Fabrication of MoS2/rGO hybrids as electrocatalyst for water splitting applications

Environmental degradation and energy constraint are important risks to long-term sustainability in the modern world. Water splitting is a vital approach for environmentally friendly and sustainable energy storage, providing a clean way to produce hydrogen without pollutants. Preparing a catalyst that is active, bifunctional, and durable for water splitting is a difficult task. We addressed the difficulty by creating a bifunctional heterogeneous catalyst, MoS2/rGO, with an ideal weight percentage of 5 wt% by a hydrothermal process. The optimized sample showed exceptional electrocatalytic activity, requiring an overpotential of 242 mV and 120 mV to achieve a current density of 10 mA cm-2 in the Hydrogen Evolution Reaction (HER) and Oxygen Evolution Reaction (OER). Furthermore, our synthesized catalyst was validated for its exceptional water-splitting capacity, with the optimized sample showing low Tafel slope values of 59 mV dec-1 for HER and 171 mV dec-1 for OER. The significant OER and HER activity seen in the 5 wt% MoS2/rGO hybrid, compared to other hybrids, is due to the many catalytic active sites that aid in charge and electron transport, as well as the synergistic interaction between MoS2 and rGO.

Physalis ixocarpa: new species of genus physalis to the flora of Pakistan from mountainous region of district Shangla, Khyber Pakhtunkhwa Pakistan

Abstract In the western mountainous region of Khyber Pakhtunkhwa Pakistan at the Shangla district, we found Physalis ixocarpa for the first time, not yet reported from Pakistan. Physalis ixocarpa was unidentified and has no ethnobotanical record in the flora of Pakistan. It is a member of family Solanaceae and having a close relation with Solanum tuberosum and Lycopersicon esculentum. The stem is prostrate with a dichotomous pattern of branches having leaves flower and fruits. Leaves are smooth, ovate and the margins of leaf blade dentation are poorly developed. The average length and width of the leaves are 6.50 and 3.61 cm respectively. P. ixocarpa grows to the length of 4-5 feet and an annual herb. The flowers of the plants are yellow in color and having purple color spots on the petals which are star-shaped. The round berry fruits are surrounded by persistent calyx and purple in color. The fruits are the 3-6cm in diameter. The plants are found in the different localities of district Shangla especially in Bar and Koz Kana. The life cycle of reporting plant is started in May and completed in November.

Meta-analysis of randomized controlled trials examining the safety and efficacy of bempedoic acid

Funding Acknowledgements

Type of funding sources: None.

Introduction

Bempedoic acid (BA), an inhibitor of ATP citrate lyase, has emerged as a new therapy for patients with dyslipidemia. The objective of this study was to perform a meta-analysis of BA's safety and cholesterol lowering efficacy.

Methods

A meta-analysis was performed using RCTs testing the safety and efficacy of BA versus placebo. The primary analysis calculated the odds ratio (OR) and 95% confidence interval (CI) of any adverse events, muscular-related AEs including myopathy, muscle weakness, and myalgias, as well as serious AEs as self-defined by the individual RCT. Additionally, we evaluated the mean difference (MD) and CI of low density lipoprotein-cholesterol (LDL-C), non-high density lipoprotein-cholesterol (non-HDL-C), total cholesterol (TC), and apolipoprotein B (ApoB) at 12 weeks, as well as LDL-C at 24 weeks of BA use as compared to placebo.

Results

Four RCTs were identified comparing BA to placebo. There was no increased risk of any AE [OR 1.04; 95%CI 0.89, 1.22], serious AE [OR 1.07; 95%CI 0.87, 1.34], or muscular-related AE [OR 1.25; 95%CI 0.98, 1.58] with BA use compared to placebo. BA resulted in a significant reduction in LDL-C [MD -21.06; 95%CI -24.49, -17.62], TC [MD -16.02; 95%CI -19.09, -12.93], non-HDL-C [MD -17.84; 95%CI -21.34, -14.34], and ApoB [MD -14.19; 95%CI -17.18, -11.21] at 12 weeks, and LDL-C at 24 weeks [MD -16.42; 95%CI -18.15, -14.69] compared to placebo.

Conclusion

In this meta-analysis testing BA versus placebo, BA significantly reduced levels of LDL-C, TC, non-HDL-C, and ApoB at 12 weeks and LDL-C at 24 weeks, and was not associated with an increased risk of any AE, muscular-related AE or serious AE. Further studies with longer time of follow up are needed to confirm the safety and long term cholesterol effects of BA.

Advanced strategies in Metal-Organic Frameworks for CO2 Capture and Separation

The continuous carbon dioxide (CO₂ ) gas emissions associated with fossil fuel production, valorization, and utilization are serious challenges to the global environment. Therefore, several developments of CO₂ capture, separation, transportation, storage, and valorization have been explored. Consequently, we documented a comprehensive review of the most advanced strategies adopted in metal-organic frameworks (MOFs) for CO₂ capture and separation. The enhancements in CO₂ capture and separation are generally achieved due to the chemistry of MOFs by controlling pore window, pore size, open-metal sites, acidity, chemical doping, post or pre-synthetic modifications. The chemistry of defects engineering, breathing in MOFs, functionalization in MOFs, hydrophobicity, and topology are the salient advanced strategies, recently reported in MOFs for CO₂ capture and separation. Therefore, this review summarizes MOF materials' advancement explaining different strategies and their role in the CO₂ mitigations. The study also provided useful insights into key areas for further investigations.

Early inflammation precedes cardiac fibrosis and heart failure in desmoglein 2 murine model of arrhythmogenic cardiomyopathy

The study of a desmoglein 2 murine model of arrhythmogenic cardiomyopathy revealed cardiac inflammation as a key early event leading to fibrosis. Arrhythmogenic cardiomyopathy (AC) is an inherited heart muscle disorder leading to ventricular arrhythmias and heart failure due to abnormalities in the cardiac desmosome. We examined how loss of desmoglein 2 (Dsg2) in the young murine heart leads to development of AC. Apoptosis was an early cellular phenotype, and RNA sequencing analysis revealed early activation of inflammatory-associated pathways in Dsg2-null (Dsg2^-/-) hearts at postnatal day 14 (2 weeks) that were absent in the fibrotic heart of adult mice (10 weeks). This included upregulation of iRhom2/ADAM17 and its associated pro-inflammatory cytokines and receptors such as TNFα, IL6R and IL-6. Furthermore, genes linked to specific macrophage populations were also upregulated. This suggests cardiomyocyte stress triggers an early immune response to clear apoptotic cells allowing tissue remodelling later on in the fibrotic heart. Our analysis at the early disease stage suggests cardiac inflammation is an important response and may be one of the mechanisms responsible for AC disease progression.

Mosquitocidal activities of Chenopodium botrys whole plant n-hexane extract against Culex quinquefasciatus

This research aimed to investigate various mosquitocidal activities of Chenopodium botrys whole- plant n-hexane extract against Culex quinquefasciatus. The extract showed remarkable larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus. During the larvicidal and pupicidal activities, the 24-hour lethal concentration (LC50) of extract against 2nd instar larvae, 4th instar larvae and pupae were 324.6, 495.6 and 950.8 ppm, respectively. During the CDC (Centers for Disease Control and Prevention) bottle bioassay for adulticidal activity, the median knockdown times (KDT50) at 1.25% concentration was 123.4 minutes. During the filter paper impregnation bioassay for adulticidal activity, the KDT50 value at 0.138 mg/cm2 concentration was 48.6 minutes. The extract was fractionated into 14 fractions through silica gel column chromatography which were then combined into six fractions on the basis of similar retention factor (Rf) value. These fractions were screened for adulticidal activity by applying CDC bottle bioassay. The fraction obtained through 60:40 to 50:50% n-hexanes-chloroform mobile phase with 0.5 Rf value showed 100% adulticidal activity at 0.2% concentration. During oviposition deterrent activity, the highest concentration (1000 ppm) showed 71.3 ± 4.4% effective repellence and 0.6 ± 0.1 oviposition activity index. During adult emergence inhibition activity, the median emergence inhibition (EI50) value was 312.3 ppm. From the outcome of the present investigation, it is concluded that the n-hexane extract of C. botrys whole- plant possesses strong larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Electrocatalytic study of NiO-MOF with activated carbon composites for methanol oxidation reaction

In this work, the methanol oxidation reaction is investigated on Ni based metal organic frameworks (MOF) and its composites with biomass derived activated carbon. NiO-MOF and composites with activated carbon were synthesized using hydrothermal method. SEM, EDX, and XRD, FTIR, TGA techniques were used for characterization of composites. The electrochemical activity of catalysts for oxidation of methanol was tested using cyclic voltammetry (CV) in 1 M KOH and 3 M CH₃OH on glassy carbon electrode in three electrode setup. The electrochemical performance shows the effect of activated carbon concentration on methanol oxidation. The electro-oxidation catalyzed by NiO-MOF with activated carbon (40 mg) composite exhibits a peak current density of 182.72 mA/cm² at 0.89 V potential with a scan rate of 50 mV/s making it a potential catalyst for electrocatalysis of methanol.

Recent advances in the metal–organic framework-based electrocatalysts for the hydrogen evolution reaction in water splitting: a review

Water splitting is an important technology for alternative and sustainable energy storage, and a way for the production of hydrogen without generating pollution.

Nanocomposites of NiO/CuO Based MOF with rGO: An Efficient and Robust Electrocatalyst for Methanol Oxidation Reaction in DMFC

In this work a novel bimetallic nickel oxide/copper oxide metal–organic framework (NiO/CuO MOF) has been developed by using two linkers: Benzene Dicarboxylic acid (BDC) and Pyrazine. The composites of NiO/CuO MOF with different amounts of reduced graphene oxide (rGO) were synthesized through a hydrothermal method and subsequently characterized by multiple significant techniques like XRD, SEM, EDX, FTIR and Raman IR for an investigation of their structural and morphological properties. The prepared series of material was later employed for electrochemical oxidation of methanol, tested by cyclic voltammetry (CV) in basic medium on a modified glassy carbon electrode (GCE). The electrochemical response depicts that increasing concentration of rGO enhances the electrocatalytic activity of the catalyst for methanol oxidation reaction (MOR). The catalyzed oxidation reaction of methanol by NiO/CuO MOF and rGO-NiO/CuO MOF composites give a superlative current density of 437. 28 mA/cm² at 0.9 V potential at 50 mV/s scan rate. This activity makes it a promising catalytic material for electrolysis of methanol in direct methanol fuel cell (DMFC).

Limited versus Aggressive Open Discectomy for a Single Level Lumbar Intervertebral Disc Prolapse

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.

Management of Spinal Injuries in Polytrauma Patients: An Experience of Tertiary Care Hospital

Spine injuries, a common component in Polytrauma are usually affects the young people and is a major cause of morbidity and poses a significant health care expenditure and considerable threats to survival and quality of life. We retrospectively assess the demographics, incidence, mode of trauma, associated spine injuries, complications, neurological improvement and mortality. Records of total 1695 admitted patients, spinal injuries were 262 patients. Among them 30(11.45%) patients were associated with Polytrauma victims. Eleven patients (36.67%) were admitted through Ortho emergency dept, 14(46.67%) patients through Intensive care unit (ICU), 5(16.66%) patients through other department (CVS, Urology). Most (56%) of the patients were young in the age range of 16 to 40 years. Cervical spines were most commonly (44%) affected followed by lumbar (31%), thoracic (13%), thoraco-lumbar (9%) and Cervico-thoracic (3%) spines. Road traffic accident was the common cause (80%). Twelve patients (40%) had problems at various steps of management and maximum problems occur in step III. Nineteen patients (63.33%) management needs co-ordination between various specialties. Significant number of patients (76.67%) required operative treatment (p<0.05) and 13.33% were managed conservatively. Mortality rate (10%) was insignificant (p>0.05%). Of these patients, 73.33% had shown neurological improvement of at least one ASIA grade. The treatment of spinal injury in polytrauma patient should follow the principle of Advanced Trauma Life Support (ATLS). Once life and limb-threatening injuries have been identified and addressed, suspected spinal cord injury patients should be immobilized as early as possible to reduced the secondary injury, improve motor and sensory function as well as reduced the extend of permanent paralysis.

Short-segment versus Long-segment Stabilization for Unstable Thoracolumbar Junction Burst Fractures

The treatment of unstable thoracolumbar junction burst fractures remains a controversial issue. We evaluate the efficacy of short segment (SS) compared with that of long-segment (LS) stabilization in terms of clinical and the radiological outcomes. Records of 88 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation from January 2004 to December 2015, studied retrospectively. These patients were divided into two groups: SS and the LS-group. Clinical parameters: back pain, disability, neurological deficit and radiologic parameters: Cobb angle, sagittal index, the kyphotic deformation of vertebral body, vertebral height and canal compromise were measured before surgery and immediately after surgery and at 3, 6 and 12 months postoperatively. Overall outcomes were evaluated using the modified Mcnab criteria at the last follow-up. Chi-squared test and paired-t test were used for statistical analysis using SPSS. There were 36 and 52 patients in the SS and LS- group, respectively. The mean age of the patients was 30.6±8.4 and 33.4±8.4 years and the mean follow-up period was 24.5 and 16.8 months in SS and LS-group respectively. In the SS-group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 15, 10, 6, 3 and 2 cases and LS- group, the fractured vertebral body level was L1, T12, L2, T11 and T10 in 22, 17, 5, 5 and 3 cases, respectively. Both groups achieved satisfactory clinical outcomes according to the modified Mcnab criteria. In the SS-group, 8(22.22%), 21(58.33%) and 7(19.44%) cases were considered to have excellent, good and fair outcome and LS-group, 18(34.61%), 25(48.08%), 6(11.54%) and 3(5.77%) cases were considered to have excellent, good, fair, and poor outcome, respectively. Short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar junction burst fracture.

Open-door Laminoplasty for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament (OPLL) using Titanium Reconstruction Miniplate and Screws

To review outcome of 25 patients who underwent open-door cervical laminoplasty for multilevel cervical spondylotic myelopathy (MCSM) and ossification of the posterior longitudinal ligament (OPLL) using titanium reconstruction miniplate and screws. Records of 18 men and 7 women aged 35 to 78 (mean, 62.6) years were reviewed retrospectively from October 2009 and October 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, Bangladesh. Four patients had 5 levels (C3-C7), 21 patients had 4 levels (C3-C6) decompression and 3 patients (12%) performed foraminotomies. A total of 104 laminae were opened, all of them were fixed with a titanium reconstruction miniplates. In 21 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 4 laminae and 4 patients fixed in 5 laminae levels. In most patients, screw fixation was unicortical and no spacer or bone graft was used. Demographic and surgical data were collected and clinical outcomes were assessed with neck pain score, neck disability index and Nurick's grading. Outcome analysis was done using Odom's criteria. The mean follow-up duration was 1.8 (range, 1-5) years. Diagnoses were MCSM (n=20), OPLL (n=5). Mean estimated blood loss (EBL) was 120ml (range: 50-200), mean surgery time was 153 min (range: 75-240). Following Nurick's grading, 23 patients (92%) improved, 2 (08%) had the same Nurick grade. No intraoperative complications were noted and average hospital stay was 6.12 days (range: 5 to 9). Significance improvements in overall NDI scores occurred at 1 year follow up (p<0.002). Radiographic evaluation showed an increase in the mean sagittal diameter from 13.3mm at pretreatment to 19.4mm post surgery. Two patients developed transient C5 palsy. Open-door Laminoplasty technique is safe, easy and achieves a good canal expansion and neurological recovery and can be used as an alternative treatment for cases of MCSM and OPLL patients without instability.

Surgical Outcome of Intradural Spinal Tumors

Results of 63 surgically treated intradural spinal tumors between the period of October 2003 and December 2014 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and in our private settings, Dhaka, were analyzed retrospectively. There were 33 males, 30 females with an average age of 52.4 years (13-70 years) and followed up for at least a year. The preoperative symptom with duration, tumors location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The tumors were located as, thoracic (n=32, 50.79%), lumbar (n=16, 25.39%), cervical (n=05, 07.93%), and junctional (n=10, 15.87%, CervicoThoracic-01, Thoracolumbar-09). The histopathological diagnosis included schwannoma (n=30, 47.7%), meningiomas (n=14, 22.3%), neurofibroma, arachnoid cyst and myxopapillary ependymoma (n=03, 04.76%) each and paraganglioma (n=01, 01.59%). Among the intramedullary tumors, ependymoma (n=03, 04.76%), astrocytoma and epidermoid cyst (n=02, 03.17%), haemangioblastoma, paraganglioma and cavernous haemangioma (n=01, 01.59%) each. The VAS score was reduced in all cases from 8.0±1.2 to 1.2±0.8 (p<0.003) and the Nurick's grade was improved in all cases from 3.0±1.3 to 1.0±0.0 (p<0.005). The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia and further neurological deterioration (Astrocytoma) (n=02, 03.17%) and dependant bedsore and recurrence (Ependymoma) (n=01, 01.59%). Aggressive surgical excision potentially minimizes neurologic morbidity and improved outcome except intramedullary tumors where initial treatment consists of maximum safe surgical resection or biopsy.

Factors Associated with Periodontal Disease in Pregnant Diabetic Women

There have been an association between systemic diseases and hormonal changes particularly diabetes which has been cited as a risk factor in the progression of periodontitis in pregnant women. The incidence and severity of periodontal diseases are increasing at a higher rate and a common condition in pregnant diabetic women among Bangladeshi population. This cross sectional study included 200 pregnant women who were selected from gynecological department and examined at the dental unit. The clinical parameters used were the Silness and Loe plaque index (PI), gingival scores and periodontal status and any relationship to socio demographic variables (age, occupation, level of education and urban or rural residence) and clinical variables (gestation period, previous pregnancy, type of diabetes and periodontal maintenance) were evaluated. The results showed that these clinical parameters increased concomitantly with an increase in the stage of pregnancy and in women with multiple pregnancies. Increased age, lower level of education, unemployment and patients residing in rural areas were associated with significantly higher gingival scores and periodontal measures. Women with increased age and multiple pregnancies usually have less interest to frequent periodontal maintenance showing a significant statistical relation between an increased age and changes in gingival and periodontal status; however no significant association was found between increased age and plaque index. It is concluded that gingival inflammatory symptoms are aggravated during pregnancy in diabetic women and are related to different clinical and demographic variables.

Transforaminal lumbar interbody fusion in symptomatic low-grade isthmic spondylolisthesis

Isthmic spondylolisthesis (IS) is the most common spondylolytic disorders and one of the most common causes of low back pain and sciatica in adolescents and adults. Although the initial management is conservative, surgery is often the ultimate solution. Interbody fusion has been found superior and replaced the gold standard postero-lateral fusion. Transforaminal Lumbar Interbody Fusion (TLIF) has been associated with fewer complications and has become the choice of surgery. This study was done to evaluate the clinical, radiological and functional outcome of TLIF in Low Grade Isthmic Spondylolisthesis (LGIS). The clinical records of 46 consecutive patients within the age range of 31 to 60 years, who had symptomatic unstable Low Grade Isthmic Spondylolisthesis (LGIS) with or without unilateral radiculopathy in Bangabandhu Sheik Mujib Medical University (BSMMU) and private settings, from April 2007 to March 2012 were reviewed with 2 year completed follow-up. Patients were evaluated for pain by Visual Analogue Score (VAS), Disability by Oswestry Disability Index (ODI), radiological fusion by Brantigan and Steffee criteria, reduction of listhesis by Taillard's method and the overall functional outcome by the Macnab's criteria. Pain (Low back and leg), disability, neurological status had highly significant (p<0.001, paired t test) improvement. Forty two (91.30%) cases achieved satisfactory radiological fusion with overall 30% reduction of slip. Satisfactory outcome was reached in 45(97.83%) cases. Transforaminal Lumbar Interbody Fusion results in significant improvement of clinical, radiological and functional debility of symptomatic LGIS in adults.

Instrumented posterior lumbar interbody fusion (PLIF) with interbody fusion device (Cage) in degenerative disc disease (DDD): 3 years outcome

This prospective interventional study carried out at Bangabandhu Sheikh Mujib Medical University and a private hospital in Dhaka, Bangladesh during the period from October 2003 to September 2011. Surgical treatment of degenerative disc disease (DDD) should aim to re-expand the interbody space and stabilize until fusion is complete. The present study conducted to find out the efficacy of using interbody fusion device (Cage) to achieve interbody space re-expansion and fusion in surgical management of DDD. We have performed the interventional study on 53 patients, 42 female and 11 male, with age between 40 to 67 years. All the patients were followed up for 36 to 60 months (average 48 months). Forty seven patients were with spondylolisthesis and 06 with desiccated disc. All subjects were evaluated with regard to immediate and long term complications, radiological fusion and interbody space re-expansion and maintenance. The clinical outcome (pain and disability) was scored by standard pre and postoperative questionnaires. Intrusion, extrusion and migration of the interbody fusion cage were also assessed. Forty seven patients were considered to have satisfactory outcome in at least 36 months follow up. Pseudoarthrosis developed in 04 cases and 06 patients developed complications. In this series posterior lumbar interbody fusion (PLIF) with interbody cage and instrumentation in DDD showed significant fusion rate and maintenance of interbody space. Satisfactory outcome observed in 88.68% cases.

Can contrast-enhanced sonography distinguish benign from malignant breast masses?

BACKGROUND

We investigated whether microvascular enhancement on contrast-enhanced sonographic (CEUS) imaging can aid in distinguishing between benign and malignant lesions and correlated these findings with histopathological findings.

METHOD

Fifteen patients with a palpable breast mass were recruited. Following informed consent, 4.8 mL of the microbubble contrast agent SonoVue was injected intravenously. Digital video clips of lesion enhancement were obtained and reviewed by a consultant radiologist who scored each lesion on the following characteristics: homogeneous versus heterogeneous enhancement, the presence or absence of focal defects, well- versus ill-defined margins and vascular morphology score (VMS).

RESULT

Histologically there were 7 malignant and 8 benign lesions. The calculated sensitivity for CEUS in the diagnosis of malignancy was 100%, with a 37.5% specificity. There was no statistically significant difference in overall mean VMS between the malignant and benign lesions.

CONCLUSION

The results of our study have not shown any additional benefit in the use of CEUS over conventional triple assessment. The positive trend seen in the higher mean VMS for the malignant tumors needs further investigation with a larger cohort of patients.

Colorectal breast metastases presenting with atypical imaging features

Breast metastases from non-breast primaries are rare in female patients and exceedingly rare in male patients, with only a handful of cases described. Lymphoma, metastatic melanoma and bronchial carcinoma are the primary sites for the majority of breast metastases. Breast metastases from colorectal carcinoma have been described previously in only a small number of cases in the literature. Here, we report a further two patients with biopsy-proven colorectal carcinoma metastases to both breasts, who demonstrate contrasting unusual and atypical imaging features that have not been reported previously. In one case, the imaging appearances mimic a multifocal primary breast carcinoma. Metastatic disease in the breast is a marker for disseminated metastatic spread, with a correspondingly poor prognosis. Therefore, we review the imaging features that differentiate metastatic breast disease from multifocal breast primaries, which are important to recognize because the management options for these patients differ greatly.

Re-examining comorbidity of Obsessive Compulsive and Attention-Deficit Hyperactivity Disorder using an empirically derived taxonomy

BACKGROUND

Using an empirically derived instrument to reduce the assessor bias inherent in structured diagnostic interviews, we sought to re-examine and validate the putative comorbidity between Obsessive Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents.

METHOD

We examined the correlation between Child Behavior Checklist (CBCL) syndrome, competence, and composite scores in children with: 1) OCD plus ADHD (OCD + ADHD), N = 47; 2) OCD without comorbid ADHD (OCD), N = 33; 3) ADHD without comorbid OCD (ADHD) N = 43; and 4) comparison controls recruited from general pediatric clinics,N = 32.

RESULTS

CBCL findings in our ADHD children were similar to previous findings reported in ADHD youth, irrespective of the presence or absence of comorbid OCD. Comorbid youth generally had additive scores on the CBCL scales, reflecting the independent contribution of symptomatic and functional impairment from each disorder.

CONCLUSION

These findings suggest that when ADHD-like symptoms are seen in OCD youth, they reflect a true comorbid state of OCD plus ADHD. The CBCL may provide a rapid assessment tool to identify comorbid ADHD in OCD youth.

Effects of intravenous lipid as a source of energy in parenteral nutrition associated hepatic dysfunction and lidocaine elimination: a study using isolated rat liver perfusion

The effects on liver function and hepatic lidocaine elimination using 20% Intralipid as a source of non-protein calories (30%) in parenteral nutrition were studied using an isolated rat liver perfusion procedure. Rats were randomly assigned to one of the three treatment groups: PNL group (n = 6), consisting of 16.94% dextrose, 2.46% Intralipid, and 5.2% amino acids; PN group (n = 5), consisting of 24.2% dextrose and 5.2% amino acids; and CF group (n = 6), chow fed (rat chow and water). The rate of lidocaine metabolism was significantly reduced after 7 d in the two PN treated groups when compared to CF. Steatosis was observed in five out of six PNL treated animals and two out of five PN treated animals. Intrinsic clearance was reduced by 80% in the PNL group and by 60% in the PN animals (p < 0.05). Molar metabolite to drug ratios revealed significant reductions in N-dealkylation, m-hydroxylation, and aryl methyl hydroxylation in groups PNL and PN; these values amounted to 67-92% (p < 0.05). These findings suggest that a dextrose-amino acid solution induced steatosis and reduced the rate of lidocaine metabolism. The incorporation of Intralipid caused further deterioration.

Immediate and short-term reproducibility of the P wave signal-averaged electrocardiogram

While abnormalities in the P wave SAECG have been associated with the occurrence of AF, its reproducibility has never been documented. The purpose of this study was to evaluate the immediate and short-term reproducibility of measurements from the P wave SAECG. P wave SAECGs were obtained using well-described techniques that utilize the QRS complex as the trigger and the P wave as template for averaging. In 28 subjects (8 controls, 11 with cardiac disease, 9 with prior AF), 3 P wave SAECGs were obtained: an initial study; on immediate reacquisition; and reacquisition after 4-5 days. Vector duration and RMS voltage of the terminal 20 ms of the P wave SAECG were measured and compared. The mean P wave duration was 152 +/- 14 ms on initial SAECG, 152 +/- 14 ms and 152 +/- 15 ms at immediate and short-term reacquisitions, respectively (both P = NS vs initial). The mean terminal RMS voltage was 6.4 +/- 6.0 mcV on initial SAECG, 6.4 +/- 5.9 mcV and 6.5 +/- 5.8 mcV at immediate and short-term reacquisitions, respectively (both P = NS vs initial). Linear regression analysis showed high reproducibility for both P wave duration (r = 0.94 for immediate and r = 0.96 for short-term reacquisition vs initial) but slightly less for terminal RMS voltage (r = 0.92 for immediate and r = 0.84 for short-term reacquisition vs initial). In subgroup analysis, P wave duration measurements were highly reproducible in controls, in subjects with cardiac disease, and in those with a history of AF. P wave duration was also reproducible for both males and females, as well as for subjects age > 65 years (r = 0.96 and 0.89 for immediate and short-term reacquisition, respectively). Terminal RMS voltage measurements were reproducible for controls, but less reproducible in other subgroups. In conclusion, P wave duration measurements on SAECG are reproducible when evaluated at immediate and short-term reacquisition regardless of age, sex, cardiac disease, or prior AF. Terminal RMS voltages were less reproducible, especially in patients with cardiac disease and/or prior AF. These findings may explain conflicting observations regarding the clinical utility of terminal P wave measurements.

Effects of cholestyramine and parenteral nutrition on hepatic metabolism of lidocaine: a study using isolated rat liver perfusion

BACKGROUND

The effect of an oral bile salt binder, cholestyramine, on parenteral nutrition-related hepatic dysfunction and lidocaine metabolism was studied in rats.

METHODS

Rats were randomly assigned to one of three treatment groups: the PN group received infusions of dextrose and amino acids; the PNC group was treated the same as the PN group, but also received oral cholestyramine; CF group animals were fed rat food and water. Lidocaine metabolism was studied in livers isolated from animals after 7 days of parenteral nutrition.

RESULTS

No differences in liver function test values of PN and PNC groups were detected compared with group fed rat food. However, lidocaine metabolism was found to be significantly reduced in both the PN and PNC groups. Significant reductions were observed in the hepatic extraction ratio (23% and 15%) and in intrinsic clearance (61% and 53%) in PN and PNC animals, respectively (p < .05). Material balance at steady state showed that recovery of lidocaine was threefold higher in the PN group and twofold higher in the PNC group than the rat food group (p < .05). Metabolite-to-drug ratios were determined for each lidocaine metabolite and this revealed significant reductions in N-dealkylation (64% and 57%) and aryl methyl hydroxylation (92% and 86%) in PN and PNC animals, respectively (p < .05).

CONCLUSIONS

Histologic findings suggest that cholestyramine feeding prevented liver dysfunction, possibly through interruption of secondary bile salt reabsorption. However, lidocaine metabolism was still impaired after cholestyramine ingestion; the impairment mechanism remains unknown.

Effects of light-exposed parenteral nutrition on hepatic function and lidocaine metabolism: a study using isolated rat liver perfusion

Effects of light-exposed parenteral solutions on hepatic function and lidocaine metabolism were studied. Male rats (190-220 g) were randomly assigned to one of the three isocaloric treatment groups: parenteral nutrition (PN) (+L) group (n = 6), animals received a solution of 24.2% dextrose and 5.2% amino acids with light exposure; PN(-L) group (n = 5), animals received the same solution without light exposure; and CF group, chow-fed animals (n = 6) that received rat chow and water. Average energy intake in these animals was approximately 33 kcal/100 g/d. Lidocaine metabolism was studied in livers isolated from animals 7 d after treatment. Liver morphology indicated that five livers from PN(+L) animals developed steatosis. The lidocaine metabolism rate was the slowest in PN(+L) animals; this is marked by changes in the steady state levels (% dose) of lidocaine [PN(+L), 47.9 +/- 17.6; PN(-L), 25.9 +/- 2.1; versus CF, 11.3 +/- 5.3; p < 0.05]. The extraction ratio and intrinsic clearance values were reduced by 41 and 86% in PN(+L) group and 16 and 70% in PN(-L) group, respectively, when compared with CF (p < 0.05). Metabolite to drug ratios indicated that N-dealkylation, ring-hydroxylation, and aryl methyl hydroxylation of lidocaine were severely impaired, particularly in the PN(+L) animals. The extents of reduction in metabolic pathways were in the ranges 79-95% in the PN(+L) group and 44-90% in the PN(-L) (p < 0.05). These findings suggest that parenteral nutrition infusion induces steatosis and reduces the rate of lidocaine metabolism and exposure of parenteral nutrition solutions to light exacerbates this change.

Effects of taurine supplementation in parenteral nutrition-associated hepatosteatosis and lidocaine metabolism. A study using isolated rat liver perfusion

The effects of taurine in parenteral nutrition (PN)-related hepatic dysfunction are controversial. The aims of the present study were to evaluate the effects of taurine on hepatic function and on lidocaine metabolism, using two strengths of taurine (15 and 50 mg/dl) that are present in commercially available preparations. Animals (N > or = 4) were randomly assigned to one of the four 7-day treatment groups: chow-fed (CF); dextrose/amino acids (PN); dextrose/amino acids and taurine, 15 mg/dl (T15); dextrose/amino acids and taurine, 50 mg/dl (T50). Between 40-75% of the animals treated with PN developed steatosis. The origin of steatosis was zonal specific and dependent on taurine treatment. All livers in the CF group had a normal cellular architecture. Lidocaine metabolism was found to be impaired in groups PN, T15, and T50. This was indicated by a significant reduction in the intrinsic clearance values: 70%, 76%, and 85% in groups PN, T15, and T50, respectively (p < 0.05). Metabolites-to-drug ratios indicated that N-dealkylation, m-hydroxylation, and aryl methyl hydroxylation were significantly reduced in all treatment groups; the most pronounced effect was observed in the T50 group. These findings suggest that PN infusion results in impaired liver function, and the reduction of drug elimination rate is exacerbated by the addition of taurine.

The NHS R&D Information Systems Strategy (ISS)

Following a strategy study which reported in August 1992 the NHS R&D Information Systems Strategy (ISS), a strategic framework for information systems, has been developed to support research and development in the NHS. This paper summarizes its main features, illustrates the benefits which specific information systems will bring, and outlines how the products of the programme are disseminated and accessed.

Role of detrusor instability in primary enuresis

We studied 50 enuretic boys and girls by supine cystometry. Detrusor instability was found in 74 percent of the cases. The mean threshold volume at which detrusor instability was demonstrated was 200 mL. The mean bladder capacity of age-matched nonenuretic children was 325 mL. We consider detrusor instability at this reduced threshold volume to be the main cause of primary enuresis.

Reaction of fluorescein isothiocyanate with an ATP-binding site on the phosphorylase kinase alpha subunit

Phosphorylase kinase can be labeled specifically on the alpha subunit with fluorescein 5'-isothiocyanate (FITC) which concomitantly inactivates the enzyme (T. G. Sotiroudis and S. Nikolaropoulus (1984) FEBS Lett. 176, 421-425). Labeled peptides have been purified and their primary structure has been determined. The amino acid sequence of the fluorescein-labeled tryptic peptide is Lys-Met-Gln-Asp-Gly-Tyr-Phe-Gly-Gly-Ala-Arg. The environment of this fluorescein-labeled lysine has been determined by sequencing peptides isolated from a Staphylococcus aureus V8 digest and two further cyanogen bromide fragments of the purified [14C]carboxymethylated alpha subunit. The partial sequences obtained have then been localized in the primary structure of the alpha subunit [Zander et al. (1988) Proc. Natl Acad. Sci. USA 85, 2929-2933]. Both the incorporation of the fluorescent label and enzymatic inactivation are inhibited by ATP only at pH 7.0; ADP and AMP do not protect. Kinetic analysis reveals a competition between ATP and FITC; a Ki for ATP of 728 +/- 100 microM has been determined.