Posterior reversible encephalopathy syndrome while receiving irinotecan with fluorouracil and folinic acid for metastatic gastric cancer

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome with seizures, headache, altered mental status and visual disturbances. It is typically associated with posterior cerebral white matter oedema on neuroimaging. There is an increasing number of cases of PRES reported with different chemotherapeutic protocols. However, PRES is rarely reported in association with irinotecan, fluorouracil and folinic acid (FOLFIRI). We report a 28-year-old female patient with a history of Stage IV gastric cancer who presented with abdominal pain and recurrent vomiting that was thought to be related to a partial intestinal obstruction secondary to peritoneal metastasis. Eventually, she was treated with FOLFIRI. A few hours after initiation of the fluorouracil infusion in the second cycle, she developed a tonic-clonic seizure. MRI of the brain showed multiple bilatera

HEPATOCYTE APOPTOSIS INDUCTION BY ACETAMINOPHEN THROUGH MODULATION OF CASPASE/BAX PATHWAY IN MICE

Objective: Acetaminophen (APAP) overdose contributes to liver damage through modulation of pro-apoptotic processing. This study evaluated the involvement of caspase/Bax factors in APAP hepatotoxicity in vivo and in vitro. Methods: The involvement of caspase/Bax factors in APAP hepatotoxicity was evaluated in BALB/c mice and on isolated primary mouse hepatocytes. In vitro MTT assay was carried out on primary cultured mouse hepatocytes treated with APAP (2.5, 5, 10 mmol) and Annexin V/PI staining was employed to cell suspension for imaging under fluorescence microscopy. In addition, caspase-3 concentrations were determined in cell lysates. In vivo, mice were treated with a toxic dose of APAP (700 mg/kg) and immunodetection of Bax was made by Western Blot. Vitamin C (Vit C) was used as a hepato-protectant due to its known antioxidant activities. Results: In vitro dose-dependent increase in mitochondrial electron transport capacity was evident in isolated mouse primary hepatocytes incubated with the high dose of APAP (10 mmol) compared to both nontreated cells and cells pre-treated with Vitamin C (Vit C) (0.5 mmol) (p<0.05). Apoptosis was confirmed in hepatocytes through Annexin V staining after APAP treatment and the signal was reduced when hepatocytes were pre-treated with Vit C. In addition, caspase-3 concentration was decreased in cells pretreated with Vit C prior to APAP exposure. In vivo, Bax immunodetection utilizing western blotting was increased in mice treated with the toxic dose of APAP (700 mg/kg) and attenuated through pre-treatment with Vit C. Conclusion: Modulation of apoptotic caspase/Bax pathway is present in hepatocytes undergoing APAP-induced toxicity

Ruptured testicular abscess: a rare complication of epididymo-orchitis

Epididymo-orchitis is a medical condition characterised by inflammation of epididymis and testis which is a common urological diagnosis encountered by healthcare professionals. Misdiagnosis and under treatment can lead to poor outcome such as infarction and abscess formation. We presented a 33-year-old man, with no known medical illness, presented with one-week history of left testicular pain, swelling and fever. He was commenced on Amoxicillin by his general practitioner. Physical examination showed left swollen and tender testis and normal right testis. Investigations showed an elevated white cell count (WCC) 41.3x103 /L and colour doppler ultrasound (USG) testes showed left epididymo-orhitis. He was admitted and treated with IV Unasyn® (Ampicillin+Sulbactam) for 5 days. His symptoms improved, and he discharged home well with one week oral Unasyn®. He represented 2 weeks later with worsening left scrotal swelling and pain. Clinical examination found a swollen, tender and erythematous scrotum with 1x1cm defect in the left scrotum with purulent discharge. He underwent operation incision and drainage of left scrotum and left orchidectomy. Post-operatively he recovered well. Histopathology reported as epididimoorchitis with abscess, necrosis and perforation. As a conclusion, testicular rupture and abscess formation secondary to epididymo-orchitis is an uncommon reported complication. Immediate recognition and treatment is crucial as a delayed diagnosis can lead to sepsis and infertility

Passively mode-locked ultrashort pulse fiber laser incorporating multi-layered graphene nanoplatelets saturable absorber

In this paper, a passive mode-locked erbium-doped fiber laser (EDFL) incorporating graphene nanoplatelet (GNP) powder-based saturable absorber (SA) with short pulse duration in femtosecond range is demonstrated. A good synthesis of GNP can be simply produced via a combination of thermal, chemical, and mechanical exfoliation of expandable graphite. The GNP-SA is fabricated by mechanically imprinting the powder onto the tip of a single mode fiber ferrule. The characterization of SA is done via focus ion beam scanning electron microscope, energy dispersive X-ray spectroscopy, as well as Raman spectroscopy. The fabricated GNP-SA has 1.8 % modulation depth and C-band transmission loss of less than 1.8 dB. The ring-configuration EDFL integrated with GNP-SA yields a mode-locking threshold of 22.6 mW pump power. Net anomalous dispersion of the laser cavity is validated by the observation of Kelly’s sideband in the optical spectrum. At maximum pump power of 115.8 mW, the mode-locked EDFL has a pulse repetition rate of 13.11 MHz, sech2 profile fitted pulse duration of 694 fs, peak-to-pedestal extinction ratio of 58.2 dB, average output power of 6.7 mW, and pulse energy of 507.2 pJ. Our proposed GNP-SA is feasible as a mode-locker for ultrashort pulsed fiber laser with advantage in terms of simple synthesis and fabrication technique

Microplastic in the environment: identification, occurrencand mitigation measures

Microplastic is an emerging pollutant causing trouble worldwide due to its extensive distribution and potential hazards to the ecological system. Some fundamental questions about micro-plastics, such as their presence, source, and possible hazards, remain unanswered. These issues develop because of a lack of systematic and comprehensive microplastic analysis. As a result, we thoroughly evaluated current knowledge on microplastics, including detection, characterization, occurrence, source, and potential harm. Microplastics are found in seawater, soil, wetlands, and air matrices worldwide based on findings. Visual classification, which can be enhanced by com-bining it with additional tools, is one of the most used methods for identifying microplastics. As soon as is practicable, microplastics analytical methods ought to be standardized. New techniques for analyzing nano-plastics are urgently needed in the meantime. Numerous studies have shown that microplastics’ impacts on people and soil are significantly influenced by their size, shape, and surface physicochemical characteristics. Finally, this study suggests areas for future research based on the knowledge gaps in the area of microplastics. © 2022 Desalination Publications. All rights reserved

Identification of bovine growth hormone (BGH) gene polymorphism using PCR-RFLP method in buffalo bulls

Growth Hormone (GH) is a single polypeptide chain synthesised and secreted from anterior pituitary gland by somatroph cells. The product of GH gene hastens metabolism and promotes the growth of many organs and tissues especially bone, muscle and visceral organs. It also regulates growth, mammary gland development and lactation. Polymorphism in this gene is associated with increase in growth and development of many tissues in the body. Aim: The objective of this study was to investigate the polymorphism of bovine growth hormone (bGH) gene in buffalo bulls (Bubalus bubalis) using the PCR-RFLP (polymerase chain reaction–restriction fragment length polymorphism) technique. Design: Genomic DNA was extracted from a total of 10 bulls, consisting of Murrah – Swamp crossbred and pure Swamp buffalo bulls. A The 446 segment of the bGH gene was amplified. The DNA amplicons were detected in 2% agarose gel following 45 minutes of electrophoresis. They were thereafter digesting with AluI endonuclease restriction enzyme, and the digested DNA were detected in 2% agarose gel following electrophoresis for about 45minutes in all samples Results: Similar bands of approximately 300 and 146-bp each, with no variation, were detected in 2% agarose gel following electrophoresis in all the animals tested. Conclusion: Based on the Alu1 digestion result, all samples produced the same allele of the gene, with no polymorphism detected

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate) decrease in the incidence of deep sternal wound infection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal wound infection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases

Amaze: a double-blind, multicentre randomised controlled trial to investigate the clinical effectiveness and cost-effectiveness of adding an ablation device-based maze procedure as an adjunct to routine cardiac surgery for patients with pre-existing atrial fibrillation

Background: Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. Objectives: To determine whether or not the maze procedure is safe, improves clinical and patient outcomes and is cost-effective for the NHS in patients with AF. Design: Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised controlled trial. Patients were randomised on a 1 : 1 basis using random permuted blocks, stratified for surgeon and planned procedure. Setting: Eleven acute NHS specialist cardiac surgical centres. Participants: Patients aged ≥ 18 years, scheduled for elective or in-house urgent cardiac surgery, with a documented history (> 3 months) of AF. Interventions: Routine cardiac surgery with or without an adjunct maze procedure administered by an AF ablation device. Main outcome measures: The primary outcomes were return to sinus rhythm (SR) at 12 months and quality-adjusted life-years (QALYs) over 2 years after randomisation. Secondary outcomes included return to SR at 2 years, overall and stroke-free survival, drug use, quality of life (QoL), cost-effectiveness and safety. Results: Between 25 February 2009 and 6 March 2014, 352 patients were randomised to the control (n = 176) or experimental (n = 176) arms. The odds ratio (OR) for return to SR at 12 months was 2.06 [95% confidence interval (CI) 1.20 to 3.54; p = 0.0091]. The mean difference (95% CI) in QALYs at 2 years between the two trial arms (maze/control) was –0.025 (95% CI 0.129 to 0.078; p = 0.6319). The OR for SR at 2 years was 3.24 (95% CI 1.76 to 5.96). The number of patients requiring anticoagulant drug use was significantly lower in the maze arm from 6 months after the procedure. There were no significant differences between the two arms in operative or overall survival, stroke-free survival, need for cardioversion or permanent pacemaker implants, New York Heart Association Functional Classification (for heart failure), EuroQol-5 Dimensions, three-level version score and Short Form questionnaire-36 items score at any time point. Sixty per cent of patients in each trial arm had a serious adverse event (p = 1.000); most events were mild, but 71 patients (42.5%) in the maze arm and 84 patients (45.5%) in the control arm had moderately severe events; 31 patients (18.6%) in the maze arm and 38 patients (20.5%) in the control arm had severe events. The mean additional cost of the maze procedure was £3533 (95% CI £1321 to £5746); the mean difference in QALYs was –0.022 (95% CI –0.1231 to 0.0791). The maze procedure was not cost-effective at £30,000 per QALY over 2 years in any analysis. In a small substudy, the active left atrial ejection fraction was smaller than that of the control patients (mean difference of –8.03, 95% CI –12.43 to –3.62), but within the predefined clinically equivalent range. Limitations: Low recruitment, early release of trial summaries and intermittent resource-use collection may have introduced bias and imprecise estimates. Conclusions: Ablation can be practised safely in routine NHS cardiac surgical settings and increases return to SR rates, but not survival or QoL up to 2 years after surgery. Lower anticoagulant drug use and recovery of left atrial function support anticoagulant drug withdrawal provided that good atrial function is confirmed. Further work: Continued follow-up and long-term clinical effectiveness and cost-effectiveness analysis. Comparison of ablation methods. Trial registration: Current Controlled Trials ISRCTN82731440.NIHR Health Technology Assessment programm

Effects on heart pumping function when using foam and gauze for negative pressure wound therapy of sternotomy wounds

<p>Abstract</p> <p>Background</p> <p>Negative pressure wound therapy (NPWT) has remarkable effects on the healing of poststernotomy mediastinitis. Foam is presently the material of choice for NPWT in this indication. There is now increasing interest in using gauze, as this has proven successful in the treatment of peripheral wounds. It is important to determine the effects of NPWT using gauze on heart pumping function before it can be used for deep sternotomy wounds. The aim was to examine the effects of NPWT when using gauze and foam on the heart pumping function during the treatment of a sternotomy wound.</p> <p>Methods</p> <p>Eight pigs underwent median sternotomy followed by NPWT at -40, -70, -120 and -160 mmHg, using foam or gauze. The heart frequency, cardiac output, mean systemic arterial pressure, mean pulmonary artery pressure, central venous pressure and left atrial pressure were recorded.</p> <p>Results</p> <p>Cardiac output was not affected by NPWT using gauze or foam. Heart frequency decreased during NPWT when using foam, but not gauze. Treatment with foam also lowered the central venous pressure and the left atrial pressure, while gauze had no such effects. Mean systemic arterial pressure, mean pulmonary artery pressure and systemic vascular resistance were not affected by NPWT. Similar haemodynamic effects were observed at all levels of negative pressure studied.</p> <p>Conclusions</p> <p>NPWT using foam results in decreased heart frequency and lower right and left atrial filling pressures. The use of gauze in NPWT did not affect the haemodynamic parameters studied. Gauze may thus provide an alternative to foam for NPWT of sternotomy wounds.</p