Relationship between T-lymphocyte cytokine levels and sero-response to hepatitis B vaccines

AIM: To investigate the cellular defects by analyzing the (Th1/Th2) cytokine levels in vaccine responders and non-responders. METHODS: Peripheral blood mononuclear cell (PBMC) from responders and non-responders were stimulated with or with out recombinant HBsAg or PHA. Broad spectrum of cytokines viz (Th1) IFN-γ, IL-2, TNF-α, IL-12 and (Th2) IL-10, IL-4 were measured after in vitro stimulation with recombinant HBsAg and were compared with respective antibody titers. RESULTS: A significant decrease (P = 0.001) in Th1 and Th2 cytokines namely, IL-2, INF-γ, TNF-α and IL-10in non-responders was observed. The level of IL-4 was not significant between the three groups. Furthermore, despite a strong Th1 and Th2 cytokine response, the level of IL-12 was elevated in high-responders compared to other groups (P = 0.001) and demonstrated a positive correlation with anti-HBs titers and Th1 cytokine response. CONCLUSION: Our findings suggest that unrespon-siveness to recombinant hepatitis B vaccines (rHB) is multifactorial, including specific failure of antigen presentation or the lack of both T helper Th1 and Th2 response.

Indications of antibiotic prophylaxis in dental practice-Review

Antibiotics are frequently used in dental practice.Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry.Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria.It is indicated when there is evidence of clinical sign involvement and spread of infection.Antibiotics are prescribed in dental practice for treating odontoge nic infections,non-odontogenic infections,as prophylaxis against focal and local infection.Special care needs to be addressed to patients with organ transplants,poorly controlled diabetes and pregnancy.Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care.The present paper reviews the indications of antibiotics in dental practice.

Radiation signature on exposed cells: Relevance in dose estimation

The radiation is considered as a double edged sword, as its beneficial and detrimental effects have been demonstrated. The potential benefits are being exploited to its maximum by adopting safe handling of radionuclide stipulated by the regulatory agencies. While the occupational workers are monitored by personnel monitoring devices, for general publics, it is not a regular practice. However, it can be achieved by using biomarkers with a potential for the radiation triage and medical management. An ideal biomarker to adopt in those situations should be rapid, specific, sensitive, reproducible, and able to categorize the nature of exposure and could provide a reliable dose estimation irrespective of the time of the exposures. Since cytogenetic markers shown to have many advantages relatively than other markers, the origins of various chromosomal abnormalities induced by ionizing radiations along with dose-response curves generated in the laboratory are presented. Current status of the gold standard dicentric chromosome assay, micronucleus assay, translocation measurement by fluorescence insitu hybridization and an emerging protein marker the g-H2 AX assay are discussed with our laboratory data. With the wide choice of methods, an appropriate assay can be employed based on the net.

Clavicle Hook Depth and Impingement Syndrome—A Cause-Effect Relationship

Background: Clavicular hook plates are effective fixation devices for lateral end clavicle fractures and acromioclavicular joint dislocations and have been extensively used in the last decade. Although this plate achieves a high percentage of union, there are concerns about sub-acromial osteolysis and impingement of supraspinatus tendon. Objective: To show that impingement of supraspinatus tendon can be prevented by measuring the depth between acromion and supraspinatus tendon posteriorly and using hook plates of appropriate depth. Materials and Methods: We performed a prospective study on 25 patients with lateral end clavicle fractures and acromio clavicular joint disruptions by measuring the depth between posterior border of acromion and the superior border of supraspinatus at the point of application of hook plate. Fixation is then done by appropriate sized hook plate. Results: None of the patients had impingement of supraspinatus tendon. Five patients developed subacromial osteolysis which did not have any impact on shoulder function. Conclusion: There is a variation in anatomy of the acromion in different ethnic groups. Hence uniform sized hook plate will be inappropriate. A smaller hook depth is needed in south Asian population to prevent impingement.

Tuberculous Olecranon Bursitis

Olecranon bursal involvement due to tuberculosis is not often seen in literature. Involvement is often seen in the subdeltoid and trochanteric bursa, with concomitant skeletal involvement. We report a patient with isolated tuberculous granuloma of the olecranon bursa with no comorbid illness.

Effect of flupirtine on the growth and viability of U373 malignant glioma cells

Objective： Flupirtine is a non-opioid analgesic without antipyretic or antiphlogistic properties but with favorable tolerability in humans. ＂Ibis analgesic also exhibits neuroprotective activities. Furthermore, flupirtine antagonizes glutamate- and . , 2＋ NMDA-mduced mtracellular levels of Ca and counteracts the effects of focal cerebral Lscherma. Although fluplrtme has been used to relieve pain caused by different diseases and clinical procedures, information on the safety and efficacy of flupirtine is limited. ＂fhe present study was conducted to investigate the neuroprotective effects of flupirtine on U373 malignant glioma （MG） cell lines. Methods： Cellviability and cell cycle analysis was performed by MTF assay and flow cytomet-,＇y, respectively. Results： Variations in the growth of U373 MG cells in $ mM N-methyl-D-aspartate （NMDA）, 1 mM flupirtine, and combined treatment indicated the antagonistic effects of NMDA and flupirtine on MG cell lines. The variation in the percentage of gated cellpopulation in different cell cycle phases showed significant variations after 48 h of treatment. Conclusion： Flupirtine has neuroprotective effect of on U373 MG cells, which limits its use in the pain management of brain tumors. This property warrants further studies using animal models and large-scale clinical trials.

TYMS gene 5'-and 3'-untranslated region polymorphisms and risk of non-syndromic cleft lip and palate in an Indian population

Dear Editor： Increased homocysteine levels due to vitamin B6 or B12 deficiency or genetic defects in folate pathway genes are associated with an increased incidence of non-syndromic cleft lip with or without cleft palate （NSCLP）tlj. Thymidylate synthase （TS） is a folate-dependent enzyme that catalyzes methylation of 2＇-deoxyuridine-5＇-monophosphate （dUMP） to 2＇-deox- ythymidine-5＇-monophosphate （dTMP）, a rate-limiting step in DNA synthesis,

Angiotensin Ⅱ stimulates expression of transcription factors c-Jun and c-Fos in cyclosporine induced human gingival fibroblasts

The present study demonstrates that the expression of c-Jun and c-Fos are elevated in gingival fibroblast cells treated with angiotensin Ⅱ and cyclosporine.The healthy human gingival tissues were collected and gingival fibroblasts were isolated and cultured.We used RT-PCR and Western blot analysis to identify the expression of c-Jun and c-Fos in cyclosporine and angiotensin II treated human gingival fibroblast cells.We found that angiotensin Ⅱ in combination with cyclosporine induces c-Jun and c-Fos expressions significantly;however,the angiotensin Ⅱ antagonist losartan inhibits the expression of c-Jun and c-Fos(p<0.01).The data suggest that angiotensin Ⅱ in combination with cyclosporine modulates the expression of c-Jun and c-Fos in human gingival fibroblast cells.

Anteromedial Plating of Humerus—An Easier and Effective Approach

Plate osteosynthesis of humeral shaft fractures is an established surgical procedure. Iatrogenic radial nerve palsy appears to be common complication in treating these fractures. A case series of 20 fracture shafts of humerus were treated with anteromedial plating through anterolateral approach. There was no radial nerve palsy in any of the cases and all achieved fracture union.

Anaesthetic Challenges in Cardiac Interventional Procedures

The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.

Our Experience in 33 Patients of Multiple Ventricular Septal Defect Closure

Study: Retrospective study of 33 patients with multiple VSD during March 2009 to March 2014. Technique: The defects were located by injecting the cardioplegia solution into left atrium after occluding the pulmonary artery. Through right atrial approach, the large ventricular septal defects were closed by pericardial patch. The smaller ventricular septal defects were closed directly. Results: Out of 33 patients, 20 patients were multiple ventricular septal defects, 5 patients were atrioventricular canal defect with multiple ventricular septal defects and 8 patients were transposition of great arteries with multiple ventricular septal defects. All the patients had severe pulmonary arterial hypertension. The mean age and body weight at repair was 4.51 months and 5.41 kg respectively. Failure to locate additional ventricular septal defects happened in 1 patient where the pulmonary artery banding was done. Six patients had residual ventricular septal defect after surgery, and no significant left to right shunted. One patient had permanent pacemaker implanted in the postoperative period due to the heart block. There was no early and late mortality. Conclusion: Management of multiple ventricular septal defects is quite complex. Right atrial approach of ventricular septal defects closure is safe, simple and effective in closure of multiple ventricular septal defects.

MDCT in Diagnosis of Uncommon Fistulous Complications of Severe Pancreatitis-Pictorial Essay

Fistulous complication of pancreatitis is a surgical emergency with varied clinical presentations. Early diagnosis is very important to minimize morbidity whereas delayed or missed diagnosis can cause life threatening consequences. Multi detector computed tomography (MDCT) with and without intravenous contrast is an accurate and reliable imaging modality allowing prompt diagnosis and management. In this essay, we present an overview of the radiological features found in uncommon fistulous complications of pancreatitis.

Imaging in Double Gall Bladder with Acute Cholecystitis—A Rare Entity

Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the management and to avoid unnecessary bile duct injury during surgery. We report a case of duplicated gall bladder presenting as acute cholecystitis.

Reserpine Improves Working Memory

Despite exhaustive search, no drug is in sight for AD. Earlier, we reported that reserpine, an antihypertensive and antipsychotic drug, ameliorates Amyloid beta (Aβ-AD causing peptide) toxicity and confers several positive enhancements in the C. elegans model system. Here, we evaluate whether reserpine can provide protection against working memory and against AD in the mouse model. Reserpine (0.08 mg) was administered orally on alternate days to the non-Tg and accelerated Aβ deposition (at 2 months of age)and cognitive deficit (4 months of age) developing 5XFAD AD Tg mouse model expressing mutant human APP (3 familial mutations) and human Presenilin1(2 familial mutations) in the neurons, and follow their working memory for 2 months using the spontaneous Y-maze alteration behavioral paradigm. Reserpine enhanced working memory in non-Tg mice and improved the cognitive deficit in the 5XFAD AD Tg mice. Hence, reserpine can be considered for a detailed evaluation in the 3X Tg AD mouse model and a pilot study in AD patients.

Cutaneous B cell lymphoma presenting as a soft tissue swelling

Cutaneous lymphomas are classified as B cell and T cell lymphomas which are seen very rarely. They present as papules or nodules in the absence of any extracutaneous involvement. We present a patient who had a diffuse cutaneous B cell lymphoma and review literature of this uncommon tumour.

Use of Ventilation-Index in the Development of Exposure Model for Indoor Air Pollution—A Review

In indoor environment, emission factor of the cooking fuel plays a vital role in determining correlation between exposure assessment and health effects. Both indoor and outdoor air pollution exposures are widely influenced by the ventilation status. An optimum control of the air change rate has also significant impact on the exposure pattern. A number of studies revealed that the indoor particulates and gaseous exposures, resulting from the combustion of various cooking fuels, are associated with significant adverse health effects on pregnant mothers and new born babies. The impacts of ventilation status on air pollution exposure in households’ kitchens or living rooms have not been explored enough. Except a few studies with concrete rooms, especially in industries, no other studies have been established on the correlation between the ventilation index and air pollution exposure. The intent of this review is to discuss reported findings focused on the ventilation and exposure to air pollution. This will obviously help better understanding to modulate exposure profile in household condition using simple tool of ventilation measurement.

Withania somnifera Root Extract Enhances Telomerase Activity in the Human HeLa Cell Line

Aging is a decelerating unidirectional process of life. Shortening of telomeric DNA, the (TTAGGG)n hexanucleotide repeats, which form the caps at the chromosome ends, is implicated to determine the aging process, and more importantly the healthy lifespan itself. Telomerase, a ribonucleoprotein having reverse transcriptase activity, arrests telomere loss through addition of the TTAGGG repeats de novo, to the ends of the chromosome. The telomere/telomerase maintenance is an inevitable necessity to delay aging and for a healthy lifespan. Here, we report the potential of full-spectrum, high concentration Ashwagandha (Withania somnifera), an Ayurvedic medicinal herb, root extract to increase telomerase activity. HeLa cells, when treated with various concentrations of Ashwagandha root extract, showed an increase in telomerase activity measured with the established Telomerase Rapid Amplification Protocol (TRAP) assay. Ashwagandha root extract increased telomerase activity with highest enhancement of ~45% at 10 - 50 μg concentration. Thus, Ashwagandha root extract has the anti-aging inducing potential.

Carcinoma of the Ovary Presenting as Cutaneous Metastases

Introduction: Cutaneous metastasis is common from malignancies of the genitourinary system and occasionally from the digestive system. Cutaneous metastases, due to ovarian carcinoma as a presenting feature, being diagnosed on cytology, are uncommonly reported. Case Report: A 70-year-old lady presented with a cutaneous nodule and progressive abdominal distension. Investigations for metastatic nodule showed it to be a lesion from the ovary. Discussion: Carcinoma ovary is often diagnosed when patients present with ascites and the association with a parietal wall deposit is uncommon. The occurrence of a parietal wall nodule when the ascites is negative for malignant cells is not previously documented. Conclusion: We discuss literature of the malignancies that present with a parietal wall metastases and the management of ovarian carcinoma.

Automated Segmentation of Left Ventricle Using Local and Global Intensity Based Active Contour and Dynamic Programming

The aim of this work is to develop an improved region based active contour and dynamic programming based method for accurate segmentation of left ventricle （LV） from multi-slice cine short axis cardiac magnetic resonance （MR） images. Intensity inhomogeneity and weak object boundaries present in MR images hinder the segmentation accuracy. The proposed active contour model driven by a local Gaussian distribution fitting （LGDF） energy and an auxiliary global intensity fitting energy improves the accuracy of endocardial boundary detection. The weightage of the global energy fitting term is dynamically adjusted using a spatially varying weight function. Dynamic programming scheme proposed for the segmentation of epicardium considers the myocardium probability map and a distance weighted edge map in the cost matrix. Radial distance weighted technique and conical geometry are employed for segmenting the basal slices with left ventricle outflow tract （LVOT） and most apical slices. The proposed method is validated on a public dataset comprising 45 subjects from medical image computing and computer assisted interventions （MICCAI） 2009 segmentation challenge. The average percentage of good endocardial and epicardial contours detected is about 99%, average perpendicular distance of the detected good contours from the manual reference contours is 1.95 mm, and the dice similarity coefficient between the detected contours and the reference contours is 0.91. Correlation coefficient and the coefficient of determination between the ejection fraction measurements from manual segmentation and the automated method are respectively 0.9781 and 0.9567, for LV mass these values are 0.9249 and 0.8554. Statistical analysis of the results reveals a good agreement between the clinical parameters determined manually and those estimated using the automated method.

Influence of the SNPs on the structural stability of CBS protein： Insight from molecular dynamics simulations

Cystathionine β-synthase is an essential enzyme of the trans-suifuration pathway that condenses serine with homocysteine to form cystathionine. Missense mutations in CBS are the major cause of inherited homocystinuria, and the detailed effect of disease associated amino acid substitutions on the structure and stability of human CBS is yet unknown. Here, we apply a unique approach in combining in silico tools and molecular dynamics simulation to provide structural and functional insight into the effect of SNP on the stability and activity of mutant CBS. In addition, principal component analysis and free energy landscape were used to predict the collective motions, thermodynamic stabilities and essential subspace relevant to CBS function. The obtained results indicate that C109R, E176K and D376N mutations have the diverse effect on dynamic behavior of CBS protein. We found that highly conserved D376N mutation, which is present in the active pocket, affects the protein folding mechanism. Our strategy may provide a way in near future to understand and study effects of functional nsSNPs and their role in causing homocystinuria.