Do preoperative pancreatic computed tomography attenuation index and enhancement ratio predict pancreatic fistula after pancreaticoduodenectomy?

BACKGROUND

The commonly used predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) have subjective assessment components and can be used only in the postoperative setting. Also, the available objective predictors based on preoperative cross-sectional imaging were not prospectively studied.

AIM

To evaluate the accuracy of the pancreatic attenuation index (PAI) and pancreatic enhancement ratio (PER) for predicting CR-POPF following PD and its correlation with pancreatic fat fraction and fibrosis.

METHODS

A prospective observational study included patients who underwent PD for benign and malignant pathology of the periampullary region or pancreatic head between February 2019 and February 2021. Patients undergoing extended or total pancreatectomy and those with severe atrophy of pancreatic tissue or extensive parenchymal calcifications in the pancreatic head and neck precluding calculation of PAI and PER were excluded from the study. Preoperatively PAI was measured in the neck of the pancreas by marking regions of interest (ROI) in the non-contrast computed tomography (CT), and PER was measured during the contrast phase of the CT abdomen. Also, the fibrosis score and fat fraction of the pancreatic neck were assessed during the histopathological examination. Demographic, clinical and preoperative radiological indices (PAI, PER) were evaluated to predict CR-POPF. Preoperative pancreatic neck CT indices were correlated with the histopathological assessment of fat fraction and fibrosis.

RESULTS

Of the 70 patients who underwent PD, 61 patients fulfilling the inclusion criteria were included in the analysis. The incidence of CR-POPF was 29.5% (18/61). PAI had no association with the development of CR-POPF. Of the preoperative parameters, PER (mean ± standard deviation [SD]) was significantly lower in patients developing CR-POPF (0.58 ± 0.20 vs 0.81 ± 0.44, P = 0.006). The area under the curve for the PER was 0.661 (95%CI: 0.517-0.804), which was significant (P = 0.049). PER cut-off of 0.673 predicts CR-POPF with 77.8% sensitivity and 55.8% specificity. PAI and PER had a weak negative correlation (Strength-0.26, P = 0.037). Also, PER showed a moderately positive correlation with fibrosis (Strength 0.50, P < 0.001). Patients with CR-POPF had a significantly higher incidence of the intraabdominal abscess (50% vs 2.3%, P < 0.001), delayed gastric emptying (83.3% vs 30.2, P < 0.001), and prolonged mean (± SD) postoperative hospital stay (26.8 ± 13.9 vs 9.6 ± 3.6, P = 0.001).

CONCLUSION

PER exhibited good accuracy in predicting the development of CR-POPF. PER additionally showed a good correlation with PAI and fibrosis scores and may be used as an objective preoperative surrogate for assessing pancreatic texture. However, ROI-based PAI did not show any association with CR-POPF and pancreatic fat fraction.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically - A Prospective Cohort Study

Introduction:

Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures.

Material and methods:

This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle society-AOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed.

Results:

Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and pre-operative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), pre-operative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly.

Conclusion:

Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Study on reversal of ABCB1 mediated multidrug resistance in Colon cancer by acetogenins: An in-silico approach

Multi-Drug Resistance (MDR) exerted by tumor cells is majorly due to the overexpression of ATP Binding cassette transporters such as ABCB1/P-glycoprotein (P-gp). Annonaceous acetogenins (AGEs) exert anticancer activity by strongly inhibiting NADH oxidase of cancer cells. The present in silico study aims at screening a potent MDR inhibitor among acetogenins from the plant Annona muricata. Twenty-four AGEs were selected and screened for their pharmacokinetic properties. An inward facing conformation of P-gp is required for understanding the interaction of AGEs at the drug binding region and hence the human P-gp protein was modeled. The selected compounds were then docked with the ATP binding site and the drug binding site of modeled human P-gp. Annonacin A.1, Annohexocin.1 and Annomuricin E.1 docked better with high MM/GBSA dG binding in the drug binding region as compared with the conventional drugs. These compounds had a better docking score as compared with control inhibitor drugs at the ATP binding region. The complexes were subjected to MD simulation and Annonacin A was stable throughout the simulation period. Therefore, Annonacin A might act as a competitive inhibitor for the chemo drugs for binding at the drug binding region of P-gp. Hence it is capable of decreasing the efflux of chemo drugs out of the cells by P-Glycoprotein/ABCB1/MDR1. With this computational study, it is concluded that this compound might potentially reverse MDR, and hence can be taken forward for validation studies.Communicated by Ramaswamy H. Sarma.

Quantification of biomaterial dispersion during otologic procedures and role of barrier drapes in Covid 2019 era - a laboratory model

BACKGROUND

Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic.

OBJECTIVE

To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery.

METHODS

The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1-10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed.

RESULTS

Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027).

CONCLUSION

Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

BACKGROUND

This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the "Combined Diabetes and Renal Control Trial" (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes.

METHODS

An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial.

RESULTS

Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects.

CONCLUSIONS

The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

TRIAL REGISTRATION NUMBER

Trial registered with the International Standard Randomised Controlled Trial (ISRCTN10546597). Registered 12 September 2016 (Retrospectively registered).

The Highly Selective Metal-Free Oxidation of Sulfides, Tellurides and Phosphines Using Sodium Bromate in the Presence of Recyclable Ionic Liquid [Bmim]HSO4, at 80 °C

The metal-free oxidation of sulfides to sulfones using sodium bromate (NaBrO3) in [bmim]HSO4:H2O (3:1, v/v) at 80 °C is reported. Phenylalkyl, phenylbenzyl, diaryl and heteroaryl sulfides were transformed to the corresponding sulfones. Aryl tellurides and phosphines were oxidised to the corresponding telluroxides and phosphine oxides. All the reactions proceeded smoothly and gave high yields in 20–55 min. The ionic liquid [bmim]HSO4 was easily recovered and recycled.

A Green Approach for the Synthesis of Novel 7,11-Dihydro-6H-chromeno[3,4-e]isoxazolo[5,4-b]pyridin-6-one Derivatives Using Acidic Ionic Liquid [C4mim][HSO4]

A multicomponent reaction capable of affording a wide range of novel 7,11-dihydro-6H-chromeno[3,4-e]isoxazolo[5,4-b]pyridin-6-one derivatives via one-pot three-component condensation of 4-hydroxycoumarin, aromatic aldehydes, and 5-amino-3-methylisoxazole in ionic liquid 1-butyl-3-methylimidazolium hydrogen sulfate ([C4mim][HSO4]) is reported. Structures have been confirmed by spectral and X-ray studies. Crystal packing of 4b has also been reported. Green solvent, short reaction time, easy workup, and high yields are the salient features of the present protocol.

A facile and green approach for the synthesis of spiro[naphthalene-2,5′-pyrimidine]-4-carbonitrile via a one-pot three-component condensation reaction using DBU as a catalyst

A series of novel spiro[naphthalene-2,5′-pyrimidine]-4-carbonitriles were synthesized using 1,3-dimethylbarbituric acid, aldehydes and cyclohexylidene malononitrile in presence of DBU. The structures were confirmed by spectral data and X-Ray crystallography.

Asynchronous symmetry-based sequences for homonuclear dipolar recoupling in solid-state nuclear magnetic resonance

We show a theoretical framework, based on triple-mode Floquet theory, to analyze recoupling sequences derived from symmetry-based pulse sequences, which have a non-vanishing effective field and are not rotor synchronized. We analyze the properties of one such sequence, a homonuclear double-quantum recoupling sequence derived from the C72 (1) sequence. The new asynchronous sequence outperforms the rotor-synchronized version for spin pairs with small dipolar couplings in the presence of large chemical-shift anisotropy. The resonance condition of the new sequence is analyzed using triple-mode Floquet theory. Analytical calculations of second-order effective Hamiltonian are performed to compare the efficiency in suppressing second-order cross terms. Experiments and numerical simulations are shown to corroborate the results of the theoretical analysis.

An efficient, green synthesis of novel regioselective and stereoselective indan-1,3-dione grafted spirooxindolopyrrolizidine linked 1,2,3-triazoles via a one-pot five-component condensation using PEG-400

An efficient synthesis of highly diversified novel functionalized indan-1,3-dione grafted spirooxindolopyrrolizidine linked 1,2,3-triazole conjugates is reported using Cu(i) as a catalyst in PEG-400.

Chemical profiling of Elaeocarpus serratus L. by GC-MS

OBJECTIVE

To determine the possible bioactive components of the ethanolic extract of leaves of Elaeocarpus serratus (E. serratus).

METHODS

The present research was carried out by using GC-MS analysis, while mass spectra of the compounds found in the extract was matched with the National Institute of Standards and Technology and Wiley library.

RESULTS

Thirty components from leaves of the above said plant were identified. The active principles with their retention time, molecular formula, molecular weight and concentration (%) in the ethanol extracts of leaf of E. serratus are obtained.

CONCLUSIONS

This is the first report of documentation of active constituents from leaves of E. serratus. The research reveals the potential of E. serratus leaves as a good source of bioactive compounds such as fatty acid esters, alcohols, hydrocarbons, aldehydes, alkenes, fatty acids and amides that justify the use of this plant for its various ailments by traditional practitioners.

Rheological properties of a reentrant nematic liquid crystal

We report experimental studies on small angle light scattering (SALS), and rheodielectric and electrorheological properties of a binary mixture of octyloxy cyanobiphenyl and hexyloxy cyanobiphenyl liquid crystals. The mixture exhibits nematic (N) to smectic-A (SmA) phase transitions, and then again to a reentrant nematic (N(R)) phase transition. Rapid shear thinning in the quenched samples in the low shear rate region in the N and SmA phases observed from SALS experiments is attributed to the realignment of the director within the domains. The domains are elongated along the shear direction at higher shear rates. The temperature variation of the effective viscosity and static dielectric constant reveals the changes in the director orientation across N-SmA-N(R) phase transitions. At a steady shear rate the effective viscosity increases with the electric field in all the phases and saturates at much higher fields. It also exhibits two anomalous peaks across N-SmA-N(R) phase transitions beyond a particular field. The shear modulus of the SmA phase in an intermediate field is significantly larger than that measured at both low and high fields. This enhanced viscoelasticity of the SmA phase is argued to originate from the increased dislocation density.

Effect of electric field on the rheological and dielectric properties of a liquid crystal exhibiting nematic-to-smectic-A phase transition

We report simultaneous measurements of shear viscosity (η) and dielectric constant (ε) of octyloxy cyanobiphenyl (8OCB) in the nematic (N) and smectic-A (SmA) phases as functions of temperature and electric field. With increasing electric field η increases in the N phase whereas it decreases in the SmA phase and saturates beyond a particular field in both the phases. The flow curves in the intermediate-field range show two Newtonian regimes in the N phase. The temperature-dependent behavior of η and ε at zero or at small electric field suggests the occurrence of several structures that results from precessional motion of the director along the neutral direction as reported in similar other system. We show that the precessional motions are gradually suppressed with increasing electric field and the effective viscosity resembles with the Miesowicz viscosity η1 at high enough electric field. In the intermediate field range the temperature-dependent η exhibits anomalous behavior across the N-SmA phase transition which is attributed to the large contribution of Leslie coefficient α1.

Epitaxial Growth of Co3O4 Films by Low Temperature, Low Pressure Chemical Vapor Deposition

The growth of strongly oriented or epitaxial thin films of metal oxides generally requires relatively high growth temperatures or infusion of energy to the growth surface through means such as ion bombardment. We have grown high quality epitaxial thin films of Co3O4 on different substrates at a temperature as low as 450°C by low-pressure metal-organic chemical vapor deposition (MOCVD) using cobalt(II) acetylacetonate as the precursor. With oxygen as the reactant gas, polycrystalline Co3O4 films are formed on glass and Si(100) in the temperature range 350-550°C. Under similar conditions of growth, highly oriented films of Co3O4 are formed on SrTiO3(100) and LaAlO3(100). The film on LaAlO3(100) grown at 450°C show a rocking curve FWHM of 1.61°, which reduces to 1.32° when it is annealed in oxygen at 725°C. The film on SrTiO3(100) has a FWHM of 0.330 (as deposited) and 0.29° (after annealing at 725°C). The ø-scan analysis shows cube-on-cube epitaxy on both these substrates. The quality of epitaxy on SrTiO3(100) is comparable to the best of the pervoskite-based oxide thin films grown at significantly higher temperatures.

Fauntail naevus

A case of fauntail naevus in a teenaged girl with radiological evidence of bifid vertebrae without any neurological, urological or orthopaedic complications is presented.

Degree of peroxidative status in neuronal tissues by different routes of inorganic mercury administration

Mercuric chloride was administered by three routes--subcutaneous, intramuscular and intraperitoneal to adult female Wistar rats. The peroxidative status of the cerebral cortex, cerebellum and the sciatic nerves were studied. Enhanced levels of lipid peroxides indicate progressing cellular injury. All the experimental groups show high levels of reduced glutathione and increased activities of glutathione peroxidase, superoxide dismutase and catalase. Neurotoxic status was more pronounced in intramuscularly administered mercuric chloride, followed subsequently by intraperiotoneal and subcutaneous routes of administration.