An investigation of the storage and biosynthesis of phenylpropenes in sweet basil

Plants that contain high concentrations of the defense compounds of the phenylpropene class (eugenol, chavicol, and their derivatives) have been recognized since antiquity as important spices for human consumption (e.g. cloves) and have high economic value. Our understanding of the biosynthetic pathway that produces these compounds in the plant, however, has remained incomplete. Several lines of basil (Ocimum basilicum) produce volatile oils that contain essentially only one or two specific phenylpropene compounds. Like other members of the Lamiaceae, basil leaves possess on their surface two types of glandular trichomes, termed peltate and capitate glands. We demonstrate here that the volatile oil constituents eugenol and methylchavicol accumulate, respectively, in the peltate glands of basil lines SW (which produces essentially only eugenol) and EMX-1 (which produces essentially only methylchavicol). Assays for putative enzymes in the biosynthetic pathway leading to these phenylpropenes localized many of the corresponding enzyme activities almost exclusively to the peltate glands in leaves actively producing volatile oil. An analysis of an expressed sequence tag database from leaf peltate glands revealed that known genes for the phenylpropanoid pathway are expressed at very high levels in these structures, accounting for 13% of the total expressed sequence tags. An additional 14% of cDNAs encoded enzymes for the biosynthesis of S-adenosyl-methionine, an important substrate in the synthesis of many phenylpropenes. Thus, the peltate glands of basil appear to be highly specialized structures for the synthesis and storage of phenylpropenes, and serve as an excellent model system to study phenylpropene biosynthesis.

Genetic diversity of Ocimum gratissimum L. based on volatile oil constituents, flavonoids and RAPD markers

Morphological, chemical and genetic differences of 12 tree basil (Ocimum gratissimum L.) accessions were studied to determine whether volatile oils and flavonoids can be used as taxonomical markers and to examine the relationship between RAPDs to these chemical markers. Eugenol, thymol, and geraniol were the major volatile oil constituents found in Ocimum gratissimum. Xantomicrol and cirsimaritin were the major external flavones. The accessions morphologically described as O. gratissimum var. gratissimum contained eugenol as the major volatile oil constituent, and cirsimaritin as the major flavone. Ocimum gratissimum var. macrophyllum accessions contained thymol as the major volatile oil constituent, and xantomicrol as the major flavone. A distinct essential oil and flavone chemotype (producing geraniol and a mixture of the flavones cirsimaritin, isothymusin, xanthomicrol, and luteolin) was found in an accession genetically more distant from the other two groups when analyzed by molecular markers. The accessions could be divided based on volatile oil constituents into six groups: (1) thymol: alpha-copaene (ot24, ot25, ot26, and ot28); (2) eugenol:spathulenol (ot17, ot63, and ot52); (3) thymol:p-cymene (ot65); (4) eugenol:gamma-muurolene (ot27 and ot29); (5) eugenol:thymol: spathulenol (ot85); and (6) geraniol (ot84). Cluster analysis of RAPD markers showed that there are three groups that are distinct genetically and highly correlated (r=0.814) to volatile oil constituents.

Silent ischemia in minor stroke and TIA patients identified on MR imaging

BACKGROUND

In a general population of patients with stroke, the rate of new MRI lesions at 1 week was much higher than expected. With patients with minor stroke and TIA having a higher risk of recurrent clinical events, the authors examined whether patients with minor stroke and TIA also had a high rate of asymptomatic lesions on repeat MRI scanning.

METHODS

Patients with minor stroke and TIA presenting within 12 hours of symptom onset with a NIH Stroke Scale score less than six, who had a baseline MRI and a 1-month follow-up, were enrolled in this study. The follow-up study was examined for new diffusion-weighted imaging lesions as compared to the baseline study. Clinical or MRI factors predicting recurrent lesions were examined.

RESULTS

A total of 143 patients were enrolled and 14 patients (9.8%; 95% CI 5.4, 15.9) had MR evidence of new lesions at 30 days. Six of these new lesions were clinically asymptomatic (42.9%; 95% CI 17.7, 71.1). A trend to increased likelihood of new lesions at 30 days was seen with progressing baseline scan lesion number (none [2.2%], solitary [12.9%], multiple [19.8%]: p = 0.046). Patients whose mechanism of stroke was large artery or cardioembolic were the most likely to have new lesions on follow-up MRI.

CONCLUSION

Minor stroke and TIA are associated with a 10% risk of new lesions on MRI and half of these new lesions are asymptomatic. This risk is lower than seen in more severely affected patients with stroke. Patients with multiple lesions at baseline are at an increased risk for new ischemic lesions.

Racemic epinephrine use in croup and disposition

The purpose of this study was to determine the effectiveness of a protocol for the outpatient management of laryngotracheitis (croup) using racemic epinephrine and steroids. The authors retrospectively reviewed fifty consecutive charts of children with croup who were treated under this protocol in the Scottish Rite Children's Medical Center Emergency Department (Atlanta, GA) and discharged to home after 2 hours of observation. Forty-seven of the 50 children had stridor at rest and/or retracting at rest on presentation to the emergency department. Forty-seven of the 50 patients did not require further medical care within 48 hours. One patient required another emergency visit and additional treatment with racemic epinephrine. Two patients were lost to follow-up. This study suggests that selected children presenting with croup and significant distress may be effectively treated with racemic epinephrine and steroids, observed for at least 2 hours, and safely discharged home.

Chemistry and quality of Hibiscus (Hibiscus sabdariffa) for developing the natural-product industry in Senegal

The objectives of this study were to assess and improve the quality of the hibiscus calyces from Senegal over 2 production seasons (2004 to 2005), to develop and adapt new procedures for the determination of hibiscus anthocyanins and analysis of the 2 major ones, delphinidin-3-sambubioside and cyanidin-3-sambubioside. The foreign matter, total ashes, and acid insoluble ashes showed that the calyces harvested in 2005 were produced following hygienic practices, while the color assessment of the calyces and analysis of hibiscus active principles also showed higher amounts of anthocyanins in 2005. A protocol to measure anthocyanins by pH-differential UV-Vis spectrophotometry was adapted to measure the hibiscus anthocyanins from a water extract. The spectrophotometric method for quantitation of total anthocyanins showed a close correlation (r(2)= 0.82) when compared with the HPLC method, suggesting the use of the colorimetric method in quality control programs as an affordable alternative method to assess anthocyanin content in hibiscus. New and raised standards for the cleanliness and active principle content in hibiscus are also proposed. This study demonstrated that the implementation of a quality control program and the application of agricultural good practices in the production and processing of hibiscus calyces can lead to higher quality natural plant products.

In vivo andin vitro activities of the seed extract ofPiper guineense Schum. and Thonn. against skin and gill monogenean parasites of gold?sh (Carassius auratus auratus)

Methanol extracts of the seeds of Piper guineense (Piperaceae) were active against gold fish (Carassius auratus auratus L. Pisces Cyprinidae) monogenean parasites. The seed extract of P. guineense was administered at different concentrations (0.5-2.0 mg/L) under in vivo and in vitro conditions. There was a higher efficacy of the effects of the extracts against fish parasites under in vitro situations than under in vivo. Three major compounds (piperanine, N-isobutyl (E,E)-2,4 decadienamide and Deltaalpha,beta-dihydrowasanine) were identified from the seed extract of Piper guineense by LC-MS analysis.

Use of magnetization transfer for improved contrast on gradient-echo MR images of the cervical spine

PURPOSE

To evaluate whether magnetization transfer (MT) can improve image contrast on gradient-recalled echo (GRE) magnetic resonance (MR) images of the cervical spine.

MATERIALS AND METHODS

Sagittal and axial two-dimensional conventional GRE and MT GRE images were obtained in 103 patients with degenerative disk disease or intrinsic cord lesions. The contrast-to-noise ratios (C/Ns) for the cervical spinal cord and cerebrospinal fluid (CSF) were compared for images obtained at various MT power level and section-select flip angle combinations. Axial three-dimensional GRE images were also obtained with application of MT and C/N evaluated in 10 additional patients.

RESULTS

Tailored two-dimensional MT GRE images, obtained with a moderate MT power level and a section-select flip angle similar to the Ernst angle for CSF, provided an average of 2.2-2.4-fold improvement in spinal cord-CSF C/N than conventional GRE images (P < .001).

CONCLUSION

The MT GRE images demonstrated superior delineation of disk herniations, foraminal stenosis, and intrinsic cord lesions over conventional GRE and T2-weighted spin-echo images in clinical cervical spine examinations.

Anthocyanin inheritance and instability in purple basil (Ocimum basilicum L.)

The instability of the purple pigments (anthocyanins) in purple basil varieties (Ocimum basilicum L.) limits their use as ornamental plants and as a potential anthocyanin source. Several self-pollinated generations of all purple plants were unsuccessful in stabilizing anthocyanin expression. In this study we investigated the inheritance and stability patterns of leaf traits using the Purple Ruffles variety. The results from the complete diallele crosses indicated anthocyanin expression in vegetative tissue is controlled by two dominant genes and ruffled leaf texture is controlled by a single recessive gene. Genes controlling leaf margin and leaf base structures were tightly linked to leaf texture. Essential oil production and oil constituents in leaves did not change as a result of the reversion in color. Color stability in cuttings was affected by the environment and the location where cuttings were taken. An accumulation of secondary metabolites (apigenin, genistein, and kaempferol) in green-reverted sectors on purple leaves was detected using reverse-phase high-performance liquid chromatography (HPLC) analysis; this suggested a potential block in the anthocyanin pathway. We hypothesize the reversion mutation is occurring in an anthocyanin regulatory gene.

Developmental studies of Artemisia annua: flowering and artemisinin production under greenhouse and field conditions

Cuttings of a clone of A. annua L. (Asteraceae), grown under 16 h photoperiod for 55 days were transferred to six photoperiod treatments in the greenhouse. Under short photoperiods (8, 10, or 12 h), plants flowered after two weeks; plants under long photoperiods (16, 20, or 24 h) remained vegetative until termination of treatment after 10 weeks. When plants grown under long photoperiod treatments were transferred to 8-h photoperiod, flowering occurred 2 weeks later. Flower induction in plants grown under field conditions occurred when the photoperiod was determined to the 13.3 h. Artemisinin levels in all studies were found to be highest at anthesis. Artemisinin content was 4- to 11-fold higher in inflorescences than in leaves.

Hydrocarbon poisonings

Many different compounds are classified as petroleum distillates. Most ingestions can be managed by careful observation and respiratory support.

Promethazine-induced dystonic reaction

The case of a 15-year-old girl who experienced an acute dystonic reaction to promethazine therapy administered during an uncomplicated episode of acute gastroenteritis is reported. The pertinent literature is reviewed.

Site of action for endotoxin-induced cortisol release in the suppression of preovulatory luteinizing hormone surges

The study was conducted to identify the mechanisms of endotoxin/cortisol action in the suppression of preovulatory LH surges in heifers infused with Escherichia coli (E. coli ) endotoxin. The hypotheses tested were that 1) endotoxin stimulates the release of progesterone, possibly from the adrenal leading to the LH blockade; 2) cortisol released in response to endotoxin infusion blocks the synthesis of estradiol at the ovarian level, culminating in a failure of the LH surge. Eight Holstein heifers were given two injections of prostaglandin F(2alpha) (PG), 11 d apart, to synchronize estrus. Starting from 25 h after the second injection of PG (PG-2), the uterus of each heifer was infused either with 5 ml of pyrogen-free water (control, n = 3) or with E. coli endotoxin (5 mug/kg of body weight) in 5 ml of pyrogen-free water (treated, n = 5), once every 6 h for 10 treatments. Blood samples were obtained every 15 min for 1 h before infusion and again 2 h after each infusion, then hourly until 1 h before the next infusion. After the tenth infusion, blood was collected daily until estrus. Serum progesterone concentrations remained at baseline values (< 1 ng/ml) in control and treated heifers. The total amount of progesterone measured starting 24 to 84 h after PG-2 injection was not different between control and treated heifers (P 0.05). In the control heifers, serum estradiol concentrations remained basal (< 10 pg/ml) until 4 h before the LH surge. Serum estradiol concentrations increased to 20 +/- 5.6 pg/ml, 4 h before the LH surge in control heifers (LH surge occurred 60 to 66 h after the PG-2 injection). There were no changes in serum estradiol concentrations in treated heifers during the sampling period, and the concentrations remained < 10 pg/ml. The total amount of estradiol measured in control heifers was higher (P < 0.05) than in treated heifers. The results if this study suggest that increases in cortisol concentrations after the infusion of endotoxin might block the synthesis of estradiol at the ovarian level, resulting in the failure of a preovulatory LH surge to occur.

CT assessment of conjugate eye deviation in acute stroke

Conjugate eye deviation seen on clinical examination helps to localize pathology in acute ischemic stroke. Eye deviation can also be assessed on a CT head scan. The authors found that CT eye deviation reliably lateralizes to the ischemic hemisphere (positive predictive value 93%) without reference to clinical examination. In an era of thrombolysis and rapid decision making in acute ischemic stroke, eye deviation on CT can help quickly direct attention to the affected hemisphere.

Antiobesity properties of two African plants (Afromomum meleguetta and Spilanthes acmella) by pancreatic lipase inhibition

Ethanol extracts of seeds of Afromomum meleguetta and flower buds of Splilanthes acmella presented pancreatic lipase inhibitory activities in a concentration related manner under in vitro conditions. The two plants were extracted with 70% ethanol by sonication, fractionated on silica gel and tested at concentrations in the range 0.75-2.0 mg/mL. Lipase inhibitory activities of 90% and 40% were observed in A. meleguetta and S. acmella, respectively. The two plants have potentials as candidates for weight reduction and obesity control.

Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancer patients: a survey of oncology clinicians

Palliative care (pc) is part of the recommended standard of care for patients with advanced cancer. Nevertheless, delivery of pc is inconsistent. Patients who could benefit from pc services are often referred late-or not at all. In planning for improvements to oncology pc practice in our health care system, we sought to identify barriers to the provision of earlier pc, as perceived by health care providers managing patients with metastatic colorectal cancer (mcrc). We used the Michie Theoretical Domains Framework (tdf) and Behaviour Change Wheel (bcw), together with knowledge of previously identified barriers, to develop a 31-question survey. The survey was distributed by e-mail to mcrc health care providers, including physicians, nurses, and allied staff. Responses were obtained from 57 providers (40% response rate). The most frequently cited barriers were opportunity-related-specifically, lack of time, of clinic space for consultations, and of access to specialist pc staff or services. Qualitative responses revealed that resource limitations varied by cancer centre location. In urban centres, time and space were key barriers. In rural areas, access to specialist pc was the main limiter. Self-perceived capability to manage pc needs was a barrier for 40% of physicians and 30% of nurses. Motivation was the greatest facilitator, with 89% of clinicians perceiving that patients benefit from pc. Based on the Michie tdf and bcw model, interventions that best address the identified barriers are enablement and environmental restructuring. Those findings are informing the development of an intervention plan to improve oncology pc practices in a publicly funded health care system.

Reduction of contact factors in sickle cell disease

Surface-mediated reactions of clotting were compared in 21 black children with homozygous sickle cell disease, 12 age-matched controls, and 15 adults. Both the coagulant and antigen titers of Hageman factor (factor XII) were decreased in asymptomatic patients compared with those in the control groups. These findings were associated with slight but significant reductions in the plasma titers of prekallikrein and high molecular weight kininogen. A further decrease from the initially low titers of these contact factors was observed during vaso-occlusive crises. Additionally, we observed a disparate relationship between Hageman factor coagulant activity and its antigen titers. These data provide evidence for reduction of the contact factors in patients with homozygous sickle cell disease.

Thalamic amnesia: Korsakoff syndrome due to left thalamic infarction

In order to support the concept that a lesion of the thalamus is sufficient to cause a Korsakoff syndrome, we are presenting 5 patients, all of whom developed the syndrome after sustaining a left (dominant) thalamic infarction. Two patients had pure thalamic strokes followed by a permanent Korsakoff syndrome. One of these patients was studied with neuropsychometric testing, as well as with a modern MRI scan. In 2 other patients, clinical and imaging data indicate that infarction was not limited to the thalamus. Another patient had bilateral thalamic infarcts but only a temporary Korsakoff syndrome. Neuropathological data are needed to elucidate the exact anatomical substrate of dominant thalamic Korsakoff syndrome.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

BACKGROUND

Advance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.

METHODS

Raw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.

RESULTS

Statistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.

CONCLUSIONS

ACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

Relationship of artemisinin content of tissue-cultured, greenhouse-grown, and field-grown plants of Artemisia annua

Artemisinin content of Artemisia annua L. plants grown under long days in a greenhouse was highly correlated (r = 0.931** and 0.954**, P = 0.01) with the same clones grown under long days in the field. The correlation of artemisinin content of clones grown in long days in tissue culture and in the greenhouse was r = 0.502*. Correlation of artemisinin content of tissue-cultured clones obtained two years apart was r = 0.61**. Broad-sense heritability estimates for artemisinin production based on vegetatively propagated clones derived from a random-mating population and grown in the greenhouse and field varied from 0.91 (greenhouse, individual basis) to 0.98 (combined greenhouse and field, family basis). These results indicate that genetic progress can be expected from intercrossing high artemisinin clones selected in the greenhouse under long days.

Tongue in cheek? Or in the bottle?

The case of an eight-year-old girl whose tongue became entrapped in a bottle is presented. Management options are discussed. Successful management utilizing a positive pressure technique is described and illustrated.

Impact of the COVID-19 pandemic on shoulder arthroplasty: surgical trends and postoperative care pathway analysis

BACKGROUND

COVID-19 triggered disruption in the conventional care pathways for many orthopedic procedures. The current study aims to quantify the impact of the COVID-19 pandemic on shoulder arthroplasty hospital surgical volume, trends in surgical case distribution, length of hospitalization, posthospital disposition, and 30-day readmission rates.

METHODS

This study queried all Medicare (100% sample) fee-for-service beneficiaries who underwent a shoulder arthroplasty procedure (Diagnosis-Related Group code 483, Current Procedural Terminology code 23472) from January 1, 2019, to December 18, 2020. Fracture cases were separated from nonfracture cases, which were further subdivided into anatomic or reverse arthroplasty. Volume per 1000 Medicare beneficiaries was calculated from April to December 2020 and compared to the same months in 2019. Length of stay (LOS), discharged-home rate, and 30-day readmission for the same period were obtained. The yearly difference adjusted for age, sex, race (white vs. nonwhite), Centers for Medicare & Medicaid Services Hierarchical Condition Category risk score, month fixed effects, and Core-Based Statistical Area fixed effects, with standard errors clustered at the provider level, was calculated using a multivariate analysis (P < .05).

RESULTS

A total of 49,412 and 41,554 total shoulder arthroplasty (TSA) cases were observed April through December for 2019 and 2020, respectively. There was an overall decrease in shoulder arthroplasty volume per 1000 Medicare beneficiaries by 14% (19% reduction in anatomic TSA, 13% reduction in reverse shoulder arthroplasty, and 3% reduction in fracture cases). LOS for all shoulder arthroplasty cases decreased by 16% (-0.27 days, P < .001) when adjusted for confounders. There was a 5% increase in the discharged-home rate (88.0% to 92.7%, P < .001), which was most prominent in fracture cases, with a 20% increase in discharged-home cases (65.0% to 73.4%, P < .001). There was no significant change in 30-day hospital readmission rates overall (P = .20) or when broken down by individual procedures.

CONCLUSIONS

There was an overall decrease in shoulder arthroplasty volume per 1000 Medicare beneficiaries by 14% during the COVID-19 pandemic. A decrease in LOS and increase in the discharged-home rates was also observed with no significant change in 30-day hospital readmission, indicating that a shift toward an outpatient surgical model can be performed safely and efficiently and has the potential to provide value.

Comparison of a Multi-Component Physical Function Battery to Usual Walking Speed for Assessing Lower Extremity Function and Mobility Limitation in Older Adults

OBJECTIVES

To compare a composite measure of physical function that comprises locomotor and non-locomotor tests (i.e., the Mobility Battery Assessment (MBA)) with traditional measures of mobility (4-m usual gait speed (UGS), six-minute walk (6MW) gait speed, and short physical performance battery (SPPB) score) for assessing lower extremity function and discriminating community dwelling older adults with and without mobility limitations.

DESIGN

Cross-sectional, observational study.

SETTING

Laboratory-based.

PARTICIPANTS

89 community-dwelling older adults (74.9±6.7).

MEASUREMENTS

Using principal component analysis we derived an MBA score for 89 community-dwelling older adults, and quantified 4-m UGS, 6MW gait speed, and SPPB score. The MBA score was based on five lab-based tests. We also quantified self-reported lower extremity function/mobility using the Neuro-QOL Lower Extremity Function-Mobility instrument. Based on this data a continuous score was derived and subjects were classified as "mobility limited" or "non-mobility limited". Correlations between the mobility measures and the Neuro-QOL score were calculated, and ROC curves were constructed to determine the AUC for the mobility measures ability to predict mobility limitations.

RESULTS

The MBA had the largest AUC (0.92) for discriminating mobility limitations and exhibited the strongest correlation (0.73) with the Neuro-QOL Lower Extremity Function-Mobility Scale. The worst performing predictors were the 4-meter UGS and stair climb power both with an AUC of 0.8 for discriminating mobility limitations, and a low correlation with Neuro-QOL Lower Extremity Function Scale of 0.39 and 0.46, respectively.

CONCLUSION

The MBA score moderately improves the magnitude of correlation and discrimination of mobility limitation in older adults than singular, standard tests of mobility.

Pediatric knee fractures

PURPOSE OF REVIEW

Fractures about the knee are a common occurrence in children, and characteristics of the growing skeleton make children susceptible to specific fractures that do not occur in adults. The purpose of this review is to help the clinician to recognize, understand, and appropriately treat these injuries.

RECENT FINDINGS

Pediatric knee fractures are diagnosed by a comprehensive history and physical examination supplemented with appropriate imaging modalities. Depending on the injury, treatment may include immobilization, arthroscopic treatment, or open reduction and internal fixation.

SUMMARY

A thorough understanding of pediatric knee fractures will enable clinicians to appropriately manage these injuries and provide patients with a rapid return to preinjury activities.

Intra-specific variability of feverfew: correlations between parthenolide, morphological traits and seed origin

Parthenolide, a biologically active sesquiterpene lactone found in feverfew [Tanacetum parthenium (L.) Schultz Bip., Asteraceae], has been indirectly linked to the anti-migraine action of feverfew preparations. Commercial preparations of feverfew leaves are known to vary widely in parthenolide content. Thirty-one feverfew accessions of diverse origin were examined for morphological traits and parthenolide content. Significant variation in parthenolide content was found among the populations. Mean parthenolide levels ranged from non-detectable to 1.68% +/- 0.97 (per dry weight) based upon HPLC-UV-MS. In general, feverfew plants grown from wild-collected seed from botanical gardens and the USDA accessions had higher mean parthenolide levels (0.72% +/- 0.57) than plants from commercial sources, including the generic material (0.34% +/- 0.23) and cultivars (0.35% +/- 0.40). Feverfew varieties with a light green/yellow leaf color had significantly higher mean parthenolide levels (1.61% +/- 0.61%) than darker-leafed varieties. A significant positive correlation between days to anthesis and parthenolide content was observed. Parthenolide levels did not correlate with floral morphology. This study shows that further selection for improved horticultural attributes and natural product content has potential to improve feverfew for the botanical/medicinal plant industry.