Inosine attenuates post-stroke neuroinflammation by modulating inflammasome mediated microglial activation and polarization

To date, various agents and molecules have been developed to treat post-stroke neuroinflammation; however, none of them are clinically successful. Post-stroke neuroinflammation is primarily attributed to microglial polarization as the generation of inflammasome complexes shifts microglia to their M1 phenotype and regulate the downstream cascade. Inosine, an adenosine derivative reported to maintain cellular energy homeostasis in stressed condition. Although, the exact mechanism is still unexplored, various studies have reported that it can stimulate axonal sprouting in different neurodegenerative diseases. Hence, our present study aims to decipher the molecular mechanism of inosine mediated neuroprotection by modulating inflammasome signaling towards altered microglial polarization in ischemic stroke. Inosine was administered intraperitoneally to male Sprague Dawley rats at 1 h post ischemic stroke and were further evaluated for neurodeficit score, motor coordination and long-term neuroprotection. Brains were harvested for infarct size estimation, biochemical assays and molecular studies. Inosine administration at 1 h post ischemic stroke decreased infarct size, neurodeficit score, and improved motor co-ordination. Normalization of biochemical parameters were achieved in the treatment groups. Microglial polarization towards its anti-inflammatory phenotype and modulation of inflammation were evident by relevant gene and protein expression studies. The outcome provides preliminary evidence of inosine mediated alleviation of post-stroke neuroinflammation via modulation of microglial polarization towards its anti-inflammatory form through regulating the inflammasome activation.

Glial Cells Response in Stroke

As the second-leading cause of death, stroke faces several challenges in terms of treatment because of the limited therapeutic interventions available. Previous studies primarily focused on metabolic and blood flow properties as a target for treating stroke, including recombinant tissue plasminogen activator and mechanical thrombectomy, which are the only USFDA approved therapies. These interventions have the limitation of a narrow therapeutic time window, the possibility of hemorrhagic complications, and the expertise required for performing these interventions. Thus, it is important to identify the contributing factors that exacerbate the ischemic outcome and to develop therapies targeting them for regulating cellular homeostasis, mainly neuronal survival and regeneration. Glial cells, primarily microglia, astrocytes, and oligodendrocytes, have been shown to have a crucial role in the prognosis of ischemic brain injury, contributing to inflammatory responses. They play a dual role in both the onset as well as resolution of the inflammatory responses. Understanding the different mechanisms driving these effects can aid in the development of therapeutic targets and further mitigate the damage caused. In this review, we summarize the functions of various glial cells and their contribution to stroke pathology. The review highlights the therapeutic options currently being explored and developed that primarily target glial cells and can be used as neuroprotective agents for the treatment of ischemic stroke.

Routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia: is it worth it?

This article discusses the place of routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia. Benefits include reducing the probability of accidental awareness or excessive depth of anaesthesia, and creating training opportunities to improve familiarity with its use, but these must be weighed against the costs, as it may not be advantageous from a cost–benefit perspective.

Efficacy of Capecitabine Plus Irinotecan vs Irinotecan Monotherapy as Second-line Treatment in Patients With Advanced Gallbladder Cancer: A Multicenter Phase 2 Randomized Clinical Trial (GB-SELECT)

Importance

There is therapeutic uncertainty regarding use of combination or single-agent chemotherapy in the treatment of patients with gallbladder cancer who experience disease progression after first-line chemotherapy.

Objective

To compare the efficacy of capecitabine plus irinotecan (CAPIRI) vs irinotecan (IRI) alone in patients with advanced gallbladder cancer (GBC) who have disease progression after gemcitabine-based first-line treatment.

Design, Setting, and Participants

The GB-SELECT trial was a multicenter, open-label, phase 2, randomized clinical trial of CAPIRI vs IRI alone for treatment of gallbladder cancer in patients who had disease progression after prior gemcitabine-based chemotherapy.The study was carried out in 2 tertiary care institutions in India. Patients aged between 18 and 70 years with histopathologic diagnosis of adenocarcinoma gallbladder, advanced or metastatic disease, previous treatment with gemcitabine-based chemotherapy, adequate hematologic, liver, and renal functions, and ECOG performance status of 1 or less were included in the study between August 2018 and January 2020. The data were analyzed for this report with cutoff on May 19, 2020.

Interventions

Patients were randomized 1:1 to receive capecitabine, 1700 mg/m2 per day, on days 1 to 14 plus intravenous irinotecan, 200 mg/m2, on day 1 or intravenous irinotecan, 240 mg/m2, on day 1, in 21-day cycles until disease progression or unacceptable toxic effects.

Main Outcomes and Measures

The primary end point was overall survival (OS) at 6 months. The secondary end points were progression-free survival and quality of life.

Results

A total of 98 patients were randomized, 49 in each arm, with median (range) age of 51 (29-70) years, with 60 (61%) being women. In the CAPIRI vs IRI arms, the number of deaths at 6 months, 6-month OS, and median OS were 35, 34, 38.4% (95% CI, 24.2%-52.6%) and 5.16 (95% CI, 4.26-6.06) months vs 34, 29, 54.2% (95% CI, 39.4%-69.0%) and 6.28 (95% CI, 4.25-8.30) months, respectively, with a hazard ratio of 1.02 (95% CI, 0.64-1.49, P = .93). There were no chemotherapy-related deaths but more patients required dose modification in CAPIRI compared with the IRI arm (13 [27%] vs 4 [9%], respectively, P = .03).

Conclusions and Relevance

There was no significant difference in OS between treatment with capecitabine plus irinotecan or irinotecan alone among previously treated patients with gallbladder cancer. Single-agent irinotecan should be the preferred treatment option for such patients.

Trial Registration

CTRI/2017/10/010112.

Development of a selective androgen receptor modulator for transdermal use in hypogonadal patients

We have identified a non-steroidal selective androgen receptor modulator (SARM), termed LY305, that is bioavailable through a transdermal route of administration while highly cleared via hepatic metabolism to limit parent compound exposure in the liver. Selection of this compound and its transdermal formulation was based on the optimization of skin absorption properties using both in vitro and in vivo skin models that supported PBPK modeling for human PK predictions. This molecule is an agonist in perineal muscle while being a weak partial agonist in the androgenic tissues such as prostate. When LY305 was tested in animal models of skeletal atrophy it restored the skeletal muscle mass through accelerated repair. In a bone fracture model, LY305 remained osteoprotective in the regenerating tissue and void of deleterious effects. Finally, in a small cohort of healthy volunteers, we assessed the safety and tolerability of LY305 when administered transdermally. LY305 showed a dose-dependent increase in serum exposure and was well tolerated with minimal adverse effects. Notably, there were no statistically significant changes to hematocrit or HDL after 4-week treatment period. Collectively, LY305 represents a first of its kind de novo development of a non-steroidal transdermal SARM with unique properties which could find clinical utility in hypogonadal men.

Fine needle aspiration cytology in breast tuberculosis: diagnostic difficulties--study of eleven cases

BACKGROUND

Incidence of extra-pulmonary tuberculosis is on the rise. Tuberculosis of breast is rare and have multifaceted clinical presentation, often mimicking carcinoma and pyogenic breast abscess.

AIM

To study morphologic variations and diagnostic difficulties of breast tuberculosis on fine needle aspiration cytology (FNAC).

METHODS

FNAC smears of breast tuberculosis were studied by Leishman's Stain and categorized into four groups. Cytology smears were also studied for presence of Acid Fast Bacilli (AFB) by Ziehl Neelsen (ZN) stain. Histology of excised tissue was studied by Hematoxylin and Eosin stain (H& E).

RESULTS

Out of 11 cases, 10 were females and 1 was male. Group 1 (n = 2) showed epithelioid granulomas with necrosis. Group 2 (n = 2) showed epithelioid granulomas without necrosis. Group 3 (n = 3) showed necrosis with a few scattered epithelioid histiocytes. Group 4 (n = 4) showed necrosis with numerous neutrophilic inflammatory cells. In four cases, caseous necrosis could be identified on cytology smears. AFB were found in five cases on FNAC smears. Histology confirmed diagnosis of tuberculosis in all cases.

CONCLUSION

In developing countries like India, based on clinical history and other features, FNAC smears showing epithelioid granulomas with or without necrosis should be considered as breast tuberculosis as demonstration of AFB is not mandatory. Identification of caseous necrosis alone is diagnostic of breast tuberculosis in cytology smears.

A phase transition close to room temperature in BiFeO3 thin films

BiFeO3 (BFO) multiferroic oxide has a complex phase diagram that can be mapped by using appropriately substrate-induced strain in epitaxial films. By using Raman spectroscopy, we conclusively show that films of the so-called supertetragonal T-BFO phase, stabilized under compressive strain, display a reversible temperature-induced phase transition at about 100 °C, and thus close to room temperature.

Upright posture and maximal exercise increase platelet aggregability and prostacyclin production in healthy male subjects

BACKGROUND

It is well accepted that heavy physical exertion can trigger the onset of myocardial infarction, but the mechanism is uncertain. As platelet and endothelial function play an important role in thrombotic events, platelet and prostacyclin responses to maximal treadmill exercise were studied.

METHODS/RESULTS

The study subjects were 40 healthy men, mean (SEM) age 29 (5) years. Platelet aggregation was measured on a four channel aggregometer. Plasma 6-keto-prostaglandin F1alpha was analysed using an enzyme immunoassay technique. Upright posture and exercise produced an increase in platelet aggregability, as indicated by a fall in the threshold concentration of adrenaline (epinephrine) from 7.6 (1.5) microM at rest to 4.3 (1.0) microM after exercise (p = 0.002). The collagen lag time became significantly shorter with exercise (from 79.1 (3.1) seconds at rest to 71.9 (2.6) seconds after exercise, p = 0.003). Exercise was also associated with a 55% increase in plasma 6-keto-prostaglandin F1alpha (from 38.1 (75%CI 29.0 to 46.5) pg/ml at rest to 59.2 (47.3 to 66.8) pg/ml after exercise, p<0.001).

CONCLUSIONS

In healthy male subjects, upright posture and maximal exercise increased platelet aggregability but this increase was counteracted by an increase in prostacyclin production. In patients with endothelial dysfunction, a reduced prostacyclin response to exercise may promote a transient prothrombotic imbalance that may trigger cardiovascular disease onset.

Unusual presentation of late regional cardiac tamponade after aortic surgery

Localized pericardial effusion leading to cardiac tamponade is seen occasionally in patients after cardiac surgery. This condition may be difficult to diagnose clinically because of unusual presenting symptoms and absence of conventional signs of cardiac tamponade. A case of localized pericardial effusion with presenting symptoms of fever and increasing fatigue is described in this study. The definitive diagnosis was made using transesophageal echocardiography. Surgical drainage of localized effusion resulted in prompt hemodynamic and symptomatic improvement.

Role of side chain moiety in the hydrolysis of penicillins by beta-lactamase

Various beta-lactam compounds and structurally related moieties were examined as substrates of beta-lactamase from Bacillus cereus 5/B NCTC 9946. The enzyme was specific for penicillins and none of the cephalosporins were hydrolysed. Electronic environment of allylic carboxy group in dihydrothiazine ring restricts the acceptance of cephalosporins as substrates. The efficiency of hydrolysis of penicillins is dependent on dense resonating electronic environment of phenyl ring present in the side chain, flexibility of the side chain and the distance between the phenyl ring and carbonyl group in the side chain.

REM syndrome (reticular erythematous mucinosis): report of a further case or variant of it

A 50-year-old woman had cervical lymphadenopathy, swollen and waxy-looking gums, and a diamond-shaped, reticular erythematous eruption on her back of eight years' duration. Histologic examination of the gingival tissue and skin showed round-cell infiltration around the small blood vessels and in the upper part of the dermis, and an extensive eosinophilic amorphous deposit throughout the dermis that stained with Alcian blue. The clinical and histologic features, although not identical, resembled those reported by Lischka and Orthenberger (1972) and later by Steigleder et al (1974).