A microfluidic route for synthesis of scandium oxide microspheres, their characterization and neutron activation

Radioactive scandium-46 microspheres have applications in mapping flow in a chemical reactor through a technique known as radioactive particle tracking (RPT). In the present study a novel microfluidic method has been developed for synthesis of controlled size scandium oxide microspheres. An inline/in-situ mixing of the scandium precursor and gelling agents was implemented which makes the microfluidic platform amenable for truly continuous operation. Microspheres of size varying from 937 to 666 μm were produced by varying O/A ratio from 10 to 30. Perfectly spherical and monodispersed (PDI <10 %) microspheres were obtained at O/A 15 and beyond. The morphology, elemental composition, and structure of the microspheres were analysed by SEM, EDS and XRD, respectively. Subsequently the microspheres were irradiated with thermal neutrons in a nuclear reactor to obtain radioactive Sc-46 oxide microspheres. The activity produced on each Sc-46 microspheres with different sizes was in the range 19.5-34.0 MBq.

Nature of Subdiffusion Crossover in Molecular and Polymeric Glassformers

A crossover from a non-Gaussian to Gaussian subdiffusion has been observed ubiquitously in various polymeric and molecular glassformers. We have developed a framework that generalizes the fractional Brownian motion model to incorporate non-Gaussian features by introducing a jump kernel. We illustrate that the non-Gaussian fractional Brownian motion model accurately characterizes the subdiffusion crossover. From the solutions of the non-Gaussian fractional Brownian motion model, we gain insights into the nature of van Hove self-correlation in non-Gaussian subdiffusive regime, which is found to exhibit exponential tails, providing first such experimental evidence in molecular glassformers. The validity of the model is supported by comparison with incoherent quasielastic neutron scattering data obtained from several molecular and polymeric glassformers.

Noncanonical Relationship between Heterogeneity and the Stokes-Einstein Breakdown in Deep Eutectic Solvents

The relationship between Stokes-Einstein breakdown (SEB) and dynamical heterogeneity (DH) is of paramount importance in the physical chemistry of complex fluids. In this work, we employ neutron scattering to probe the DH and SEB in a series of deep eutectic solvents (DESs) composed of acetamide and lithium salts. Quasielastic neutron scattering experiments reveal SEB in the jump diffusion of acetamide, represented by a fractional Stokes-Einstein relationship. Among these DESs, lithium perchlorate exhibits the most pronounced SEB while lithium bromide displays the weakest. Concurrently, elastic incoherent neutron scans identify that bromide DES is the most heterogeneous and perchlorate is the least. For the first time, our study unveils a counterintuitive incommensurate relationship between DH and SEB. Further, it reveals the intricate contrasting nature of the SEB-DH relationship when investigated in proximity to the glass-transition temperature and further away from it.

Oral Propranolol Therapy for Infantile Hemangioma: Long-term Follow-up

β-blocker therapy is currently the treatment of choice for infantile hemangiomas (IH), albeit with limited data on long-term treatment outcomes. Herein, authors treated 67 IH lesions in 47 patients with oral propranolol at 2 mg/kg/d for a median of 9 mo and followed them up for a median of 48 mo. While no maintenance therapy was required for 18 lesions (26.9%), the rest needed maintenance therapy. Both treatment regimens had comparable efficacy (83.3±23.9% and 92.0±13.8%) but chances of IH recurrence was higher in lesions requiring maintenance therapy. Also, patients treated at ≤5 mo of age had a significantly better response and a lower recurrence rate than patients treated at >5 mo of age (95.0±7.9% vs. 87.0±17.5%, p = 0.05). Authors' experience suggests that longer durations of maintenance therapy offered no added advantage to the overall improvement of IH while treatment initiation at an earlier age showed better improvement and lower recurrence rates.

An Open-Label Non-Randomized Preliminary Noninferiority Study Comparing Home-Based Handheld Narrow-Band UVB Comb Device with Standard Hospital-Based Whole-Body Narrow-Band UVB Therapy in Localized Vitiligo

Background

Narrow-band ultraviolet B (NB-UVB) is the standard therapy for vitiligo.

Objective

The objective of this study is to compare the safety and clinical efficacy of a handheld NB-UVB comb device with the standard whole-body NB-UVB therapy in localized stable vitiligo.

Materials and Methods

Thirty-one vitiligo patients were allocated to either daily therapy with a home-based handheld comb device (group A, n = 17) or thrice-weekly hospital-based whole-body NB-UVB therapy (group B, n = 14) for 4 months, based on their preference. The primary and secondary outcomes were assessed at each follow-up, and appropriate statistical tools were used for analysis.

Results

Of the 31 patients enrolled, 26 patients (study groups A/B: 15/11) completed the study. Primary outcome: Median percentage repigmentation of the representative patch in groups A and B were 51.35% and 63.85%, respectively (P = 0.64). The median size reduction of the representative patch in both groups was statistically significant (P < 0.05). The mean difference between "per protocol analysis" and "intention to treat" showed noninferiority. Secondary outcomes: Both groups were comparable on Lund and Browder score, patient global assessment and investigator global assessment scores, adverse events, color match, and change in the quality of life. The comparison group had a significantly greater number of missed sessions (P = 0.02). The majority of patients had a "good" response in both groups.

Conclusion

Handheld NB-UVB comb device daily with a fixed dose of fluence was found to be noninferior with better compliance to standard whole-body NB-UVB therapy.

Evaluation of a paraffin-based moisturizer compared to a ceramide-based moisturizer in children with atopic dermatitis: A double-blind, randomized controlled trial

BACKGROUND

Moisturizers are first-line therapy for treatment of atopic dermatitis (AD). Although there are multiple types of moisturizers available, head-to-head trials between different moisturizers are limited.

OBJECTIVE

To evaluate if a paraffin-based moisturizer is as effective as ceramide-based moisturizer in children with AD.

MATERIALS AND METHODS

In this double-blind, randomized comparative trial of pediatric patients with mild to moderate AD, subjects applied either a paraffin-based or ceramide-based moisturizer twice daily. Clinical disease activity using SCOring Atopic Dermatitis (SCORAD), quality of life using Children/Infants Dermatology Life Quality Index (CDLQI/IDLQI), and transepidermal water loss (TEWL) were measured at baseline and at follow-up at 1, 3, and 6 months.

RESULTS

Fifty-three patients were recruited (27 ceramide group and 26 paraffin group) with a mean age of 8.2 years and mean disease duration of 60 months. The mean change in SCORAD at 3 months in the ceramide-based and paraffin-based moisturizer groups was 22.1 and 21.4, respectively (p = .37). The change in CDLQI/IDLQI, TEWL over forearm and back, amount and days of topical corticosteroid required, median time to remission and disease-free days at 3 months were similar in both groups. As the 95% confidence interval (CI) of mean change in SCORAD at 3 months in both groups (0.78, 95% CI: -7.21 to 7.52) was not within the predefined margin of equivalence (-4 to +4), the conclusion of equivalence could not be proven.

CONCLUSION

Both the paraffin-based and ceramide-based moisturizers were comparable in improving the disease activity in children with mild to moderate AD.

Copper(ii) and cobalt(iii) Schiff base complexes with hydroxy anchors as sensitizers in dye-sensitized solar cells (DSSCs)

Two Schiff base complexes of copper(ii) and cobalt(iii) having the formulae [CuL₂] (Cu-Sal) and [CoL₃] (Co-Sal) (HL = 2-(((2-hydroxyethyl)imino)methyl)phenol) have been synthesized and characterized microanalytically, spectroscopically and in the case of Cu-Sal using single crystal X-ray diffraction technique. The single crystal X-ray analysis reveals a square planar geometry around Cu(ii) satisfied by phenoxide oxygen and imine nitrogen of the L^- ligand to generate a six membered chelate ring. The solid state structure of Cu-Sal is satisfied by varied intermolecular non-covalent interactions. The nature of these interactions has been addressed with the aid of Hirshfeld surface analysis. Both compounds have been used as sensitizers in TiO₂ based dye sensitized solar cells (DSSCs) and the DSSC experiments revealed that Co-Sal offers better photovoltaic performance in comparison to Cu-Sal. The Co-Sal exhibited a J _sc of 9.75 mA cm^-2 with a V _oc of -0.648 V, incident photon to current conversion efficiency (IPCE) of 57% and η of 3.84%. The relatively better photovoltaic performance of Co-Sal could be attributed to better light absorption and dye loading than that of Cu-Sal.

Evaluation of mixing performance and validation of CFD simulations in baffled anaerobic digesters using radiotracer technique

The anaerobic digesters find usage in treating the huge amount of waste such as trash, garbage, human waste and animal waste. The sustained performance of an anaerobic digester depends on the flow pattern and mixing behaviour in the digester. A cylindrical digester tank with vertical baffles can provide flow behaviour approaching that of a plug flow reactor. However, the presence of dead zones and recirculating regions cause non-ideal flow in the digester. In this work, the mixing behaviour in two scaled-down models of baffled digester tanks is characterized by measurement of residence time distribution (RTD) using a radioactive tracer. While the first design has three vertical baffles, the second design include horizontal static flaps on the baffles. The flow behaviour in the digester is also simulated using computational fluid dynamics (CFD) and RTD is obtained computationally. The comparison of RTD curves obtained from CFD simulations with those obtained from radiotracer experiments show good agreement between them. There appear to be only minor difference in the flow behaviour and the RTD curves in the two digester designs. Using the RTD curve data, two commonly used RTD models, tank-in-series and dispersion models, have been fitted and both models are able to predict the RTD in the digester qualitatively.

Sex-based comparisons of clinical characteristics and outcomes of patients with embolic stroke of undetermined source with implantable loop recorders

Funding Acknowledgements

Type of funding sources: None.

Introduction

Embolic strokes of undetermined source (ESUS) constitute a significant proportion of all ischemic strokes, but sex-based comparisons of clinical characteristics and outcomes of ESUS patients have not been well explored. As such, we aimed to examine how sex influences outcomes of ESUS patients.

Methods

Retrospective cohort study performed on consecutive ESUS patients with an implanted ILR between December 2013 to September 2021. We obtained information on the patients’ characteristics, treatments, and outcomes from the electronic medical records. Cox regression was used to investigate whether sex was independently associated with outcomes.

Results

There were 176 patients included in this study. The mean duration of follow-up was 1254 ± 724 days. Mean age was 60.8 ± 12.0 and 47 (26.7%) of patients were female. On univariable Cox regression analysis for subsequent atrial fibrillation (AF) on implantable loop recorder (ILR), patients with subsequent AF on ILR were more likely to be female (HR 2.19, 95% CI 1.04–4.63, p = 0.040), older (HR 1.07, 95% CI 1.03–1.12, p = 0.001), have a lower glomerular filtration rate (eGFR) (HR 0.98, 95% CI 0.97– 0.99, p = 0.004), and have previous percutaneous coronary intervention (PCI) (HR 2.60, 95% CI 1.05–6.46, p = 0.039). On multivariable Cox regression, after adjustment for age, eGFR and previous PCI status, female sex remained independently associated with the development of subsequent AF on ILR. Female sex was not associated with other outcomes including mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.

Conclusions

In this cohort of ESUS patients with ILR implantation, female sex was independently associated with a higher risk of development of AF on ILR. However, female sex was not a predictor of mortality, subsequent acute myocardial infarction, stroke/transient ischemic attack and heart failure.

Characteristics and outcomes of aortic stenosis patients with and without stroke

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Sia CH was supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme

Background

Aortic stenosis (AS) is related to several atherosclerosis risk factors and is associated with an increased risk of ischaemic stroke. Some reports suggest that aortic valve calcification may predispose to embolic stroke although this is not well-studied. The literature is also sparse regarding individual stroke subtypes and predictors of stroke in AS.

Purpose

We aimed to 1) Describe rates of ischaemic stroke in AS including specific stroke subtypes; 2) Compare clinical and echocardiographic characteristics of patients with AS who subsequently developed ischaemic stroke versus those who did not, and 3) Identify independent variables associated with subsequent stroke in AS.

Methods

Patients with AS were recruited from an echocardiography database from September 2011 to December 2015 at a single tertiary centre. The primary study endpoint was acute ischaemic stroke. Clinical characteristics and echocardiographic parameters were compared between patients who suffered a stroke after AS diagnosis and those who did not. Multivariable Cox regression analysis was used to identify factors associated with subsequent stroke.

Results

A total of 703 patients with AS were studied, with a median follow-up duration of 3.0 (IQR 0.5, 5.0) years. Twenty-two patients (3.1%) developed stroke following AS diagnosis (large vessel, 18.2%; cardioembolic, 50.0%; small vessel, 18.2%; other determined ischaemic stroke, 13.6%). These patients had a greater prevalence of previous stroke or transient ischaemic attack (TIA) (50.0%) compared to patients who did not develop subsequent stroke (20.9%), p&lt;0.001. Patients with AS who developed subsequent stroke also more commonly had atrial fibrillation at the time of indexed echocardiography (40.0%) compared to their counterparts who did not develop stroke (13.5%), p=0.004 (Table 1). Other cardiovascular risk factors and traditional echocardiographic parameters of AS severity were similar between the 2 groups. Degenerative calcified aortic valve was not associated with the development of all types of ischaemic stroke or cardioembolic stroke. AS severity was also not associated with development of stroke. Multivariable Cox regression analysis found previous stroke or TIA (HR 8.00, 95% CI 2.70–23.58, p&lt;0.001) and atrial fibrillation at time of echocardiography (HR 8.81, 95% CI 1.34–10.80, p=0.012) to be independent predictors of subsequent stroke in AS. The key findings of our study are summarised in Figure 1.

Conclusions

Cardioembolic stroke is the most common stroke subtype in patients with AS. Previous history of stroke or TIA and atrial fibrillation at time of diagnostic echocardiography are independent predictors of subsequent stroke in AS. Calcified aortic valve was not found to be a risk factor for all types of ischaemic stroke or cardioembolic stroke.

Lateral diffusion of lipids in the DMPG membrane across the anomalous melting regime: effects of NaCl

The anionic dimyristoyl phosphatidylglycerol (DMPG) membrane in solvents with a low ionic strength is known to exhibit an unusually wide melting regime between the gel and fluid phase characterized by various anomalous macroscopic characteristics, such as low turbidity and high electrical conductivity and viscosity. A recent neutron spin echo study [Kelley, E. G. et al., Struct. Dyn., 7 (2020) 054704] revealed that during the extended melting phase transition the DMPG membrane becomes softer and exhibits faster collective bending fluctuation compared to the higher temperature fluid phase. In contrast, in the present work, using incoherent quasielastic neutron scattering through the anomalous phase transition regime we find that single-particle lateral and internal lipid motions in the DMPG membrane show regular temperature dependence, with no enhanced dynamics evident in the anomalous melting regime. Further, we find that incorporation of NaCl in DMPG suppresses the anomalous extended melting regime, concurrently enhancing the single-particle lipid dynamics, both the lateral diffusivity and (to a lesser extent) the internal lipid motion. This seems rather counterintuitive and in variance with the dynamic suppression effect exerted by a salt on a zwitterionic membrane. However, since incorporation of a salt in anionic DMPG leads to enhanced cooperativity, the disrupted cooperativity in the salt-free DMPG is associated with the baseline lipid dynamics that is suppressed to begin with, whereas addition of salt partially restores the cooperativity, thus enhancing lipid dynamics compared to the salt-free baseline DMPG membrane state. These results provide new insights into the ion-membrane interaction and divulge a correlation between microscopic dynamics and the structure of the lipid bilayer.

Modulation of Diffusion Mechanism and Its Correlation with Complexation in Aqueous Deep Eutectic Solvents

Aqueous mixtures of deep eutectic solvents (DESs) have gained traction recently as an effective template to tailor their physicochemical properties. But detailed microscopic insights into the effects of water on the molecular relaxation phenomenon in DESs are not entirely understood. DESs are strong network-forming liquids due to the extensive hydrogen bonding and complex formation between their species, and therefore, water can behave as a controlled disruptor altering the microscopic structure and dynamics in DESs. In this study, the role of water in the diffusion mechanism of acetamide in the aqueous mixtures of DESs synthesized using acetamide and lithium perchlorate is investigated using molecular dynamics (MD) simulation and quasielastic neutron scattering (QENS). The acetamide dynamics comprises localized diffusion within transient cages and a jump diffusion process across cages. The jump diffusion process is observed to be strongly enhanced by about a factor of 10 as the water content in the system is increased. Meanwhile, the geometry of the localized dynamics is unaltered by addition of water, but the localized diffusion becomes significantly faster and more heterogeneous with increasing water concentration. The accelerating effects of water on localized diffusion are also substantiated by QENS experiments. The water concentration in the DES is observed to control the solvation structure of lithium ions, with the ions becoming significantly hydrated at 20 wt % water. The formation of interwater and water-acetamide hydrogen bonds is observed. The increase in water concentration is found to increase the number of H-bonds; however, their lifetimes are found to decrease substantially. Similarly, the lifetimes of acetamide-lithium complexes are also found to be diminished by increasing water concentration. A power-law scaling relationship between lifetimes and diffusion constants is established, elucidating the extent of coupling between diffusive processes and hydrogen bonding and microscopic complexation. This study demonstrates the ability to use water as an agent to probe the role of structural relaxation and complex lifetimes of diffusive processes at different time and length scales.

Clinical characteristics, echocardiographic features and long-term outcomes of patients with ischaemic versus non-ischaemic left ventricular thrombus

Background

Left ventricular thrombus (LVT) may develop in patients following myocardial infarction (MI), as well as in ischaemic and non-ischaemic cardiomyopathies, and may result in acute ischaemic stroke. Smaller studies comparing LVT associated with ischaemic and non-ischaemic aetiologies only reported 1-year outcomes or focused on specific subpopulations. We aimed to compare the clinical and echocardiographic characteristics and longer-term outcomes in a large population of patients with ischaemic versus non-ischaemic LVT.

Methods

This was a retrospective study of 552 consecutive patients with echocardiographically-identified LVT from March 2011 to January 2021 at a tertiary centre. Ischaemic LVT included LVT associated with MI and ischaemic cardiomyopathy. Non-ischaemic LVT included cases without evidence of ischaemia. Echocardiographic images were interpreted by trained cardiologists. We studied thrombus resolution as well as 5-year rates of ischaemic stroke and all-cause mortality.

Results

Of the 552 patients, mean age was 59.9 years and 84.4% were male. 492 patients had ischaemic LVT and 60 patients had non-ischaemic LVT. Ischaemic LVT was associated with older age (60.4 versus 55.3 years), male sex (86.8% versus 65.0%), smoking (49.2% versus 25.0%) and hyperlipidaemia (54.3% versus 28.3%). Left ventricular ejection fraction (LVEF) was lower in non-ischaemic LVT (28.9% versus 31.9%). LVEF ≤35% was associated with increased mortality in ischaemic LVT (HR 2.11, 95% CI 1.32–3.38). Rates of thrombus resolution, stroke and all-cause mortality were similar in the 2 groups. Anticoagulation was associated with a lower risk of stroke in ischaemic LVT (HR 0.32, 95% CI 0.16–0.66) and lower mortality in both ischaemic (HR 0.44, 95% CI 0.26–0.72) and non-ischaemic LVT (HR 0.14, 95% CI 0.03–0.61).

Conclusion

Patients with ischaemic LVT were more often older, male, smokers and had cardiovascular co-morbidities compared to those with non-ischaemic LVT. Thrombus resolution, stroke and all-cause mortality rates were similar in both groups. Anticoagulation was associated with lower mortality but this needs to be investigated in future prospective studies.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CHS was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Faculty Scheme

Multiscale lipid membrane dynamics as revealed by neutron spectroscopy

The plasma membrane is one of the principal structural components of the cell and, therefore, one of the key components of the cellular life. Because the membrane's dynamics links the membrane's structure and function, the complexity and the broad range of the membrane's motions are essential for the enormously diverse functionality of the cell membrane. Even for the main membrane component, the lipid bilayer, considered alone, the range and complexity of the lipid motions are remarkable. Spanning the time scale from sub-picosecond to minutes and hours, the lipid motion in a bilayer is challenging to study even when a broad array of dynamic measurement techniques is employed. Neutron scattering plays a special role among such dynamic measurement techniques, particularly, because it involves the energy transfers commensurate with the typical intra- and inter- molecular dynamics and the momentum transfers commensurate with intra- and inter-molecular distances. Thus, using neutron scattering-based techniques, the spatial and temporal information on the lipid motion can be obtained and analysed simultaneously. Protium vs. deuterium sensitivity and non-destructive character of the neutron probe add to the remarkable prowess of neutron scattering for elucidating the lipid dynamics. Herein we present an overview of the neutron scattering-based studies of lipid dynamics in model membranes, with a discussion of the direct relevance and implications to the real-life cell membranes. The latter are much more complex systems than simple model membranes, consisting of heterogeneous non-stationary domains composed of lipids, proteins, and other small molecules, such as carbohydrates. Yet many fundamental aspects of the membrane behavior and membrane interactions with other molecules can be understood from neutron scattering measurements of the model membranes. For example, such studies can provide a great deal of information on the interactions of antimicrobial compounds with the lipid matrix of a pathogen membrane, or the interactions of drug molecules with the plasma membrane. Finally, we briefly discuss the recently emerging field of neutron scattering membrane studies with a reach far beyond the model membrane systems.

Double zero tillage and foliar phosphorus fertilization coupled with microbial inoculants enhance maize productivity and quality in a maize-wheat rotation

Maize is an important industrial crop where yield and quality enhancement both assume greater importance. Clean production technologies like conservation agriculture and integrated nutrient management hold the key to enhance productivity and quality besides improving soil health and environment. Hence, maize productivity and quality were assessed under a maize–wheat cropping system (MWCS) using four crop-establishment and tillage management practices [FBCT–FBCT (Flat bed–conventional tillage both in maize and wheat); RBCT–RBZT (Raised bed–CT in maize and raised bed–zero tillage in wheat); FBZT–FBZT (FBZT both in maize and wheat); PRBZT–PRBZT (Permanent raised bed–ZT both in maize and wheat], and five P-fertilization practices [P₁₀₀ (100% soil applied-P); P₅₀ + 2FSP (50% soil applied-P + 2 foliar-sprays of P through 2% DAP both in maize and wheat); P₅₀ + PSB + AM-fungi; P₅₀ + PSB + AMF + 2FSP; and P₀ (100% NK with no-P)] in split-plot design replicated-thrice. Double zero-tilled PRBZT–PRBZT system significantly enhanced the maize grain, starch, protein and oil yield by 13.1–19% over conventional FBCT–FBCT. P₅₀ + PSB + AMF + 2FSP, integrating soil applied-P, microbial-inoculants and foliar-P, had significantly higher grain, starch, protein and oil yield by 12.5–17.2% over P₁₀₀ besides saving 34.7% fertilizer-P both in maize and on cropping-system basis. P₅₀ + PSB + AMF + 2FSP again had significantly higher starch, lysine and tryptophan content by 4.6–10.4% over P₁₀₀ due to sustained and synchronized P-bioavailability. Higher amylose content (24.1%) was observed in grains under P₅₀ + PSB + AMF + 2FSP, a beneficial trait due to its lower glycemic-index highly required for diabetic patients, where current COVID-19 pandemic further necessitated the use of such dietary ingredients. Double zero-tilled PRBZT–PRBZT reported greater MUFA (oleic acid, 37.1%), MUFA: PUFA ratio and P/S index with 6.9% higher P/S index in corn-oil (an oil quality parameter highly required for heart-health) over RBCT-RBCT. MUFA, MUFA: PUFA ratio and P/S index were also higher under P₅₀ + PSB + AMF + 2FSP; avowing the obvious role of foliar-P and microbial-inoculants in influencing maize fatty acid composition. Overall, double zero-tilled PRBZT–PRBZT with crop residue retention at 6 t/ha per year along with P₅₀ + PSB + AMF + 2FSP while saving 34.7% fertilizer-P in MWCS, may prove beneficial in enhancing maize productivity and quality so as to reinforce the food and nutritional security besides boosting food, corn-oil and starch industry in south-Asia and collateral arid agro-ecologies across the globe.

Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis

BACKGROUND

Transient hyperglycaemia in the context of illness with or without known diabetes has been termed as 'stress hyperglycaemia'. Stress hyperglycaemia can result in poor functional outcomes in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy. We investigated the association between stress hyperglycaemia and clinical outcomes in AIS patients undergoing intravenous thrombolysis (IVT).

METHODS

We examined 666 consecutive patients with AIS who underwent IVT from 2006 to 2018. All patients had a glycated haemoglobin level (HbA1c) and fasting venous blood glucose measured within 24 h of admission. Stress hyperglycaemia ratio (SHR) was defined as the ratio of the fasting glucose to the HbA1c. Univariate and multivariate analyses were employed to identify predictors of poor functional outcomes (modified Rankin Scale 3-6 at 3 months) after IVT.

RESULTS

Three-hundred and sixty-one patients (54.2%) had good functional outcomes. These patients tended to be younger (60.7 ± 12.7 vs. 70 ± 14.4 years, P < 0.001), male (70.7% vs. 51.5%, P < 0.001), had lower prevalence of atrial fibrillation (13.0% vs. 20.7%, P = 0.008) and lower SHR (0.88 ± 0.20 vs. 0.99 ± 26, P < 0.001). Patients with high SHR (≥0.97) were slightly older than those with low SHR (<0.97) and were more likely to have diabetes mellitus. On multivariate analysis, higher SHR was independently associated with poor functional outcomes (adjusted odds ratio 3.85, 95% confidence interval 1.59-9.09, P = 0.003).

CONCLUSION

SHR appears to be an important predictor of functional outcomes in patients with AIS undergoing IVT. This may have important implications on the role of glycaemic control in the acute management of ischaemic stroke.

Transethnic analysis of psoriasis susceptibility in South Asians and Europeans enhances fine-mapping in the MHC and genomewide

Because transethnic analysis may facilitate prioritization of causal genetic variants, we performed a genomewide association study (GWAS) of psoriasis in South Asians (SAS), consisting of 2,590 cases and 1,720 controls. Comparison with our existing European-origin (EUR) GWAS showed that effect sizes of known psoriasis signals were highly correlated in SAS and EUR (Spearman ρ = 0.78; p < 2 × 10-14). Transethnic meta-analysis identified two non-MHC psoriasis loci (1p36.22 and 1q24.2) not previously identified in EUR, which may have regulatory roles. For these two loci, the transethnic GWAS provided higher genetic resolution and reduced the number of potential causal variants compared to using the EUR sample alone. We then explored multiple strategies to develop reference panels for accurately imputing MHC genotypes in both SAS and EUR populations and conducted a fine-mapping of MHC psoriasis associations in SAS and the largest such effort for EUR. HLA-C*06 was the top-ranking MHC locus in both populations but was even more prominent in SAS based on odds ratio, disease liability, model fit and predictive power. Transethnic modeling also substantially boosted the probability that the HLA-C*06 protein variant is causal. Secondary MHC signals included coding variants of HLA-C and HLA-B, but also potential regulatory variants of these two genes as well as HLA-A and several HLA class II genes, with effects on both chromatin accessibility and gene expression. This study highlights the shared genetic basis of psoriasis in SAS and EUR populations and the value of transethnic meta-analysis for discovery and fine-mapping of susceptibility loci.

Can the microscopic and macroscopic transport phenomena in deep eutectic solvents be reconciled?

Deep eutectic solvents (DESs) have become ubiquitous in a variety of industrial and pharmaceutical applications since their discovery. However, the fundamental understanding of their physicochemical properties and their emergence from the microscopic features is still being explored fervently. Particularly, the knowledge of transport mechanisms in DESs is essential to tune their properties, which shall aid in expanding the territory of their applications. This perspective presents the current state of understanding of the bulk/macroscopic transport properties and microscopic relaxation processes in DESs. The dependence of these properties on the components and composition of the DES is explored, highlighting the role of hydrogen bonding (H-bonding) interactions. Modulation of these interactions by water and other additives, and their subsequent effect on the transport mechanisms, is also discussed. Various models (e.g. hole theory, free volume theory, etc.) have been proposed to explain the macroscopic transport phenomena from a microscopic origin. But the formation of H-bond networks and clusters in the DES reveals the insufficiency of these models, and establishes an antecedent for dynamic heterogeneity. Even significantly above the glass transition, the microscopic relaxation processes in DESs are rife with temporal and spatial heterogeneity, which causes a substantial decoupling between the viscosity and microscopic diffusion processes. However, we propose that a thorough understanding of the structural relaxation associated to the H-bond dynamics in DESs will provide the necessary framework to interpret the emergence of bulk transport properties from their microscopic counterparts.

Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar “V” osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Water accelerates the hydrogen-bond dynamics and abates heterogeneity in deep eutectic solvent based on acetamide and lithium perchlorate

Deep eutectic solvents (DESs) have become a prevalent and promising medium in various industrial applications. The addition of water to DESs has attracted a lot of attention as a scheme to modulate their functionalities and improve their physicochemical properties. In this work, we study the effects of water on an acetamide based DES by probing its microscopic structure and dynamics using classical molecular dynamics simulation. It is observed that, at low water content, acetamide still remains the dominant solvate in the first solvation shell of lithium ions, however, beyond 10 wt. %, it is replaced by water. The increase in the water content in the solvent accelerates the H-bond dynamics by drastically decreasing the lifetimes of acetamide-lithium H-bond complexes. Additionally, water-lithium H-bond complexes are also found to form, with systematically longer lifetimes in comparison to acetamide-lithium complexes. Consequently, the diffusivity and ionic conductivity of all the species in the DES are found to increase substantially. Non-Gaussianity parameters for translational motions of acetamide and water in the DES show a conspicuous decrease with addition of water in the system. The signature of jump-like reorientation of acetamide is observed in the DES by quantifying the deviation from rotational Brownian motion. However, a notable decrease in the deviation is observed with an increase in the water content in the DES. This study demonstrates the intricate connection between H-bond dynamics and various microscopic dynamical parameters in the DES, by investigating the modulation of the former with addition of water.

A split-tattoo randomized Q-switched neodymium-doped yttrium-aluminium-garnet laser trial comparing the efficacy of a novel three-pass, one-session method with a conventional method in the treatment of blue/black tattoos in darker skin types

Tattoos with blue/black ink show good lightening of pigment after treatment with 1064 nm Q-switched (QS) neodymium-doped yttrium-aluminium-garnet (Nd:YAG) laser. In this randomized trial, we compared the efficacy of a novel three pass, one session procedure (R15 method) with a conventional method for treating blue/black tattoos in darker skin types. Tattoos were treated with 1064 nm QS Nd:YAG Laser with a spot size of 4 mm, fluence of 5 J/cm² and frequency of 5 Hz. The tattoo pigment lightening was comparable with both methods. Thread-like tattoos had significantly better pigment lightening with fewer side effects than the broad band-like tattoos. We would like to recommend the R15 method of the QS Nd:YAG laser for thread-like tattoos, which can save patients' time, cut short the frequency of their hospital visits and, more importantly, decrease the cost involved in it.

Genu valgum deformity - correction by a wedgeless implantless femoral "V" osteotomy

Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.

Diffusion of confined fluids in microporous zeolites and clay materials

Fluids exhibit remarkable variation in their structural and dynamic properties when they are confined at the nanoscopic scale. Various factors, including geometric restriction, the size and shape of the guest molecules, the topology of the host, and guest-host interactions, are responsible for the alterations in these properties. Due to their porous structures, aluminosilicates provide a suitable host system for studying the diffusion of sorbates in confinement. Zeolites and clays are two classes of the aluminosilicate family, comprising very ordered porous or layered structures. Zeolitic materials are important due to their high catalytic activity and molecular sieving properties. Guest molecules adsorbed by zeolites display many interesting features including unidimensional diffusion, non-isotropic rotation, preferred orientation and levitation effects, depending on the guest and host characteristics. These are useful for the separation of hydrocarbons which commonly exist as mixtures in nature. Similarly, clay materials have found application in catalysis, desalination, enhanced oil recovery, and isolation barriers used in radioactive waste disposal. It has been shown that the bonding interactions, level of hydration, interlayer spacing, and number of charge-balancing cations are the important factors that determine the nature of diffusion of water molecules in clays. Here, we present a review of the current status of the diffusion mechanisms of various adsorbed species in different microporous zeolites and clays, as investigated using quasielastic neutron scattering and classical molecular dynamics simulation techniques. It is impossible to write an exhaustive review of the subject matter, as it has been explored over several decades and involves many research topics. However, an effort is made to cover the relevant issues specific to the dynamics of different molecules in microporous zeolites and clay materials and to highlight a variety of interesting features that are important for both practical applications and fundamental aspects.

Impact of a Psychodermatological Education Package on the Subjective Distress, Family Burden, and Quality of Life among the Primary Caregivers of Children Affected with Epidermolysis Bullosa

Background

Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL.

Objectives

To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB.

Methods

In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied.

Results

The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI.

Conclusions

PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.

Contrasting Behaviors of FA and MA Cations in APbBr3

It is known that the organic units in hybrid halide perovskites are free to rotate, but it is not clear if this freedom is of any relevance to the structure-property relationship of these compounds. We have employed quasi-elastic neutron scattering using two different spectrometers, thus providing a wide dynamic range to investigate the cation dynamics in methylammonium lead bromide (MAPbBr₃) and formamidinium lead bromide (FAPbBr₃) over a large temperature range covering all known crystallographic phases of these two compounds. Our results establish a plastic crystal-like phase forming above 30 K within the orthorhombic phase of MAPbBr₃ related to 3-fold rotations of MA units around the C-N axis with an activation energy, E_a, of ∼27 meV, which has no counterpart in the FA compound. MA exhibits an additional 4-fold orientational motion of the whole molecule via rotation of the C-N axis itself with an E_a of ∼68 meV common for the high-temperature tetragonal and cubic phases. In contrast, the FA compound exhibits only an isotropic orientational motion of the whole FA unit with E_a ≈ 106 meV within the orthorhombic phase and a substantially reduced common E_a of ∼62 meV for the high-temperature tetragonal and cubic phases. Our results suggest that the rotational dynamics of the organic units, crystallographic phases, and physical properties of these compounds are intimately connected.

A split face randomized controlled trial comparing 1,064 nm Q-switched Nd-YAG laser and modified Kligman's formulation in patients with melasma in darker skin

BACKGROUND

No randomized studies compared the efficacy and safety of modified Kligman's triple combination (TC) with 1,064 nm Q-switched Nd-YAG laser (QSNYL) in melasma in darker skin.

OBJECTIVES

To compare the efficacy and safety of QSNYL and TC in the treatment of melasma in Fitzpatrick skin types IV and V.

METHODS

In this split face randomized controlled trial, participants' cheeks were randomized to receive either weekly QSNYL (group A) or daily TC (group B) for 12 weeks, followed by 12 weeks of follow-up.

RESULTS

Twenty-eight patients completed the intervention, and 21 of them completed follow-up. We found a significant but modest reduction in mean melanin index, modified Melasma Area Severity Index (MASI), and photographic and patient's assessment in both modalities (P < 0.01). No significant differences were detected between the groups. All patients had reappearance of pigmentation by the end of follow-up. Adverse reactions were significantly more in group B (P < 0.001).

LIMITATION

The desired sample size could not be achieved.

CONCLUSION AND RELEVENCE

No statistically significant differences were observed between QSNYL and TC as monotherapy in melasma. Reappearance of melasma is inevitable after stopping treatment.

Comparison of Platelet-Rich Plasma Prepared Using Two Methods: Manual Double Spin Method versus a Commercially Available Automated Device

Background:

In the absence of a standard protocol, several methods and devices have been used for preparing platelet-rich plasma (PRP) with varying platelet concentrations.

Methods:

Venous blood sample from 20 patients was used for preparing PRP using two methods: a manual double-spin method (1^st spin at 160 g × 10 min, 2^nd spin at 400 g × 10 min), and using a commercially available automated device (DrPRP-Kit®, REMI Laboratory Instruments). Platelet, erythrocyte, and total leukocyte counts were calculated for each PRP sample and compared.

Results:

Platelet count in the PRP prepared with the manual double-spin method (PRP_m, 12.51 ± 5.89 × 10⁵/μL) as well as with the automated device (PRP_a, 7.25 ± 4.74 × 10⁵/μL) had significantly higher mean platelet count than whole blood (2.58 ± 0.81 × 10⁵/μL, P < 0.001). The mean platelet count in PRP_m was statistically significantly higher than PRP_a (P < 0.001). The platelet capture efficiency of the manual method (mean 47.11%, median 41.75%) was statistically significantly higher than that of the automated device (mean 31.89%, 29.51%, P = 0.012). Platelet counts in both PRPs were variable, but the counts were more dispersed in PRP_a(coefficient of variation 65%) as compared to PRP_m(coefficient of variation 47%).

Conclusion:

The manual double-spin method had a higher platelet capture efficiency resulting in a higher platelet concentration as compared to the automated device. Though there was a significant interindividual variation in the platelet yield in the PRPs produced by both methods, results were more consistent with the manual method.

A split-face randomized controlled study comparing the efficacy and safety of intralesional radiofrequency-assisted subcision vs conventional subcision in postacne scars

BACKGROUND

Postacne scars have significant psychosocial distress among patients. Subcision is a well-known treatment modality specially for rolling type of acne scars, but is a crude mechanical process, which carries a risk of hematoma formation.

AIMS

To compare the efficacy and safety of radiofrequency-assisted subcision (rSubcision) with conventional subcision in postacne scars.

METHODS

In this randomized, split-face study, adult patients with postacne scars were randomized to receive either conventional subcision or rSubcision in 2 sessions, 4 weeks apart and followed up for 2 months. Outcome was measured using Goodman and Baron score (GBS), investigator global assessment (IGA) by two blinded dermatologists, and patient global assessment (PGA).

RESULTS

Seventeen out of 21 patients completed the treatment. Statistical analysis of the results was performed using SPSS 15.0 statistical software (SPSS). Patients in both the groups had significant improvement from baseline according to quantitative scoring (P = .0001), number of scars (P = .0001), IGA, and PGA. The improvement was comparable in both the groups according to GBS and IGA but better on rSubcision side in terms of PGA. Two patients developed small entry point burn during rSubcision which healed in one month and one developed persistent hematoma with conventional subcision.

CONCLUSIONS

Both modalities were comparable in terms of assessment scores and investigator assessment, but patients found improvement better on rSubcision side.

Intravenous thrombolysis for large vessel or distal occlusions presenting with mild stroke severity

BACKGROUND AND PURPOSE

We investigated the effectiveness of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) patients with large vessel or distal occlusions and mild neurological deficits, defined as National Institutes of Health Stroke Scale scores < 6 points.

METHODS

The primary efficacy outcome was 3-month functional independence (FI) [modified Rankin Scale (mRS) scores 0-2] that was compared between patients with and without IVT treatment. Other efficacy outcomes of interest included 3-month favorable functional outcome (mRS scores 0-1) and mRS score distribution at discharge and at 3 months. The safety outcomes comprised all-cause 3-month mortality, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH and severe systemic bleeding.

RESULTS

We evaluated 336 AIS patients with large vessel or distal occlusions and mild stroke severity (mean age 63 ± 15 years, 45% women). Patients treated with IVT (n = 162) had higher FI (85.6% vs. 74.8%, P = 0.027) with lower mRS scores at hospital discharge (P = 0.034) compared with the remaining patients. No differences were detected in any of the safety outcomes including symptomatic ICH, asymptomatic ICH, severe systemic bleeding and 3-month mortality. IVT was associated with higher likelihood of 3-month FI [odds ratio (OR), 2.19; 95% confidence intervals (CI), 1.09-4.42], 3-month favorable functional outcome (OR, 1.99; 95% CI, 1.10-3.57), functional improvement at discharge [common OR (per 1-point decrease in mRS score), 2.94; 95% CI, 1.67-5.26)] and at 3 months (common OR, 1.72; 95% CI, 1.06-2.86) on multivariable logistic regression models adjusting for potential confounders, including mechanical thrombectomy.

CONCLUSIONS

Intravenous thrombolysis is independently associated with higher odds of improved discharge and 3-month functional outcomes in AIS patients with large vessel or distal occlusions and mild stroke severity. IVT appears not to increase the risk of systemic or symptomatic intracranial bleeding.

Effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with lichen planus pigmentosus: A pilot study

The persistent discoloration in lichen planus pigmentosus (LPP) is secondary to persistent melanophages in the superficial dermis in these patients. We evaluated the effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with LPP. Nine females with a clinical diagnosis of LPP were included in the study. After six sessions of laser with toning protocol, performed over a representative area of 5 × 5 cm² at 2-weekly intervals, the mean clinical improvement as per the physician assessment was 25.7% (10-40%). There was no significant reduction in melanin and erythema index. On expression analysis using quantitative-polymerase chain reaction, the reduction in tyrosinase (p = 0.03) was statistically significant, though, the reduction in other pigment and immunological markers was not significant. The immunohistochemistry quantification data of corresponding proteins also did not show any significant difference. Post inflammatory hypopigmentation was noted in one patient. Q-switched Nd-YAG laser toning protocol resulted in modest clinical and histological improvement in patients of LPP.

Rituximab as an adjuvant therapy for pemphigus: experience in 61 patients from a single center with long-term follow-up

BACKGROUND

Rituximab is increasingly being used as an adjuvant treatment for recalcitrant or relapsed pemphigus, but information on its use as a first-line agent is limited. We describe the long-term effectiveness and safety of rituximab in the treatment of pemphigus and compare the treatment outcomes when rituximab is used as first-line treatment vis-à-vis after treatment failure or relapse.

METHODS

This was a retrospective review of 61 patients with pemphigus treated with rituximab at our center from March 2012 to October 2018.

RESULTS

Of the 61 patients, 51 achieved complete remission (on or off treatment) and 10 had partial remission. Forty-nine (80.33%) patients achieved complete remission off prednisolone over a mean period of 8.08 ± 4.45 (range 3-20) months. Seventeen (27.9%) patients relapsed after a mean period of 23.94 ± 13.15 months after first rituximab cycle and 15.97 + 13.7 months after stopping prednisolone. Treatment-related serious adverse effects were noted in six (9.8%) patients. Eighteen (29.5%) patients were administered rituximab as the first-line adjuvant, while 43 (70.5%) patients received it after treatment failure or relapse. In both groups, remission rates on prednisolone (88.9%, 81.4%) and off prednisolone (88.9%, 76.7%) were comparable (P > 0.05). Relapse rates in the group which received rituximab as first-line treatment were about half of those who received rituximab after relapse or treatment failure (16.7% vs. 32.6%, P = 0.348). No statistically significant difference was seen in the times to different treatment endpoints (disease control, complete remission on and off prednisolone, and relapse) between the two groups.

CONCLUSIONS

Rituximab is a safe and effective adjuvant in the treatment of pemphigus. Treatment outcomes were better for patients who received rituximab as first-line treatment, but the difference was not statistically significant.

Membrane softening by nonsteroidal anti-inflammatory drugs investigated by neutron spin echo

In spite of their well-known side effects, the nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications for their antipyretic and anti-inflammatory actions. Interaction of NSAIDs with the plasma membrane plays a vital role in their therapeutic actions and defines many of their side effects. In the present study, we investigate the effects of three NSAIDs, aspirin, ibuprofen, and indomethacin, on the structure and dynamics of a model plasma membrane using a combination of small angle neutron scattering (SANS) and neutron spin echo (NSE) techniques. The SANS and NSE measurements were carried out on a 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) membrane, with and without NSAIDs, at two different temperatures, 11 °C and 37 °C, where the DMPC membrane is in the gel and fluid phase, respectively. SANS data analysis shows that incorporation of NSAIDs leads to bilayer thinning of the membrane in both the phases. The dynamic properties of the membrane are represented by the intermediate scattering functions for NSE data, which are successfully described by the Zilman and Granek model. NSE data analysis shows that in both gel and fluid phases, addition of NSAIDs results in a decrease in the bending rigidity and compressibility modulus of the membrane, which is more prominent when the membrane is in the gel phase. The magnitude of the effect of NSAIDs on the bending rigidity and compressibility modulus of the membrane in the gel phase follows an order of ibuprofen > aspirin > indomethacin, whereas in the fluid phase, it is in the order of aspirin > ibuprofen > indomethacin. We find that the interaction between NSAIDs and phospholipid membranes is strongly dependent on the chemical structure of the drugs and physical state of the membrane. Mechanical properties of the membrane can be quantified by the membrane's bending rigidity. Hence, the present study reveals that incorporation of NSAIDs modulates the mechanical properties of the membrane, which may affect several physiological processes, particularly those linked to the membrane curvature.

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient's quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P <  0.01), recreation and mood (P <  0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.

DRD2 methylation and regional grey matter volumes in young adult offspring from families at ultra-high risk for alcohol dependence

Dopaminergic alteration is a prominent feature in those with AD and may influence brain development in those with a family history of AD. MRI scans (3T) from 43 HR offspring (27.4 ± 3.6 years) and 45 controls (24.5 ± 4.1 years) provided whole brain (WB) and region of interest (ROI) analyses. The VBM8 toolbox was used for WB analysis (threshold p < 0.005; cluster = 100 voxels); the MarsBaR ROI toolbox provided region of interest data. Pyrosequencing of CpG sites within the DRD2 gene was performed. DRD2 methylation was significantly increased in association with familial high-risk status. Significant familial risk group differences were seen with HR individuals showing reduced volume of the Left Inferior Temporal, Left Fusiform and Left Insula regions relative to LR controls. These regions have previously been linked to social cognition. DRD2 methylation was negatively related to grey matter volumes in these regions. Because these regions, have been previously linked to facial affect perception and social cognition, lesser grey matter volumes in individuals at high-risk for developing AD suggests that neural underpinnings of social cognitive impairment may be a premorbid risk factors for AD.

Safety and efficacy of autologous noncultured dermal cell suspension transplantation in the treatment of localized facial volume loss: A pilot study

Background

Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost.

Aim

To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies.

Methods

It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done.

Results

On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10-90%) and 80% (range: 0-90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0-40) and 0% (range: 0-50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89-6.04 mm), which increased to 2.912 mm (range: 0.88-7.07 mm, P = 0.03) at 6 months.

Limitations

Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients.

Conclusions

Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects.

In vitro assessment of gentamicin and azithromycin-based combination therapy against Neisseria gonorrhoeae isolates in India

PURPOSE

The public health burden of infections caused by Neisseria gonorrhoeae is magnified due to high rates of resistance to traditional antimicrobials. The aim of this study was to evaluate the in vitro efficacy of an alternative dual therapy comprising gentamicin and azithromycin.

METHODOLOGY

The E-test method was used to determine the minimum inhibitory concentrations (MICs) of gentamicin and azithromycin individually prior to testing in combination using the cross or 90^o angle formation method. A total of 70 clinical isolates of N.gonorrhoeae displaying varying ceftriaxone MICs along with 2 reference strains (WHO K and P) and 1 ceftriaxone-resistant QA isolate were examined. The fractional inhibitory concentration index (FICI) was calculated and the results were interpreted using the following criteria: synergy, FICI ≤0.5; indifference or additive, FICI >0.5 to ≤4.0; and antagonism, FICI >4.0.

RESULTS

A total of 54 (77.1 %) isolates displayed indifference, while 16 (22.9 %) demonstrated synergy. When azithromycin was tested alone, the MICs ranged from 0.016 to 2 µg ml^-1 . However, in combination with gentamicin, the mean MIC value of all isolates decreased from 0.275 µg ml^-1 to 0.090 µg ml^-1 (P=0.05).When gentamicin was tested alone, the MICs ranged from 0.25 to 8 µg ml^-1, with a mean MIC of 4.342 µg ml^-1, whereas in combination with azithromycin it decreased significantly to 2.042 µg ml^-1 (P=0.04).

CONCLUSION

No antagonism was observed in this combination, suggesting that it could be a future treatment option as we prepare for a post-cephalosporin era. However, comprehensive in vivo evaluations are warranted and recommendations should be made based on clinical trials.