Uterine leiomyomata in pregnancy

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Targeting Antioxidant Pathways with Ferrocenylated N-Heterocyclic Carbene Supported Gold(I) Complexes in A549 Lung Cancer Cells

Ferrocenylated-Au(i) carbenes were designed, synthesized, and studied for their ability to generate reactive oxygen species and target antioxidant pathways via multiple mechanisms.

Ferrocene containing N-heterocyclic carbene (NHC) ligated gold(i) complexes of the type [Au(NHC)₂]⁺ were prepared and found to be capable of regulating the formation of reactive oxygen species (ROS) via multiple mechanisms. Single crystal X-ray analysis of bis(1-(ferrocenylmethyl)-3-mesitylimidazol-2-ylidene)-gold(i) chloride (5) and bis(1,3-di(ferrocenylmethyl)imidazol-2-ylidene)-gold(i) chloride (6) revealed a quasi-linear geometry around the gold(i) centers (i.e., the C–Au–C bond angle were measured to be ∼177° and all the Au–C_carbene bonds distances were in the range of 2.00 (7)–2.03 (1) Å). A series of cell studies indicated that cell proliferation inhibition and ROS generation were directly proportional to the amount of ferrocene contained within the [Au(NHC)₂]⁺ complexes (IC₅₀ of 6 < 5 < bis(1-benzyl-3-mesitylimidazol-2-ylidene)-gold(i) chloride (4)). Complexes 4–6 were also confirmed to inhibit thioredoxin reductase as inferred from lipoate reduction assays and increased chelatable intracellular zinc concentrations. RNA microarray gene expression assays revealed that 6 induces endoplasmic reticulum stress response pathways as a result of ROS increase.

ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1)

AIM

Surgical site infection (SSI) remains a common postoperative morbidity, particularly in colorectal resections, and poses a significant financial burden to the healthcare system. The omission of mechanical bowel preparation, as is performed in enhanced recovery after surgery programmes, appears to further increase the incidence. Various wound protection methods have been devised to reduce the incidence of SSIs. However, there are few randomized controlled trials assessing their efficacy. The aim of this study is to investigate whether ALEXIS wound retractors with reinforced O-rings are superior to conventional wound protection methods in preventing SSIs in colorectal resections.

METHODOLOGY

Patients undergoing elective open colorectal resections via a standardized midline laparotomy were prospectively randomized to either ALEXIS or conventional wound protection in a double-blinded manner. A sample size of 30 in each arm was determined to detect a reduction of SSI from 20% to 1% with a power of 80%. Secondary outcomes included postoperative pain. The operative wound was inspected daily by a specialist wound nurse during admission, and again 30 days postoperatively. Statistical analysis was performed using spss version 13 with P < 0.05 considered significant.

RESULTS

Seventy-two patients were recruited into the study but eight were excluded. There were no SSIs in the ALEXIS study arm (n = 34) but six superficial incisional SSIs (20%) were diagnosed in the control arm (P = 0.006). Postoperative pain score analysis did not demonstrate any difference between the two groups (P = 0.664).

CONCLUSION

The ALEXIS wound retractor is more effective in preventing SSI in elective colorectal resections compared with conventional methods.

Menstrual characteristics associated with endometriosis

This case-controlled study investigates whether the presence of menstrual characteristics, which may increase the exposure of the peritoneal cavity to retrograde menstruation, increases the risk of developing endometriosis. The menstrual characteristics considered were 1. age at menarche of less than 12 years, 2. duration of menstrual flow greater than five days and 3. menstrual cycle lengths of < 28 days. The frequency with which these menstrual characteristics occurred in 305 women with proven endometriosis was compared with their frequency in 305 age-matched women without endometriosis. Adjusting for the confounding factors of parity, age at first childbirth and social class, the only menstrual characteristic that was significantly associated with endometriosis was menstrual cycle lengths of less than 28 days (odds ratio 1.83; 95% confidence intervals 1.60-2.55). There was insufficient evidence to conclude that the presence of menstrual characteristics which may increase the exposure of the peritoneal cavity to retrograde menstruation, increase a women's risk of developing endometriosis. The association of short menstrual cycle lengths with endometriosis may have been consequential rather than causal.

Dual targeting of the cancer antioxidant network with 1,4-naphthoquinone fused Gold(i) N-heterocyclic carbene complexes

To achieve a systems-based approach to targeting the antioxidant pathway, 1,4-naphthoquinone annulated N-heterocyclic carbene (NHC) [bis(1,3-dimesityl-4,5-naphthoquino-imidazol-2-ylidene)-gold(i)] [silver(i) dichloride] (1), [bis(1,3-dimesityl-4,5-naphthoquino-imidazol-2-ylidene)-gold(i)] chloride (2), and 1,3-dimesityl-4,5-naphthoquino-imidazol-2-ylidene)-gold(i) chloride (3)) were designed, synthesized, and tested for biological activity in a series of human cancer cell lines. The solution phase of complexes 1-3 were assigned using several spectroscopy techniques, including NMR spectroscopic analysis. Complexes 1 and 3 were further characterized by single crystal X-ray diffraction analysis. Electrochemical and spectroelectrochemical studies revealed that quinone reductions are reversible and that the electrochemically generated semiquinone and quinone dianions are stable under these conditions. Complex 1, containing two NHC-quinone moieties (to accentuate exogenous ROS via redox cycling) centered around a Au(i) center (to inactivate thioredoxin reductase (TrxR) irreversibly), was found to inhibit cancer cell proliferation to a much greater extent than the individual components (i.e., Au(i)-NHC alone or naphthoquinone alone). Treatment of A549 lung cancer cells with 1 produced a 27-fold increase in exogenous reactive oxygen species (ROS) which was found to localize to the mitochondria. The inhibition of TrxR, an essential mediator of ROS homeostasis, was achieved in the same cell line at low administrated concentrations of 1. TrxR inhibition by 1 was similar to that of auranofin, a gold(i) containing complex known to inhibit TrxR irreversibly. Complex 1 was found to induce cell death via an apoptotic mechanism as confirmed by annexin-V staining. Complex 1 was demonstrated to be efficacious in zebrafish bearing A549 xenografts. These results provide support for the suggestion that a dual targeting approach that involves reducing ROS tolerance while concurrently increasing ROS production can perturb antioxidant homeostasis, enhance cancer cell death in vitro, and reduce tumor burden in vivo, as inferred from preliminary zebra fish model studies.

Endometriosis and race

The pelvic findings of 202 infertile women undergoing diagnostic laparoscopy in Kuala Lumpur, Malaysia were compared to that of 464 infertile women undergoing diagnostic laparoscopy in Aberdeen, United Kingdom. Endometriosis was significantly more common in the women from Kuala Lumpur (51% against 22%, p less than 0.001). There was however no significant difference seen in the severity of the disease (AFS Classification, 1985). These findings confirm our clinical impression that endometriosis is more common in Asian women when compared to Caucasian women.

Endometriosis and infertility: raised iron concentration in the peritoneal fluid and its effect on the acrosome reaction

Endometriosis and infertility are commonly associated. This study investigated the role of accelerated lipid peroxidation of spermatozoa by the peritoneal fluid of patients with endometriosis as a cause for this association. It proposes that the increased iron concentration present in the fluid of these patients acts as a catalyst for the process. Peritoneal fluid from 25 patients with endometriosis and 25 matched controls was obtained at laparoscopy. Spermatozoa were incubated in the fluid from both groups and the subsequent acrosome reaction rates analysed. The relationship between these results and iron concentration in the fluid was examined. A significant decrease in the acrosome reaction rate was seen in the endometriotic group (P = 0.034). Overall, a decrease in the acrosome reaction rate was associated with an increased iron concentration in the fluid (18 of the 25 pairs). In mild disease, (six of 11 pairs), the relationship was not as marked as that in severe disease (12 of 14 pairs). These results suggest that the peritoneal fluid in patients with endometriosis has a detrimental action on the acrosome reaction of spermatozoa in vitro.

Endometriosis and infertility: the role of exogenous lipid peroxides in the peritoneal fluid

OBJECTIVE

To determine if lipid peroxides were raised in the pelvic peritoneal fluid of patients with endometriosis.

DESIGN

Control study involving patients with and without endometriosis.

METHODS

The lipid peroxide (malondialdehyde) levels in the pelvic PF of 12 patients with moderate-to severe endometriosis, 15 patients with minimal-mild endometriosis and 13 patients with normal pelvises were compared.

RESULTS

The level of lipid peroxides were not affected by the presence nor the severity of endometriosis.

CONCLUSION

Accelerated lipid peroxidation does not appear to play a role in the causal relationship between endometriosis and infertility.

COVID-19 restrictions and their influences on ambient air, surface water and plastic waste in a coastal megacity, Chennai, India

Anthropogenic activities experienced a pause due to the nationwide lockdown, imposed to contain the rapid spread of COVID-19 in the third week of March 2020. The impacts of suspension of industrial activities, vehicular transport and other businesses for three months (25 March-30 June) on the environmental settings of Chennai, a coastal megacity was assessed. A significant reduction in the key urban air pollutants [PM2.5 (66.5%), PM10 (39.5%), NO2 (94.1%), CO (29%), O3 (45.3%)] was recorded as an immediate consequence of the reduced anthropogenic activities. Comparison of water quality of an urban river Adyar, between pre-lockdown and lockdown, showed a substantial drop in the dissolved inorganic N (47%) and suspended particulate matter (41%) during the latter period. During the pandemic, biomedical wastes in India showed an overall surge of 17%, which were predominantly plastic. FTIR-ATR analysis confirmed the polymers such as polypropylene (25.4%) and polyester (15.4%) in the personal protective equipment.

Efficacy of laparoscopic electrocoagulation in infertile patients with minimal or mild endometriosis

The cumulative pregnancy rates in 17 infertile patients with minimal or mild endometriosis who underwent laparoscopic electrocoagulation were compared with those of 20 similar patients who underwent only diagnostic laparoscopy. A life-table method of analysis was used. No significant differences in pregnancy rates was evident at either 6 months (p greater than 0.5) or 12 months (p greater than 0.5) of follow-up. These results question the use of laparoscopic electrocoagulation for the treatment of infertile patients with minimal or mild endometriosis.

Oocyte and follicular fluid characteristics in women with mild endometriosis

The follicular development, fertilization and cleavage rates and follicular fluid endocrinology were assessed in 20 women with mild endometriosis during a spontaneous menstrual cycle. Diagnostic laparoscopy was performed 32 h after the onset of the endogenous luteinizing hormone (LH) surge in the 20 women with laparoscopically confirmed mild endometriosis and in a control group of ten women with tubal infertility. There was no significant difference in oocyte maturity or fertilization and cleavage rates between the women with mild endometriosis and those in the control group. The endocrine milieu of the pre-ovulatory oocyte at the time of aspiration was similar in the two groups.

Elemental concentration and potential ecological risk assessment of reef associated surface sediments of Appa Island, Gulf of Mannar Biosphere Reserve, Southeast coast of India

Thirty three surface sediments were collected for the present study to assess the elemental concentration and its associated ecological risk in the reef associated surface sediments, Appa Island, Gulf of Mannar Biosphere Reserve, South east coast of India. The distribution of calcium carbonate in the reef sediments is controlled by coral debris and shell fragments whereas the Organic matter (OM) content are chiefly derived from mangroves and sea grasses. The circulation of trace elements and Fe, Mn are controlled by the fluvial process and re-suspended sediments. The concentration of Pb was primarily controlled by migration of pollutants through long shore sediment transport process. The main source of Pb in the study area is from coal incinerating power plants and coal handling operations from harbors.

Interspecific variations in leaf litter decomposition and nutrient release from tropical mangroves

Efficient nutrient cycling through decomposition of leaf litter often regulates the high productivity and subsequent carbon sequestration of mangrove ecosystems along the land-ocean boundary. To understand the characteristics and the potentials of mangrove leaf litter in supplying organic carbon and nutrients to the coastal waters, four major mangrove species (A. officinalis, R. mucronata, H. littoralis and S. apetala) of Bhitarkanika mangrove forest, Odisha, India, were examined in controlled environmental conditions. Half-life time (t₀.₅), estimated for decomposition of those mangrove leaf litter materials ranged from 18 to 52 days. During the incubation experiment, organic carbon from mangrove leaf litter was released primarily through physical processes and was available for heterotrophic respiration. Among the four species, leaf litter of S. apetala with the lowest initial C/N ratios, released organic carbon with low molecular weight (labile substances) that has a relatively higher potential to support the aquatic food web. On the contrary, leaf litter of R. mucronata released organic material with relatively higher molecular weight (humic substances, higher aromaticity), which revealed its superior non-labile characteristics in this unique environment. The mean total heterotrophic bacterial (THB) population in the incubation was around nine-fold higher than the control. THB population growth and Chromophoric Dissolved Organic Matter (CDOM) spectral data further suggested the rapid release of highly labile and recalcitrant carbon from S. apetala and R. mucronata (between 7th and 21st day of incubation), respectively. The mean litter fall from the Bhitarkanika mangrove forest was estimated to be 11.32 ± 1.57 Mg ha^-1 y^-1 and its corresponding carbon content was 5.43 ± 0.75 Mg C ha^-1. The study revealed the role of leaf litter leachates as an important food source to microbial communities in the adjacent coastal waters, in addition to a potential carbon sequesterer through long-term burial in mangrove soil and export to the deep sea.

Elemental concentration based potential ecological risk (PER) status of the surface sediments, Pulicat lagoon, Southeast coast of India

Eighty-three surface sediments were collected to investigate the element concentration based sediment pollution and potential ecological risk status of the Pulicat lagoon, southeast coast of India. The textural characteristics, Fe and Mn concentration in the surface sediments are chiefly controlled by the confluence of riverine inputs and vicinity of the marine environment. The varied distribution of CaCO₃ concentration is due to the depth of the lagoon followed by the sand and silty sand characteristics of the substratum. The surface sediments are derived from riverine sources. Sediment Pollution Index (SPI), Potential Ecological Risk Index of the sediments suggests that they are falling under less polluted and low potential ecological risk category.

The association of anovulation and endometriosis in the infertile female

Ninety-six infertile patients with endometriosis were studied and their endometriosis staged according to the Revised American Fertility Society Classification. Anovulation was detected in 19% of the 32 patients with Stage 1 disease but in only 3% in the remaining 64 patients with Stage II, III and IV disease. These results show that contrary to traditional belief, anovulation does occur in a significant number of patients with endometriosis, especially in minimal or mild disease.

The use of the semen analysis in predicting fertility outcome

The study investigates the use of the various parameters of the semen analysis in predicting the fertility outcome in 82 infertile couples. The sperm density, % progressive motility, % normal morphology were divided into 'normal' and 'abnormal' based on the criteria proposed by WHO. The subsequent cumulative pregnancy rates were then calculated according to this criteria. A life-table method of analysis was used. All female related fertility factors were excluded. With the exception of a sperm density of less than 20 x 10(6) per ml the other parameters showed no significant correlation with the cumulative pregnancy rates at 12 months or 24 months respectively. We concluded that the semen analysis does not predict the probable outcome of the subsequent rates even when female fertility related factors were excluded apart from a sperm density less than 20 x 10(6) per ml.

Endometriosis and social class: an Asian experience

The social class distribution in 147 patients confirmed to have endometriosis at laparoscopy was done to see if the disease was associated with affluence. Two hundred and eighty-one patients confirmed not to have endometriosis was used as controls. The patients were derived from a background population for which the social class characteristics was known. Endometriosis was significantly (p < 0.001) associated with social class 1 and 2. However there was no association between social class distribution and the severity of the disease developed.

High performance liquid chromatographic fluorescence detection method for the quantification of rivastigmine in rat plasma and brain: application to preclinical pharmacokinetic studies in rats

A highly sensitive and selective high performance liquid chromatographic fluorescence detection method has been developed and validated for the quantification of rivastigmine in rat plasma and brain. Protein precipitation and one-step liquid–liquid extraction techniques were utilized for the extraction of RSM from brain and plasma, respectively, along with an internal standard. The chromatographic separation was achieved with a column inertsil ODS-3V and a mobile phase consisting of ammonium acetate buffer (20 mM, pH 4.5) and acetonitrile (76:24, v/v) delivered at a flow rate of 1 ml/min. The lower limit of quantitation for the developed method was 10 ng/mL for both matrices. The method was found to be accurate and reproducible and was successfully used to quantify levels of RSM in plasma and brain following intravenous administration of RSM in rats.