Deciphering multi-temporal scale dynamics in the concentration, sources and processes of near surface ozone over different climatic regions of India

This study aims to investigate the factors influencing seasonal and long-term (2003-2021) changes in the near surface ozone (850 hpa) concentrations over different climatic sub-regions of India. Detailed comparison of daily (2019-2021) near surface ozone values of ERA-5 and CAAQMS (Continuous Ambient Air Quality Monitoring Stations) ground-based measurements revealed that ERA-5 is temporally in phase with CAAQMS measurements falling indifferent climatic sub-regions of India. ERA-5 near surface ozone shows statistically significant long-term (2003-2021) positive trends [2-4 percent per decade (ppd)] over most of the climatic sub-regions, over Indo-Gangetic Planes (IGPs), Southern and Central India trends are particularly strong. Trends were also estimated for each season separately, which were largely positive (2-6 ppd) over Central and Southern India in the Autumn and Winter seasons. Extensive climatological analysis reveals that the reversal of winds in the Indian monsoonal system plays a vital role in such trend patterns across the Indian subcontinent. South-westerly winds from June through September presumably bring ozone deficit air of marine origin, thus causing a dilution effect while the North-easterly winds during late Autumn and early Winters plausibly bring ozone-rich air from the stratospheric-tropospheric efflux dominated Himalayan region. It allows near surface ozone enhancement over Central and Southern India. Seasonal Principal component analysis (PCA) revealed that precursor gases (CH4 and NO2) and climatic variables especially specific humidity (SH) are the primary drivers of near surface ozone variability in the Winter season, while in Spring, climatic variables like boundary layer height (BLH), temperature (T) and SH have a significant role. Principal component regression (PCR) reveals a long-term increase in near surface ozone levels mostly dominated by precursor concentration over IGPs and Southern sub-regions. Whereas, BLH, T and SH significantly explain near surface ozone trends over North-eastern and Coastal India.

Short-term treatment with cholestyramine increases long-acting anticoagulant rodenticide clearance from rabbits without affecting plasma vitamin K1 levels nor blood coagulation

Administration of high dose vitamin K1 (VK1) overcomes coagulopathy and bleeding elicited by acute poisoning with long-acting anti-coagulant rodenticides (LAARs). However, long-term (months) treatment is required due to long LAAR biological half-lives that may lead to poor compliance and recurrent coagulopathy. The half-lives of LAARs are extended by slow metabolism, and similar to warfarin, are thought to undergo enterohepatic recirculation. We now show that treatment with the bile acid sequestrant cholestyramine (CSA) administered concomitantly with VK1 decreases plasma LAAR levels and increases LAAR fecal excretion. Daily CSA treatment for 14 days did not reduce plasma VK1 levels, nor increase prothrombin time. Collectively, these data show that CSA accelerates LAAR clearance from rabbits without adverse effects on VK1 anti-coagulation, and could provide an additional therapeutic option for treatment of LAAR poisoning.

Listening for rain: Principal component analysis and linear discriminant analysis for broadband acoustic rainfall detection

Rain falling on the ocean creates acoustic signals. Ma and Nystuen [(2005). J. Atmos. Oceanic Technol. 22, 1225-1248] described an algorithm that compares three narrowband "discriminant" frequencies to detect rain. In 2022, Trucco, Bozzano, Fava, Pensieri, Verri, and Barla [(2022). IEEE J. Oceanic Eng. 47(1), 213-225] investigated rain detection algorithms that use broadband spectral data averaged over 1 h. This paper implements a rainfall detector that uses broadband acoustic data at 3-min time resolution. Principal Component Analysis (PCA) reduces the dimensionality of the broadband data. Rainfall is then detected via a Linear Discriminant Analysis (LDA) on the data's principal component projections. This PCA/LDA algorithm was trained and tested on 5 months of data recorded by hydrophones in a shallow noisy cove, where it was not feasible to average spectral data over 1 h. The PCA/LDA algorithm successfully detected 78 ± 5% of all rain events over 1 mm/h, and 73 ± 5% of all rain events over 0.1 mm/h, for a false alarm rate of ≈ 1% in both cases. By contrast, the Ma and Nystuen algorithm detected 32 ± 5% of the rain events over 1.0 mm/h when run on the same data, for a comparable false alarm rate.

Systemic lupus erythematosus: latest insight into etiopathogenesis

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder of unknown etiology. Multifactorial interaction among various susceptible factors such as environmental, hormonal, and genetic factors makes it more heterogeneous and complex. Genetic and epigenetic modifications have been realized to regulate the immunobiology of lupus through environmental modifications such as diet and nutrition. Although these interactions may vary from population to population, the understanding of these risk factors can enhance the perception of the mechanistic basis of lupus etiology. To recognize the recent advances in lupus, an electronic search was conducted among search engines such as Google Scholar and PubMed, where we found about 30.4% publications of total studies related to genetics and epigenetics, 33.5% publications related to immunobiology and 34% related to environmental factors. These outcomes suggested that management of diet and lifestyle have a direct relationship with the severity of lupus that influence via modulating the complex interaction among genetics and immunobiology. The present review emphasizes the knowledge about the multifactorial interactions between various susceptible factors based on recent advances that will further update the understanding of mechanisms involved in disease pathoetiology. Knowledge of these mechanisms will further assist in the creation of novel diagnostic and therapeutic options.

A novel variant in the tropomyosin 3 gene presenting as an adult-onset distal myopathy - a case report

BACKGROUND

We report a patient with a novel c.737 C > T variant (p.Ser246Leu) of the TPM3 gene presenting with adult-onset distal myopathy.

CASE PRESENTATION

A 35-year-old Chinese male patient presented with a history of progressive finger weakness. Physical examination revealed differential finger extension weakness, together with predominant finger abduction, elbow flexion, ankle dorsiflexion and toe extension weakness. Muscle MRI showed disproportionate fatty infiltration of the glutei, sartorius and extensor digitorum longus muscles without significant wasting. Muscle biopsy and ultrastructural examination showed a non-specific myopathic pattern without nemaline or cap inclusions. Genetic sequencing revealed a novel heterozygous p.Ser246Leu variant (c.737C>T) of the TPM3 gene which is predicted to be pathogenic. This variant is located in the area of the TPM3 gene where the protein product interacts with actin at position Asp25 of actin. Mutations of TPM3 in these loci have been shown to alter the sensitivity of thin filaments to the influx of calcium ions.

CONCLUSION

This report further expands the phenotypic spectrum of myopathies associated with TPM3 mutations, as mutations in TPM3 had not previously been reported with adult-onset distal myopathy. We also discuss the interpretation of variants of unknown significance in patients with TPM3 mutations and summarise the typical muscle MRI findings of patients with TPM3 mutations.

Unique Clinical, Radiological and Histopathological Characteristics of a Southeast Asian Cohort of Patients with Limb-Girdle Muscular Dystrophy 2G/LGMD-R7-Telethonin-Related

AIM

We describe a cohort of five patients with limb-girdle muscular dystrophy (LGMD) 2G/LGMD-R7 in a South-east Asian cohort.

BACKGROUND

LGMD2G/LGMD-R7-telethonin-related is caused by mutations in the TCAP gene that encodes for telethonin.

METHODS

We identified consecutive patients with LGMD2G/LGMD-R7-telethonin-related, diagnosed at the National Neuroscience Institute (NNI) and National University Hospital (NUH) between January 2000 and June 2021.

RESULTS

At onset, three patients presented with proximal lower limb weakness, one patient presented with Achilles tendon contractures, and one patient presented with delayed gross motor milestones. At last follow up, three patients had a limb girdle pattern of muscle weakness and two had a facioscapular humeral pattern of weakness. Whole body muscle MRI performed for one patient with a facioscapular-humeral pattern of weakness showed a pattern of muscle atrophy similar to facioscapular-humeral dystrophy. One patient had histological features consistent with myofibrillar myopathy; electron microscopy confirmed the disruption of myofibrillar architecture. One patients also had reduced staining to telethonin antibody on immunohistochemistry.

CONCLUSION

We report the unique clinical and histological features of a Southeast Asian cohort of five patients with LGMD2G/LGMD-R7-telethonin-related muscular dystrophy and further expand its clinical and histopathological spectrum.

Bisphenol-A Mediated Impaired DRP1-GFER Axis and Cognition Restored by PGC-1α Upregulation Through Nicotinamide in the Rat Brain Hippocampus

The regulatory network of mitochondrial biogenesis and dynamics is vital for mitochondrial functions and cellular homeostasis. Any impairment in the mitochondrial network leads to neurodegenerative disorders. Our earlier studies suggest that environmental toxicant Bisphenol-A (BPA) exposure reduces neurogenesis by abnormal mitochondrial dynamics and mitochondrial biogenesis through impairment of mitochondrial fission factor dynamin-related protein (DRP1) and mitochondrial import protein GFER, which leads to demyelination, neurodegeneration, and cognitive deficits in the rats. In the present study, we found that chronic BPA exposure reduces PGC-1α levels (master regulator of mitochondrial biogenesis), alters mitochondrial localization of DRP1 and GFER, and reduces the number of PGC-1α/NeuN+ and PGC-1α/β-tubulin+ neurons in the rat hippocampus, suggesting reduced PGC-1α-mediated neurogenesis. Nicotinamide significantly increased PGC-1α protein levels, PGC-1α/NeuN+ co-labeled cells in BPA-treated rat hippocampus and PGC-1α/β-tubulin+ co-labeled cells in neuron culture derived from hippocampal neural stem cells. Interestingly, PGC-1α upregulation by nicotinamide also resulted in increased GFER levels and restored mitochondrial localization of GFER (increased GFER/TOMM20 co-labeled cells) in vitro and in vivo following BPA treatment. Nicotinamide also reduced DRP1 levels and prevented DRP1 mitochondrial localization in BPA-treated neuronal cultures and hippocampus, suggesting reduced mitochondrial fission. This resulted in reduced cytochrome c levels in neuronal culture and reduced hippocampal neurodegeneration (reduced caspase-3/NeuN+ co-labeled neurons) following nicotinamide treatment in BPA-treated group. Consequently, activation of PGC-1α by nicotinamide restored BPA-mediated cognitive deficits in rats. Results suggest that the treatment of nicotinamide has therapeutic potential and rescues BPA-mediated neuronal death and cognitive deficits by upregulating the PGC-1α and GFER-DRP1 link, thus balancing mitochondrial homeostasis.

Variations in the concentration, source activity, and atmospheric processing of PM2.5-associated water-soluble ionic species over Jammu, India

Concentrations, sources, and atmospheric processing of water-soluble ionic species associated with PM_2.5 collected from 2015 to 2017 were studied in Jammu, an urban location in the North-Western Himalayan Region (NWHR). Being ecologically sensitive and sparsely studied for dynamics in PM_2.5 and associated WSIS, the present study is important for developing robust air pollution abatement strategies for the air-shed of NWHR. Twenty-four hourly PM_2.5 samples were collected on weekly basis at a receptor site and analyzed for WSIS using ion chromatography system. On annual basis, total sum of WSIS (ΣWSIS) contributed about 28.5% of PM_2.5, where the contribution of sulfate-nitrate-ammonium, a proxy for secondary inorganic aerosols (SIA), was found to be 18.7% of PM_2.5. The ΣWSIS and PM_2.5 concentration showed a seasonal cycle with the maximum concentration during winters and the minimum in summers. Mass fraction of ΣWSIS in PM_2.5 showed an anti-phase seasonal pattern indicating more source activity during summers. Season-wise, dominant WSIS constituting PM_2.5 were NO₃^-, SO₄^2-, NH₄⁺, and K⁺ during winters; whereas summer was marked with dominant contributions from SO₄^2-, NH₄⁺, Ca²⁺, and K⁺. Seasonal variability exhibited among SIA constituents underscored the crucial role of air temperature and relative humidity regime. It was observed that nss-K⁺ + NH₄⁺ were sufficient to neutralize most of the acidic species arising from precursor gases (NO_x and SO_x). Using principal component analysis, five major sources and processes, viz. (a) biomass burning activities, (b) secondary inorganic aerosol formation, (c) input from re-suspended dust, (d) transported dust, and (e) fertilizer residue, were identified for the emissions of PM_2.5-associated WSIS over Jammu. In future studies, impacts of dry and/or wet deposition of aerosol-associated WSIS on the crop productivity in the region should be studied.

Apportionment of long-term trends in different sections of total ozone column over tropical region

The additive time-series decomposition analysis was performed on National Oceanic and Atmospheric Administration Solar Backscatter Ultraviolet Instrument Merge satellite dataset version 8.6 for the period January 1979 to December 2019 with an objective to detect and apportion long-term trends present in the total ozone column (TOC) and the long-term trends exist in the respective ozone contents present in the vertical sub-columns constituting the TOC viz. upper, middle and lower stratosphere as well as near-surface for the tropical region. Linear regression analysis was performed on the deseasonalized monthly mean time series of TOC and corresponding ozone contents present in each partitioned layer for three different time spans, viz. 1979-2019 (complete time series), 1979-1998 (pre-inflection years), and 1999-2019 (post-inflection years), where 1998 was taken as inflection year. For the complete time-series, statistically significant negative trends were observed in TOC and corresponding ozone contents in the sub-columns over most of the tropical region. Expectedly, during pre-inflection years, strong negative trends were noted for TOC and ozone contents in the partitioned vertical layers. In contrast, during the post-inflection year time span, long-term trends in TOC were statistically insignificant over two-third of the tropical region, but one-third of the subtropical region exhibited negative trends in TOC. During this time span, positive trends were observed in the ozone contents present in the upper stratospheric sub-column. However, negative trends in ozone contents persisted in the middle and the lower stratosphere. It was interesting to note that the ozone contents confined in near-surface layer manifested strong negative trends during pre-inflection years and the same reversed into strong positive trends that in post-inflection span. The observed, contrasting, long-term trends and variability in the respective partitioned layer of the TOC confounded any clear sign of recovery in the TOC over the tropical region. The continuation of declining trends in the middle stratosphere and increasing trends in the near-surface layer of ozone contents is a matter of concern.

Interplay of redox imbalance with matrix gelatinases in neutrophils and their association with disease severity in rheumatoid arthritis patients

Rheumatoid arthritis (RA) etiopathogenesis still remains complex, but involvement of several immune cells is evident. Present study focusses on evaluation of polymorphonuclear neutrophils (PMNs) in RA patients and healthy controls. From generation of oxidative species, release of inflammatory cytokines and matrix-degrading proteases, PMNs possess the ability to mediate immunological responses. Intracellular and mitochondrial ROS in PMNs and other oxidative parameters including catalase, superoxide dismutase, glutathione peroxidase, reduced glutathione and lipid peroxidation were measured in PMNs and serum samples. Gene regulation studies involved in oxidative (Keap1 and Nrf2) and degradative pathways (MMP2 and MMP9) were done using DNA methylation analysis. Intracellular expression levels of Keap1, Nrf2, Dnmt1, MMP2, and MMP9 were analyzed using flowcytometry in patients and controls. Moreover, serum levels of pro-inflammatory cytokines IL-1β, IL-6, and TNF-α were also measured. Comparative measurements amongst patients and controls were statistically analyzed, and correlations were made with disease severity scores (DAS28 ESR).

Heller myotomy versus Heller myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis

INTRODUCTION

Heller myotomy (HM) remains the gold standard procedure for achalasia. The addition of different types of fundoplication to HM has been debated in several studies. Given the contradictory reports, this meta-analysis was undertaken to compare different outcomes after HM and HM with fundoplication (HMF).

METHODS

An electronic search was performed among five major databases (PubMed, Ovid, Scopus, Cochrane Library, Google Scholar) from inception to October 2019, identifying all randomised and non-randomised studies comparing HM with HMF. Two authors searched electronic databases using the keywords 'achalasia' AND 'dysphagia' AND 'gastroesophageal reflux' and all data were pooled for random-effects meta-analysis. The primary and secondary outcomes were gastroesophageal reflux and dysphagia, respectively.

RESULTS

A total of six studies were included and involved 576 patients comparing HM and HMF. There was no statistically significant difference between gastroesophageal reflux in the HM vs HMF group (21.3% vs 22.9%, RR 1.32, 95% CI 0.60-2.88, p = 0.49). There was a slightly higher incidence of dysphagia observed in HM vs HMF (14.8% vs 10.8%, RR 1.54, 95% CI 0.98-2.41, p = 0.06).

CONCLUSIONS

There was no statistically significant difference in long-term outcomes between a group of patients undergoing HM and a group who underwent HM with fundoplication.

Imaging update in arthroplasty

Imaging of metal implants has historically been difficult, regardless of the applied modality. The number of primary arthroplasties is increasing over the years. With it, we expect the number of symptomatic complications to increase as well. Acquiring accurate imaging for diagnosis and treatment planning for these cases is of paramount importance. Significant advancements have been made to reduce artifacts, leading to better imaging representation of arthroplasty. This review article would give a background on the current ways of imaging arthroplasty and metal implants, covering recent advances in imaging techniques.

Bisphenol-A inhibits mitochondrial biogenesis via impairment of GFER mediated mitochondrial protein import in the rat brain hippocampus

Mitochondrial biogenesis relies on different protein import machinery, as mitochondrial proteins are imported from the cytosol. The mitochondrial intermembrane space assembly (MIA) pathway consists of GFER/ALR and CHCHD4/Mia40, responsible for importing proteins and their oxidative folding inside the mitochondria. The MIA pathway plays an essential role in complex IV (COX IV) biogenesis via importing copper chaperone COX17, associated with the respiratory chain. BPA, an environmental toxicant, found in consumable plastics, causes neurotoxicity via impairment in mitochondrial dynamics, neurogenesis, and cognitive functions. We studied the levels of key regulatory proteins of mitochondrial import pathways and mitochondrial biogenesis after BPA exposure in the rat hippocampus. BPA caused a significant reduction in the levels of mitochondrial biogenesis proteins (PGC1α, and TFAM) and mitochondrial import protein (GFER). Immunohistochemical analysis showed reduced co-localization of NeuN with GFER, PGC-1α, and TFAM suggesting impaired mitochondrial biogenesis and protein import. BPA exposure resulted in damaged mitochondria with distorted cristae in neurons and caused a significant reduction in GFER localization inside IMS as depicted by immunogold electron microscopy. The reduced levels of GFER resulted in defective COX17 import. The translocation of cytochrome c into the cytosol and increased cleaved caspase-3 levels triggered apoptosis due to BPA toxicity. Overall, our study implicates GFER as a potential target for impaired mitochondrial protein machinery, biogenesis, and apoptosis against BPA neurotoxicity in the rat hippocampus.

Nanomedicine against Alzheimer's and Parkinson's Disease

Alzheimer's and Parkinson's are the two most rampant neurodegenerative disorders worldwide. Existing treatments have a limited effect on the pathophysiology but are unable to fully arrest the progression of the disease. This is due to the inability of these therapeutic molecules to efficiently cross the blood-brain barrier. We discuss how nanotechnology has enabled researchers to develop novel and efficient nano-therapeutics against these diseases. The development of nanotized drug delivery systems has permitted an efficient, site-targeted, and controlled release of drugs in the brain, thereby presenting a revolutionary therapeutic approach. Nanoparticles are also being thoroughly studied and exploited for their role in the efficient and precise diagnosis of neurodegenerative conditions. We summarize the role of different nano-carriers and RNAi-conjugated nanoparticle-based therapeutics for their efficacy in pre-clinical studies. We also discuss the challenges underlying the use of nanomedicine with a focus on their route of administration, concentration, metabolism, and any toxic effects for successful therapeutics in these diseases.

Cypermethrin Impairs Hippocampal Neurogenesis and Cognitive Functions by Altering Neural Fate Decisions in the Rat Brain

Neurogenesis is a developmental process that involves fine-tuned coordination between self-renewal, proliferation, and differentiation of neural stem cells (NSCs) into neurons. However, early-life assault with environmental toxicants interferes with the regular function of genes, proteins, and other molecules that build brain architecture resulting in attenuated neurogenesis. Cypermethrin is a class II synthetic pyrethroid pesticide extensively used in agriculture, veterinary, and residential applications due to its low mammalian toxicity, high bio-efficacy, and enhanced stability. Despite reports on cypermethrin-mediated behavioral and biochemical alterations, till now, no study implicates whether cypermethrin exposure has any effect on neurogenesis. Therefore, the present study was undertaken to comprehend the effects of cypermethrin treatment on embryonic and adult neurogenesis. We found that cypermethrin exposure led to a considerable decrease in the BrdU/Sox-2+, BrdU/Dcx+, and BrdU/NeuN+ co-labeled cells indicating that cypermethrin treatment decreases NSC proliferation and generation of mature and functional neurons. On the contrary, the generation of BrdU/S100β+ glial cells was increased resulting in neurogliogenesis imbalance in the hippocampus. Further, cypermethrin treatment also led to an increased number of BrdU/cleaved caspase-3+ and Fluoro-Jade B+ cells suggesting an induction of apoptosis in NSCs and increased degeneration of neurons in the hippocampus. Overall, these results explicate that cypermethrin exposure not only reduces the NSC pool but also disturbs the neuron-astrocyte ratio and potentiates neurodegeneration in the hippocampus, leading to cognitive dysfunctions in rats.

Particulate bound polycyclic aromatic hydrocarbons over Dhauladhar region of the north-western Himalayas

A systematic yearlong study was carried out in Dhauladhar region of the North-Western Himalayas to investigate dynamics in the composition and concentration of particulate bound polycyclic aromatic hydrocarbons (PAHs) and their source(s) activity. PM₁₀ samples were collected for 24 h, once every week during January 2015-January 2016, at an urban mid-altitude site (Dharamshala) and a rural low-altitude site (Pohara). PAHs were identified and quantified using high performance liquid chromatography coupled with UV-detector. Seasonal average concentration of total PAHs followed a pattern: Summer > Winter > Autumn > Spring in the region. Seasonal average values of molecular diagnostic ratios indicated significant contribution from non-traffic (biomass burning and coal combustion) sources also during winter and spring season, whereas, traffic emissions (gasoline and diesel) were the dominant source at both the locations throughout the year in the region. The Principal Component Analysis deciphered a) emissions from gasoline driven vehicles b) diesel engine exhaust emissions c) biomass/wood burning source d) coal combustion and e) waste incineration and burning of oil/tar as major sources of PAHs in the region. Annual mean values of total Benzo(a)Pyrene Equivalent were much higher than 1 ng.m-3 over both the locations indicating higher lung cancer risk to the people living in this part of the Himalayas.

Water-soluble ionic species in atmospheric aerosols over Dhauladhar region of North-Western Himalaya

Water-soluble ionic species (WSIS) have been used as potential markers for different source(s) and underlining process(es) emitting and transforming atmospheric aerosols. PM₁₀ aerosol sampling was performed once in a week for a complete one year, at a mid-altitude urban and a low-altitude rural location simultaneously in the Dhauladhar region of the North-Western Himalaya. Aerosol samples were analysed for major WSIS (anions: F^-, Cl^-, NO₃^-, PO₄^3- and SO₄^2-; cations: Na⁺, NH₄⁺, K⁺, Ca²⁺ and Mg²⁺) using the ion chromatography system. Results showed that WSIS constitutes around 15% of PM₁₀ aerosol load in the region. SO₄^2- contributes the maximum (~ 50%) followed by NO₃^- (~ 12.5%) and NH₄⁺ (~ 12.5%) to the total concentration of WSIS analysed. During all the seasons, average concentrations of PM₁₀ and associated WSIS were observed to be higher over the rural location in comparison to the urban location. The total concentration of WSIS was found to be maximum during the winter season. Principal component analysis performed on the WSIS concentration dataset revealed four major sources of PM₁₀-associated WSIS viz. re-suspension of soil or local sediments; conversion of pollutant gases (SO_x, NO_x and NH₃) to particles, i.e., secondary inorganic aerosol formation; evaporative loss or re-suspension of inorganic (NPK) fertilizers' residues and biomass/crop-residue burning emissions in the Dhauladhar region of the North-Western Himalaya.

Altered oxidative stress markers in relation to T cells, NK cells & killer immunoglobulin receptors that are associated with disease activity in SLE patients

Systemic Lupus Erythematosus is an autoimmune disease with symptoms pervasive to all organ systems. It affects more females as compared to males (in the ratio 9:1). Oxidative stress plays a major role in the pathogenesis of SLE and other autoimmune diseases. In order to understand the relationship between cell specific oxidative stress and the severity of SLE, this research study involving the estimation of intracellular ROS accumulation in T and NK cell was conducted on SLE patients of North Indian Population. At the same time, to estimate anti-oxidant defense, Keap1 and Nrf2 levels were estimated in these cell types. The relationship between the expression of Killer immunoglobulin receptors i.e., KIR2DL4 & KIR3DL1 and oxidative stress was also evaluated as these receptors are imperative for the function and self-tolerance of NK cells.Oxidative stress was raised along with Keap1 and Nrf2 in T and NK cell subsets in SLE patients. The expression of KIR2DL4 was raised and that of KIR3DL1 was reduced in the NK cells of patients. The intensity of change in expression and its significance varied among the subsets. Nrf2 expression was raised in these species against oxidative stress as the antioxidant defense mechanism pertaining to Keap1-Nrf2 pathway, but the adequacy of response needs to be understood in further studies. The expression of KIR2DL4 and KIR3DL1 varied among the patient and healthy controls and the expression of the latter was found to have a significant positive relationship with plasma Glutathione(reduced) concentration.

Altered redox regulation by Nrf2-Keap1 system in dendritic cells of systemic lupus erythematosus patients

Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with inflammation and multiple organ involvement. Individually, dendritic cells (DCs) and oxidative stress have been well discussed for their critical involvement in the pathogenesis of disease but the precise impact of oxidative stress on DCs in relation to SLE disease activity is yet to be scrutinized. Nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/Kelch-like ECH-associated protein 1 (Keap1) pathway is the cellular mechanism to combat increased reactive oxygen species (ROS). The current study was framed in order to understand redox regulation in DCs along with an argument in context to disease activity. Here, 23 SLE patients along with 10 healthy controls were enrolled and disease activity was calculated as the recent change in SLEDAI score. We found the percentage of circulating plasmacytoid DCs (pDCs) was increased with an increase in disease activity. Altered DCs functionality along with disease activity was further supported with the differential concentration of Type I IFNs. The disease activity was positively associated with increased levels of ROS. A relevant reason for increased ROS was further explained with the decreased levels of transcription factor Nrf2. Hence, the present study suggests that SLE specific DCs displayed elevation in ROS and this outcome might be due to impaired free radical clearance by Nrf2. Correlation studies further established an association of disease activity with increased ROS, Type I IFNs levels and decreased activity of oxidative stress regulating enzymes.

Aerosol-associated n-alkanes over Dhauladhar region of North-Western Himalaya: seasonal variations in sources and processes

Particulate n-alkanes are major constituents of organic aerosols (OA). Being primary in origin, chemically stable and thus long-lived, n-alkanes retains source signatures and along with diagnostic parameters have extensively been used to identify source(s) of OA. Systematic, yearlong study was carried out in the Dhauladhar region of North-Western Himalaya (NWH) to investigate dynamics in the composition and concentration of aerosol-associated n-alkanes. PM₁₀ samples were collected for 24 h, once every week, at an urban mid-altitude location (Dharamshala) and a rural low-altitude site (Pohara). Particulate bound n-alkanes were identified and quantified using thermal desorption gas chromatography mass spectrometry (TD-GCMS). Annual mean concentrations of total n-alkanes (TNA) were 211 ± 99 ng m^-3 and 223 ± 83 ng m^-3, while mass fractions of TNA in PM₁₀ were 4410 ± 1759 ppm and 3622 ± 1243 ppm at Dharamshala and Pohara, respectively. At both sites, a slight dominance of odd carbon-numbered n-alkanes was noticed. The TNA concentration and associated diagnostic parameters indicated unique source profiles at rural and urban locations. Significant seasonal variations were attributed to the contrasting land-use settings and meteorological variations. Influence of petrogenic contributions at urban location and predominance of biogenic contributions at rural location were observed in spring and autumn seasons. Preliminary insights on sources of organic aerosols are presented here. The diagnostic parameters allowed apportionment of biogenic and petrogenic sources. Biogenic emissions from agricultural practices viz. harvesting and threshing were predominant in the rural settings, while tourism-led anthropogenic contributions significantly add to petrogenic contributions in urban environment of the NWH region.

Notch pathway up-regulation via curcumin mitigates bisphenol-A (BPA) induced alterations in hippocampal oligodendrogenesis

CNS myelination process involves proliferation and differentiation of oligodendrocyte progenitor cells (OPCs). Defective myelination causes onset of neurological disorders. Bisphenol-A (BPA), a component of plastic items, exerts adverse effects on human health. Our previous studies indicated that BPA impairs neurogenesis and myelination process stimulating cognitive dysfunctions. But, the underlying mechanism(s) of BPA induced de-myelination and probable neuroprotection by curcumin remains elusive. We found that curcumin protected BPA mediated adverse effects on oligosphere growth kinetics. Curcumin significantly improved proliferation and differentiation of OPCs upon BPA exposure both in-vitro and in-vivo. Curcumin enhanced the mRNA expression and protein levels of myelination markers in BPA treated rat hippocampus. Curcumin improved myelination potential via increasing β-III tubulin-/MBP⁺ cells (neuron-oligodendrocyte co-culture) and augmented fluoromyelin intensity and neurofilament/MBP⁺ neurons in vivo. In silico docking studies suggested Notch pathway genes (Notch-1, Hes-1 and Mib-1) as potential targets of BPA and curcumin. Curcumin reversed BPA mediated myelination inhibition via increasing the Notch pathway gene expression. Genetic and pharmacological Notch pathway inhibition by DAPT and Notch-1 siRNA exhibited decreased curcumin mediated neuroprotection. Curcumin improved BPA mediated myelin sheath degeneration and neurobehavioral impairments. Altogether, results suggest that curcumin protected BPA induced de-myelination and behavioural deficits through Notch pathway activation.

Aerosol-associated non-polar organic compounds (NPOCs) at Jammu, India, in the North-Western Himalayan Region: seasonal variations in sources and processes

Fine particulate (PM_2.5) bound non-polar organic compounds (NPOCs) and associated diagnostic parameters were studied at Jammu, an urban location in the foothills of North-Western Himalayan Region. PM_2.5 was collected daily (24 h, once a week) over a year to assess monthly and seasonal variations in NPOC concentration and their source(s) activity. Samples were analyzed on thermal desorption-gas chromatography mass spectrometry to identify and quantify source-specific organic markers. Homologous series of n-alkanes, polycyclic aromatic hydrocarbons (PAHs), isoprenoid hydrocarbons and nicotine were investigated to understand the sources of aerosols in the region. The annual mean concentration of PM_2.5 during the sampling period was found higher than the permissible limit of India's National Ambient Air Quality Standards (NAAQS) and World Health Organisation (WHO) guidelines. The rise of concentration for PM_2.5 and associated NPOCs in summer season was attributed to enhanced emission. The n-alkane-based diagnostic parameters indicated mixed contributions of NPOCs from anthropogenic sources like fossil fuel-related combustion with significant inputs from biogenic emission. Moreover, high influence of petrogenic contribution was observed in summer (monsoon) months. The quantifiable amounts of isoprenoid hydrocarbons further confirmed this observation. Total PAH concentration also followed an increasing trend from March to June, and June onwards a sharp decrease was observed. The higher concentration of environmental tobacco smoke marker nicotine in winter months was plausibly due to lower air temperature and conditions unfavourable to photo-degradation. A clear dominance of low molecular weight PAHs was noticed with rare presence of toxic PAHs in the ambient atmosphere of Jammu. PAH-based diagnostic parameters suggested substantial contribution from low temperature pyrolysis processes like biomass/crop-residue burning, wood and coal fire in the region. Specific wood burning markers further confirmed this observation.

Tagraxofusp, a novel CD123-directed cytotoxin to treat blastic plasmacytoid dendritic cell neoplasm

Tagraxofusp is a toxin-cytokine fusion protein consisting of engineered diphtheria toxin (DT) and interleukin-3 (IL-3). The IL-3 domain binds to the cluster of differentiation 123 (CD123) and translocates DT into the cytosol, which leads to cell death. Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with a strong expression of CD123. Historical data show that the prognosis of BPDCN is poor, with a median overall survival of 9 to 13 months. On December 21, 2018, the United States Food and Drug Administration (FDA) approved tagraxofusp for the treatment of adults and children with newly diagnosed or relapsed/refractory BPDCN, becoming the first FDA-approved drug for this disease. In this review, we examine the preclinical studies and phase I/II clinical studies that led to FDA approval of tagraxofusp, focusing on its molecular pharmacology, pharmacokinetics, efficacy and safety profile. We also discuss future directions regarding BPDCN management.

Review of magnetic resonance imaging features of complications after anterior cruciate ligament reconstruction

The anterior cruciate ligament (ACL) is an important stabiliser of the knee and is commonly torn in sports injuries. Common indications for imaging after ACL reconstruction include persistent symptoms, limitation of motion and re-injury. Important postoperative complications include graft failure, impingement, arthrofibrosis and graft degeneration. This article aimed to familiarise the radiologist with magnetic resonance (MR) imaging appearances of properly positioned intact ACL grafts and to provide a comprehensive review of MR imaging features of complications following ACL reconstruction.

Correlation of Foot Bimalleolar Angle and Ultrasonography in Assessing the Severity of Club Foot in Neonates Treated by the Ponseti Method

Introduction: Correlation of Pirani score and foot bimalleolar (FBM) angle has been used in few studies but correlation of FBM angle with ultrasonography has never been evaluated so they are being correlated in assessing the severity of clubfoot in neonates treated by Ponseti method. Material and Methods: Thirty-two feet with congenital talipes equinovarus (CTEV) deformity in neonates were prospectively treated by the Ponseti method. FBM angle and ultrasound parameters were measured three times i.e. at the time of initial presentation, at four weeks of treatment and at completion of treatment. The feet were divided according to the Pirani score in groups: one (0-2.0), two (2.5-4) and three (4.5-6). Correlation between FBM angle and ultrasound parameters were evaluated using Pearson correlation/regression. Results: Correlation between FBM angle and ultrasound parameters were statistically significant (p-value < 0.05). Conclusion: Ultrasound has the potential to accurately depict the pathoanatomy in clubfoot. FBM angle and ultrasound are objective methods to assess the severity of clubfoot. FBM angle and ultrasonography correlated in severity of deformity and correction achieved along the course of treatment.

Wintertime carbonaceous aerosols over Dhauladhar region of North-Western Himalayas

Carbonaceous aerosols play an important role in affecting human health, radiative forcing, hydrological cycle, and climate change. As our current understanding about the carbonaceous aerosols, the source(s) and process(es) associated with them in the ecologically sensitive North-Western Himalayas are limited; this systematic study was planned to understand inherent dynamics in the mass concentration and source contribution of carbonaceous aerosols in the Dhauladhar region. During four winter months (January 2015-April 2015), 24-h PM₁₀ samples were collected every week simultaneously at the rural site of Pohara (32.19° N, 76.20° E; 750 m amsl) and the urban location of Dharamshala (32.20° N, 76.32° E; 1350 m amsl). These samples were analyzed by using thermal/optical carbon analyzer for different carbon forms. Organic carbon (OC) dominated over elemental carbon (EC) and was found to be 59.3 and 64.1% in total carbon (TC) at Pohara and Dharamshala, respectively. The respective mass concentrations of OC and EC were higher at Pohara (6.8 ± 2.3 and 4.8 ± 2.0 μg.m^-3) in comparison to that observed in Dharamshala (5.0 ± 3.1 and 2.5 ± 0.6 μg.m^-3). The OC/EC ratio at Pohara (1.51 ± 0.41) indicates the dominance of fossil fuel combustion (coal and vehicular exhaust), while at Dharamshala, an OC/EC of 2.01 ± 1.07 signified additional contribution from secondary organic carbon (SOC). Diagnostic ratios (OC/EC and char-EC/soot-EC) suggested dominance of emissions from fossil fuel combustion sources over biomass burning sources in the region. Estimated non-sea salt (nss)K⁺/OC and nssK⁺/EC ratios indicated heterogeneity within the biomass burning sources over low and high altitude locations. A strong correlation between nssK⁺ and SOC over a high altitude urban location further suggested possible conversion of gaseous precursors to carbonaceous particles during coniferous wood burning.

Safety and effectiveness of antireflux surgery in obese patients

Introduction The incidence of gastro-oesophageal reflux disease and obesity has increased significantly in recent years. The number of antireflux procedures being carried out on people with a higher body mass index (BMI) has been rising. Evidence is conflicting for outcomes of antireflux surgery in obese patients in terms of its safety and efficacy. Given the contradictory reports, this meta-analysis was undertaken to establish the outcomes of antireflux surgery (ARS) in obese patients and its associated safety. Methods A systematic electronic search was conducted using the PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ databases to identify studies that analysed the effect of BMI on the outcomes of ARS. A meta-analysis was performed using the random effects model. The intraoperative and postoperative outcomes that were examined included operative time, conversion to an open procedure, mean length of hospital stay, recurrence of acid reflux requiring reoperation and wrap migration. Results A total of 3,772 patients were included in 13 studies. There was no significant difference in procedure conversion rate, recurrence of reflux requiring reoperation or wrap migration between obese and non-obese patients. However, both the mean operative time and mean length of stay were longer for obese patients. Conclusions ARS in obese patients with gastro-oesophageal reflux disease is safe and outcomes are comparable with those in patients with a BMI in the normal range. A high BMI should therefore not be a deterrent to considering ARS for appropriate patients.

Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

Parietex™ Composite mesh versus DynaMesh®-IPOM for laparoscopic incisional and ventral hernia repair: a retrospective cohort study

INTRODUCTION Laparoscopic incisional and ventral hernia repair (LIVHR) is widely accepted and safe but the type of mesh used is still debated. We retrospectively compared postoperative outcomes with two different meshes commonly used in LIVHR. METHODS This is a retrospective study of patients who underwent incisional hernia repair between January 2008 and December 2010. Two meshes were used: Parietex™ Composite (Covidien, New Haven, CT, USA) and the DynaMesh^®-IPOM (FEG Textiltechnik mbH, Aachen, Germany). The two groups were compared with respect to recurrence rates, incidence of seroma and intestinal obstruction. RESULTS Among the 88 patients who underwent LIVHR, 75 patients (85.2%) presented with primary incisional hernia, 10 (11.4%) presented with a first recurrence and 3 (3.4%) presented with a second recurrence. Median follow-up was 53.6 months (range 40-61 months). 12.9% of patients had recurrence in the Parietex™ Composite mesh group (n=62) in comparison to 3.8% in the DynaMesh^®-IPOM mesh group (n=26; P=0.20). DynaMesh^®-IPOM was associated with a significantly higher incidence of intestinal obstruction secondary to adhesions (11.5% vs. 0%, P=0.006) and lower incidence of seroma and haematoma formation compared to Parietex™ composite mesh group (0% vs. 6.4% of patients; P=0.185). CONCLUSIONS LIVHR is a safe and feasible technique. Dynamesh^®-IPOM is associated with a significantly higher incidence of adhesion related bowel obstruction, albeit with a lower incidence of recurrence, seroma and haematoma formation compared with Parietex™ Composite mesh. However, there is a need for further well-designed, multicentre randomised controlled studies to investigate the use of these meshes.

Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre

INTRODUCTION

Symptomatic gall stones may require laparoscopic cholecystectomy (LC), which is one of the most commonly performed general surgical operations in the western world. Patients with a high body mass index (BMI) are at increased risk of having gall stones, and are often considered at high risk of surgical complications due to their increased BMI. We believe that day case surgery could nevertheless have significant benefits in terms of potential cost savings and patient satisfaction in this population. We therefore compared the outcomes of day case patients undergoing LC stratified by BMI, with a specific focus on the safety and success of the procedure in obese and morbidly obese groups.

METHODS

We reviewed a database of day case procedures performed between January 2004 and December 2012, including all patients with symptomatic gall stone disease who underwent LC. The patients were divided in four BMI groups: less than 25 kg/m(2), 25-29 kg/m(2), 30-39 kg/m(2) and 40 kg/m(2) or above.

RESULTS

The overall success rate for day case surgery was 78%. There were no significant differences in rates of intra-abdominal collection or readmission with increasing BMI. However, increasing BMI was associated with a significant increase in the rate of wound infection.

CONCLUSIONS

LC in patients with a high BMI is safe and can be performed effectively as a day case procedure.

Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair

Background

Laparoscopic incisional and ventral hernia repair (LIVHR) is being used increasingly, with reported outcomes equivalent to those of open hernia repair. Closure of the fascial defect (CFD) is a technique that may reduce seroma formation and bulging after LIVHR. Non-closure of the fascial defect makes the repair of larger defects easier and reduces postoperative pain. The aim of this systematic review was to determine whether CFD affects the rate of adverse outcomes, such as recurrence, pseudo-recurrence, mesh eventration or bulging, and the rate of seroma formation.

Methods

A systematic search was performed of PubMed, Ovid, the Cochrane Library, Google Scholar and Scopus to identify RCTs that analysed CFD with regard to rates of adverse outcomes. A meta-analysis was done using fixed-effect methods. The primary outcome of interest was adverse events. Secondary outcomes were seroma, postoperative pain, mean hospital stay, mean duration of operation and surgical techniques employed.

Results

A total of 16 studies were identified involving 3638 patients, 2963 in the CFD group and 675 in the non-closure of facial defect group. Significantly fewer adverse events were noted following CFD than non-closure (4·9 per cent (79 of 1613) versus 22·3 per cent (114 of 511)), with a combined risk ratio (RR) of 0·25 (95 per cent c.i. 0·18 to 0·33; P &lt; 0·001). CFD resulted in a significantly lower rate of seroma (2·5 per cent (39 of 1546) versus 12·2 per cent (47 of 385)), with a combined RR of 0·37 (0·23 to 0·57; P &lt; 0·001), and shorter duration of hospital stay. No significant difference was noted in postoperative pain.

Conclusion

CFD during LIVHR reduces the rate of seroma formation and adverse hernia-site events.

A systematic review of image segmentation methodology, used in the additive manufacture of patient-specific 3D printed models of the cardiovascular system

Background

Shortcomings in existing methods of image segmentation preclude the widespread adoption of patient-specific 3D printing as a routine decision-making tool in the care of those with congenital heart disease. We sought to determine the range of cardiovascular segmentation methods and how long each of these methods takes.

Methods

A systematic review of literature was undertaken. Medical imaging modality, segmentation methods, segmentation time, segmentation descriptive quality (SDQ) and segmentation software were recorded.

Results

Totally 136 studies met the inclusion criteria (1 clinical trial; 80 journal articles; 55 conference, technical and case reports). The most frequently used image segmentation methods were brightness thresholding, region growing and manual editing, as supported by the most popular piece of proprietary software: Mimics (Materialise NV, Leuven, Belgium, 1992–2015). The use of bespoke software developed by individual authors was not uncommon. SDQ indicated that reporting of image segmentation methods was generally poor with only one in three accounts providing sufficient detail for their procedure to be reproduced.

Conclusions and implication of key findings

Predominantly anecdotal and case reporting precluded rigorous assessment of risk of bias and strength of evidence. This review finds a reliance on manual and semi-automated segmentation methods which demand a high level of expertise and a significant time commitment on the part of the operator. In light of the findings, we have made recommendations regarding reporting of 3D printing studies. We anticipate that these findings will encourage the development of advanced image segmentation methods.

Focal hand lesions: review and radiological approach

Focal hand lesions are commonly encountered in clinical practice and are often benign. Magnetic resonance (MR) imaging is the imaging modality of choice in evaluating these lesions as it can accurately determine the nature of the lesion, enhancement pattern and exact location in relation to surrounding tissues. However, while MR features of various soft tissue lesions in the hand have been well described, it is often still difficult to differentiate between benign and malignant lesions. We review the MR imaging features of a variety of focal hand lesions presenting at our institution and propose a classification into "benign", "intermediate grade" (histologically benign but locally aggressive with potential for recurrence) and frankly "malignant" lesions based on MR findings. This aims to narrow down differential diagnoses and helps in further management of the lesion, preoperative planning and, in cases of primary malignancy, local staging. Teaching Points • Hand lesions are often benign and MR is essential as part of the workup. • MR features of various hand lesions are well described but are often non-specific. • Certain MR features may help for the diagnosis but histological examination is usually required. • We aim to classify hand lesions based on MR features such as margin, enhancement and bony involvement. • Classifying these lesions can help narrow down differential diagnoses and aid management.

Proliferation, differentiation and amyloid-β production in neural progenitor cells isolated from TgCRND8 mice

The amyloid precursor protein (APP) and amyloid-β (Aβ) peptide play central roles in the pathology and etiology of Alzheimer's disease. Amyloid-induced impairments in neurogenesis have been investigated in several transgenic mouse models but the mechanism of action remains to be conclusively demonstrated. The changes in neurogenesis during this transition of increasing Aβ levels and plaque formation were investigated in the present study. We found that the proliferation of newborn cell in the dentate gyrus was enhanced prior to elevations in soluble Aβ production as well as amyloid deposition in 5-week-old TgCRND8 mice, which are well-established Alzheimer's disease models, compared to non-transgenic (Non-Tg) mice. The number of BrdU-positive cells remained higher in TgCRND8 vs Non-Tg mice for a period of 8weeks. The numbers of BrdU/NeuN-positive cells were not significantly different in TgCRND8 compared to Non-Tg mice. A significant decrease in BrdU/GFAP but not in BrdU/S100β was found in Tg vs Non-Tg at 6-weeks of age. In addition, a unique observation was made using isolated neuroprogenitor cells from TgCRND8 mice which were found to be less viable in culture and produced substantial amounts of secreted Aβ peptides. This suggests that the proliferation of neural progenitors in vivo may be modulated by high levels of APP expression and the resulting Aβ generated directly by the progenitor cells. These findings indicate that cell proliferation is increased prior to Aβ deposition and that cell viability is decreased in TgCRND8 mice over time.

A Pictorial Review of Diabetic foot Manifestations

The diabetic foot with its many associated complications and presentations can provide a challenge in diagnosis and subsequent treatment. MRI, being increasingly available commonly, is now the main investigative modality. In particular, it is helpful in differentiating between neuroarthropathy and osteomyelitis and in cases where the latter is superimposed on the former. By being well versed in the interpretation of the images, the radiologist can make crucial contribution to the care and management of these patients.

Characterization of aerosol associated non-polar organic compounds using TD-GC-MS: a four year study from Delhi, India

Aerosol associated Non-Polar Organic Compounds (NPOCs)--25 n-alkanes, 17 Polycyclic Aromatic Hydrocarbons (PAHs), and 3 Isoprenoid hydrocarbons--have been identified and quantified in PM10 samples collected over four years in time sequence (2006-2009), using Thermal Desorption Gas Chromatography Mass Spectrometry, in Delhi region. Established organic markers, associated diagnostic parameters, and molecular diagnostic ratios were used to assess and discern the contributing biogenic, petrogenic and pyrogenic sources to NPOCs. Analysis show that anthropogenic contributions to NPOCs exhibit increase from 2006 to 2009. Distribution profiles of NPOCs were significantly affected by change in season. Lower concentrations of NPOCs during summer months, and higher during winter, once scaled to Planetary Boundary Layer height, suggests that contributing sources were most active during summer months. During monsoon season high mass fractions of Total n-alkanes (ppm), Total PAHs (ppm), and Black carbon (BC) % alludes at the role of differential washout process involving hydrophilic and hydrophobic fractions of ambient aerosols. Significantly high, four year average concentrations of TPAH and BC signify the dominance of pyrogenic source contributions to PM10. High correlation between monthly mean concentrations of TPAH and BC (R(2)=0.75) suggests that besides common emission source, they are also contributed, individually, by exclusive independent sources.

Cardiogenic shock as the initial presentation of neonatal systemic hypertension

Neonatal systemic hypertension is an underappreciated etiology of cardiac failure. We present a series of three neonates who presented in cardiogenic shock secondary to severe hypertension, recognized after initial resuscitation efforts. Although the underlying etiology of the hypertension varied, all three patients had improved hemodynamics after their blood pressure was controlled. These cases suggest that neonates presenting in cardiogenic shock with hypertension, and without structural heart disease, may benefit from a thorough renal evaluation and institution of anti-hypertensive therapy.

Decorin biology, expression, function and therapy in the cornea

Decorin is a small leucine-rich proteoglycan (SLRP) that plays a vital role in many important cellular processes in several tissues including the cornea. A normal constituent of the corneal stroma, decorin is also found in the majority of connective tissues and is related structurally to other small proteoglycans. It interacts with various growth factors such as epidermal growth factor (EGF) and transforming growth factor beta (TGFβ) to regulate processes like collagen fibrillogenesis, extracellular matrix (ECM) compilation, and cell-cycle progression. Studies have linked decorin dysregulation to delayed tissue healing in patients with various diseases including cancer. In the cornea, decorin is involved in the regulation of transparency, a key function for normal vision. It has been reported that mutations in the decorin gene are associated with congenital stromal dystrophy, a disease that leads to corneal opacity and visual abnormalities. Decorin also antagonizes TGFβ in the cornea, a central regulatory cytokine in corneal wound healing. Following corneal injury, increased TGFβ levels induce keratocyte transdifferentiation to myofibroblasts and, subsequently, fibrosis (scarring) in the cornea. We recently reported that decorin overexpression in corneal fibroblasts blocks TGFβ-driven myofibroblast transformation and fibrosis development in the cornea in vitro suggesting that decorin gene therapy can be used for the treatment of corneal scarring in vivo.

A case report of chronic frontal bone osteitis presenting with recurrent unilateral lid swelling

Despite the advances in modern antimicrobial treatment, paranasal sinus disease remains relatively common. A case of chronic inflammatory frontal sinus disease presented with unilateral recurrent eyelid swelling. Clinical features and management in conjunction with ENT are discussed. An extensive literature search has shown only one other similar case reported in Russian language whose management details however are not available.