAIRED INSULIN SECRETION

Purpose of Study

Fibrocalculous Pancreatic Diabetes (FCPD) and Lean Diabetes (LD) are unique forms of diabetes affecting millions of people in developing countries, characterized by the presence or absence of pancreatic calcifications on ultrasound and insulin-requiring but ketosis-resistant diabetes. To optimize therapeutic strategies for FCPD and lean diabetes patients, it is imperative to conclusively assess their insulin secretion using gold-standard methodologies.

Methods Used

Comprehensive tests were undertaken in n=22 Indian males with FCPD (age 30±2 y, BMI 19.7±0.6 kg/m2, HbA1c 9.0±0.3%) and n=6 with LD (age 36±4 y, BMI 18.3±0.1 kg/m2, HbA1c 11.6±1.3%), and compared with n=12 age, BMI matched ND, n=16 T1D (HbA1c 9.1±0.3%) and n=12 T2D subjects (age 36±2 y, BMI 26.0±0.3 kg/m2, HbA1c 9.7±0.6%). Following correction of hyperglycemia for over two weeks, mixed-meal tolerance tests (MMTT) and C-peptide deconvolution analysis was performed to assess beta-cell function.

Summary of Results

Glucose and C-peptide responses to MMTT suggest subjects with FCPD (14.5±2.2 pmol/kg/min) and LD (15.0±2.9 pmol/kg/min) have markedly impaired insulin secretion relative to both ND and T2D (p<0.001), and not statistically different from T1D (figure 1).

Conclusions

Thus, we report the first studies showing that patients with low BMI diabetes have impaired insulin secretion despite correction of hyperglycemia, consistent with nutritional effects on beta cell development or function.

Abstract 13 Figure 1

Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity. Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days. Results: The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure. Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.

19: RESVERATROL IMPROVES INSULIN RESISTANCE WITH ANTI-INFLAMMATORY AND “BROWNING” EFFECTS IN ADIPOSE TISSUE OF OVERWEIGHT HUMANS

Purpose of Study

Resveratrol is a plant-derived polyphenol whose beneficial metabolic effects in rodents include improved insulin sensitivity, reduced inflammation, and increased muscle mitochondrial biogenesis. We set out to confirm these findings in insulin resistant human subjects, by examining the effects of resveratrol on insulin sensitivity, muscle mitochondria, and adipose inflammation.

Methods Used

Specifically, resveratrol 2 gm/day (RV) or placebo (PL) were administered for 28 days in a randomized, double-blinded fashion to n=21 non-diabetic subjects (17 M; Age=52±2; BMI=31.9±0.9 kg/m2; HOMA-IR=3.9±0.2). All subjects participated in 6-hour, stepped euglycemic hyperinsulinemic (30 and 80 mU/m2.min) ‘pancreatic clamp’ studies to assess hepatic and peripheral insulin sensitivity, with biopsies of vastus lateralis muscle and subcutaneous abdominal adipose tissue, before and after RV and PL. Muscle mitochondria were analyzed for quantity, size, area in a field, and the % area covered, using electron microscopy with Volocity image analysis.

Summary of Results

RV induced a 22% (p=0.035) increase in glucose uptake, but did not affect glucose production. There were no changes in quantity (p=0.829) or percent area (p=0.897) of muscle mitochondria. There were no changes in basal or resting energy expenditure (Kcal/day) or respiratory quotient, as assessed by indirect calorimetry (Deltatrac), or in muscle strength in these healthy middle-aged subjects. However, RV reduced adipose tissue inflammation, with decreased expression of the pro-inflammatory cytokines TNFα and IL6 in whole fat (by 68% and 52%, p<0.05), and of IL6 and PAI-1 in adipose macrophages (by 50% and 40%, p<0.05). Adiponectin expression in whole fat increased by 53% with RV. Furthermore, we observed increased expression of genes associated with ‘browning’ of adipose tissue, including UCP1 and PGC-1α (46.6% and 34.9% increases, respectively).

Conclusions

Thus, while improved insulin sensitivity was not accompanied by changes in size or number of muscle mitochondria, anti-inflammatory and ‘browning’ effects in adipose tissue could contribute to resveratrol's favorable metabolic effects in insulin resistant humans.

Histological evaluation of 400 cholecystectomy specimens

Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007) received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25%) being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%), followed by chronic active cholecystitis (20.25%), acute cholecystitis (6%), gangrenous cholecystitis (2.25%),xanthogranulomatous cholecystitis (0.50%), empyema (1%), mucocele (0.25%), choledochal cyst (0.25%), adenocarcinoma gallbladder (1.25%) and  normal  gallbladders (1%).Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25%) cases, and significantly associated with various lesions (P value 0.009). Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate  sectioning  is  mandatory  in  all  cases  to  assess  epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.

Stenting as a bail-out option after failed percutaneous transluminal angioplasty in infrainguinal vein bypass grafts

OBJECTIVES

To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses.

METHODS

An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months.

RESULTS

A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively.

CONCLUSION

The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.

Factors Affecting Medium-Term Outcomes After Crural Angioplasty in Critically Ischemic Legs

Objectives:

To study factors affecting patency and medium-term outcomes after crural angioplasty.

Materials and Methods:

All crural angioplasties between March 2003 and September 2010 were reviewed from a prospective database to analyze primary patency, amputation-free survival, and limb salvage.

Results:

Five hundred and twenty-seven limbs in 478 patients (58.7% male, mean age 73.9 ± 0.53 years) were treated. In all, 49.1% were diabetic patients and 7.4% were dialysis dependent. Primary patency was 65.5%, 57.8%, 48.5%, and 32.9% at 1, 6, 12, and 36 months, respectively. Amputation-free survival was 75.2% at 1 year and 59.0% at 3 years. Limb salvage at 3 years was 92.7%. Rutherford categories 5 and 6 had a consistent adverse effect on patency. This led to an adverse amputation-free survival and limb salvage at 3 years.

Conclusion:

Crural angioplasty is an effective treatment for limb salvage. Its outcomes are adversely affected by diabetes, renal disease, coronary disease, and worsening Rutherford grade.

Influence of thiol capping on the photoluminescence properties of L-cysteine-, mercaptoethanol- and mercaptopropionic acid-capped ZnS nanoparticles

Mercaptoethanol (ME), mercaptopropionic acid (MPA) and L-cysteine (L-Cys) having -SH functional groups were used as surface passivating agents for the wet chemical synthesis of ZnS nanoparticles. The effect of the thiol group on the optical and photoluminescence (PL) properties of ZnS nanoparticles was studied. L-Cysteine-capped ZnS nanoparticles showed the highest PL intensity among the studied capping agents, with a PL emission peak at 455 nm. The PL intensity was found to be dependent on the concentration of Zn(2+) and S(2-) precursors. The effect of buffer on the PL intensity of L-Cys-capped ZnS nanoparticles was also studied. UV/Vis spectra showed blue shifting of the absorption edge.

Genetic instability in urinary bladder cancer: An evolving hallmark

Bladder cancer is a major health-care concern. A successful treatment of bladder cancer depends on its early diagnosis at the initial stage. Genetic instability is an essential early step toward the development of bladder cancer. This instability is found more often at the chromosomal level than at the nucleotide level. Microsatellite and chromosomal instability markers can be used as a prognostic marker for screening bladder cancer. Bladder cancer can be distinguished in two different categories according to genetic instability: Cancers with chromosomal level instability and cancers with nucleotide level instability. Deoxyribonucleic acid (DNA) mismatch repair (MMR) system and its correlation with other biologic pathway, both are essential to understand the basic mechanisms of cancer development. Microsatellite instability occurs due to defects in DNA MMR genes, including human mutL homolog 1 and human mutL homolog 2. Chromosomal alterations including deletions on chromosome 3, 8, 9, 11, 13, 17 have been detected in bladder cancer. In the current review, the most recent literature of genetic instability in urinary bladder cancer has been summarized.

Virtual Screening of Natural and Synthetic Ligands Against Diabetic Retinopathy by Molecular Interaction With Angiopoietin-2

PURPOSE

Diabetic retinopathy (DR) is the most common diabetic eye disease and a leading cause of blindness. The role of angiopoietin-2 a tyrosine kinase receptor is well-reported in angiogenesis during the onset of the disease. The purpose of this study is to screen out more potential herbal molecules which can evidently be used as a better, natural and safe herbal drug against this disease.

DESIGN

In silico virtual screening and molecular interaction studies were performed.

METHODS

The current course of work focused on molecular interactions on angiopoietin-2 protein with selected natural ligands, namely allicin, ajoene, D-pinitol and salacinol, along with synthetic ones like nateglinide, biguanide, tolbutamide and tolazamide. There was an attempt to carry out the virtual comparative study between natural and synthetic ligands. Proceeding toward this approach, docking of all molecules was performed using the Autodock 4.2 program.

RESULTS

Inference of this interaction study is that D-pinitol, which is the herbal extract of Glycine max, shows a very reliable docking pattern as compared with the synthetic ligand tolazamide. Although the binding energy of a synthetic ligand is lower compared to that of the natural ones, the binding energy of synthetic and natural ligands are at an approximate level. The lower the binding energy, the better the ligand molecular interaction.

CONCLUSIONS

Our findings suggest that D-pinitol, the natural, safe ligand, can be used in the treatment of diabetic retinopathy with few or no side effects after estimating and calculating proper doses using in vitro approaches.

Use of ABO-incompatible grafts in living donor liver transplantation--first report from India

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤ 1:16 IgG and ≤ 1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.