Comparative evaluation of abdominal hysterectomy by ligasure and conventional method

Background: Hysterectomy is the 2nd most common surgical procedure performed in women and is associated with various complications like any other major surgical procedure. The objectives and aims of this study was to compare the effects of ligasure and conventional clamping and suturing in abdominal hysterectomy.Methods: A randomized controlled trial was performed by randomizing the patients in 2 groups - ligasure (A) and conventional hysterectomy (B). Operative time, no. of sutures, blood loss, hospital stay and cost factor to patient were studied as its main outcomes. A total of 100 patients were studied.Results: 66% of patients in group A had duration of surgery that was less than an hour in spite of associated co-morbidities. More no (76%) of patients in Group A had significantly less blood loss (<50 ml) as compared to 60% of patients in Group B. Only one suture was used in 80% of patients in Group A while in group B all of the patients required more than one suture from stumps to vault. There by reducing the cost of surgery.Conclusion: Apparently ligasure group seems to have less time for surgery and less blood loss and more intraoperative and postoperative complications, but to prove one ligasure group superior or inferior over conventional method we need to have more studies. But yes, Ligasure group reduces the cost of surgery to patient by reducing suture consumption as compared to conventional group.

Bi-allelic JAM2 Variants Lead to Early-Onset Recessive Primary Familial Brain Calcification.

Primary familial brain calcification (PFBC) is a rare neurodegenerative disorder characterized by a combination of neurological, psychiatric, and cognitive decline associated with calcium deposition on brain imaging. To date, mutations in five genes have been linked to PFBC. However, more than 50% of individuals affected by PFBC have no molecular diagnosis. We report four unrelated families presenting with initial learning difficulties and seizures and later psychiatric symptoms, cerebellar ataxia, extrapyramidal signs, and extensive calcifications on brain imaging. Through a combination of homozygosity mapping and exome sequencing, we mapped this phenotype to chromosome 21q21.3 and identified bi-allelic variants in JAM2. JAM2 encodes for the junctional-adhesion-molecule-2, a key tight-junction protein in blood-brain-barrier permeability. We show that JAM2 variants lead to reduction of JAM2 mRNA expression and absence of JAM2 protein in patient's fibroblasts, consistent with a loss-of-function mechanism. We show that the human phenotype is replicated in the jam2 complete knockout mouse (jam2 KO). Furthermore, neuropathology of jam2 KO mouse showed prominent vacuolation in the cerebral cortex, thalamus, and cerebellum and particularly widespread vacuolation in the midbrain with reactive astrogliosis and neuronal density reduction. The regions of the human brain affected on neuroimaging are similar to the affected brain areas in the myorg PFBC null mouse. Along with JAM3 and OCLN, JAM2 is the third tight-junction gene in which bi-allelic variants are associated with brain calcification, suggesting that defective cell-to-cell adhesion and dysfunction of the movement of solutes through the paracellular spaces in the neurovascular unit is a key mechanism in CNS calcification

Anti-epileptic effect of Ganoderma lucidum polysaccharides by inhibition of intracellular calcium accumulation and stimulation of expression of CaMKII a in epileptic hippocampal neurons

Purpose: To investigate the mechanism of the anti-epileptic effect of Ganoderma lucidum polysaccharides (GLP), the changes of intracellular calcium and CaMK II a expression in a model of epileptic neurons were investigated. Method: Primary hippocampal neurons were divided into: 1) Control group, neurons were cultured with Neurobasal medium, for 3 hours; 2) Model group I: neurons were incubated with Mg2+ free medium for 3 hours; 3) Model group II: neurons were incubated with Mg2+ free medium for 3 hours then cultured with the normal medium for a further 3 hours; 4) GLP group I: neurons were incubated with Mg2+ free medium containing GLP (0.375 mg/ml) for 3 hours; 5) GLP group II: neurons were incubated with Mg2+ free medium for 3 hours then cultured with a normal culture medium containing GLP for a further 3 hours. The CaMK II a protein expression was assessed by Western-blot. Ca2+ turnover in neurons was assessed using Fluo-3/AM which was added into the replacement medium and Ca2+ turnover was observed under a laser scanning confocal microscope. Results: The CaMK II a expression in the model groups was less than in the control groups, however, in the GLP groups, it was higher than that observed in the model group. Ca2+ fluorescence intensity in GLP group I was significantly lower than that in model group I after 30 seconds, while in GLP group II, it was reduced significantly compared to model group II after 5 minutes. Conclusion: GLP may inhibit calcium overload and promote CaMK II a expression to protect epileptic neuron

A Study of Pi Aquarii During a Quasi-normal Star Phase: Refined Fundamental Parameters and Evidence for Binarity

We present the results of recent multicolor photometric and high-resolution spectroscopic observations of the bright Be star Pi Aquarii. Observational data collected from the literature were used to study the star's variations over the last four decades. The star is identified with the IR sources F22227+0107 in the IRAS Faint Point Source catalog and MSX5_G066.0066-44.7392 in the MSX catalog. The variations in near-IR brightness of Pi Aqr are found to be among the largest reported for Be stars. Since 1996, the star has shown only weak signs of circumstellar emission, which has allowed us to refine the fundamental stellar parameters: A_V=0.15 mag., T_eff=24000K, log g=3.9, and M_V=-2.95 mag. A weak emission component of the H-alpha line has been detected during the recent quasi-normal star phase. From analysis of the H-alpha line profiles, we find anti-phased radial velocity variations of the emission component and the photospheric absorption, with a period of 84.1 days and semi-amplitudes of 101.4 and 16.7 km/s, respectively. This result suggests that Pi Aqr may be a binary system consisting of stars with masses of M_1 sin^{3}i = 12.4 M_sun, M_2 sin^{3}i = 2.0 M_sun. We also estimate the orbital inclination angle to be between 50 and 75 degrees. We suggest that the photometric, spectroscopic, and polarimetric variations observed during the second half of the 20th century may be due to variable mass transfer between the binary components.Comment: 26 pages (including 8 figs, 2 tables), accepted by Ap

Digital Media Use: Differences and Inequalities in Relation to Class and Age

This paper takes a national perspective on issues of digital media use. The paper draws upon the OfCom Media Literacy 2013 survey to explore how digital media use varies in regard to two major social variables – class and age. Both class and age feature predominantly in UK policy on digital access and use. Class and age are invoked as either things that create barriers to access or as issues to be addressed and managed through using digital media. Despite the large body of work on the 'digital divide' there is a more limited literature that explicitly addresses class. The paper seeks to act as an empirical reference point for the development of further debate around the links between class and digital media use. The paper presents a factor analysis of the OfCom data that identifies five main areas of digital media use. These five factors are then subjected to a multiple analysis of variance to explore the effects across, between and within age and class categories. A cluster analysis based on the factors identifies seven main 'User Types' that are again compared across class and age. The paper finds that class and age act relatively independently as predicators of digital media use and neither compound nor mitigate each other's effects. Importantly the paper notes that the greatest levels and breadth of Internet use can be found in NRS social class groups AB and to an extent C1. In contrast the greatest levels of non-use and limited use can be found in NRS social class groups DE. In conclusion the paper notes that age still acts as the major explanatory variable for overall use and some specific types of use, but that class also independently acts to explain patterns of digital media use. As a result any simplistic policy expectations that digital access and use issues will become less relevant as age demographics change have to be questioned

Constraining the Physical Parameters of the Circumstellar Disk of chi Ophiuchi

We present a numerical model describing a circularly symmetric gaseous disk around the Be star chi Ophiuchi. The model is constrained by long-baseline interferometric observations that are sensitive to the H-alpha Balmer line emission from the disk. For the first time our interferometric observations spatially resolve the inner region of the circumstellar disk around chi Ophiuchi and we use these results to place a constraint on the physical extent of the H-alpha-emitting region. We demonstrate how this in turn results in very specific constraints on the parameters that describe the variation of the gas density as a function of radial distance from the central star.Comment: Accepted for publication in Ap

Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

Purpose: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). Methods and Materials: 147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Results: Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Conclusions: Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics

PDXK mutations cause polyneuropathy responsive to pyridoxal 5'-phosphate supplementation.

OBJECTIVE: To identify disease-causing variants in autosomal recessive axonal polyneuropathy with optic atrophy and provide targeted replacement therapy. METHODS: We performed genome-wide sequencing, homozygosity mapping, and segregation analysis for novel disease-causing gene discovery. We used circular dichroism to show secondary structure changes and isothermal titration calorimetry to investigate the impact of variants on adenosine triphosphate (ATP) binding. Pathogenicity was further supported by enzymatic assays and mass spectroscopy on recombinant protein, patient-derived fibroblasts, plasma, and erythrocytes. Response to supplementation was measured with clinical validated rating scales, electrophysiology, and biochemical quantification. RESULTS: We identified biallelic mutations in PDXK in 5 individuals from 2 unrelated families with primary axonal polyneuropathy and optic atrophy. The natural history of this disorder suggests that untreated, affected individuals become wheelchair-bound and blind. We identified conformational rearrangement in the mutant enzyme around the ATP-binding pocket. Low PDXK ATP binding resulted in decreased erythrocyte PDXK activity and low pyridoxal 5'-phosphate (PLP) concentrations. We rescued the clinical and biochemical profile with PLP supplementation in 1 family, improvement in power, pain, and fatigue contributing to patients regaining their ability to walk independently during the first year of PLP normalization. INTERPRETATION: We show that mutations in PDXK cause autosomal recessive axonal peripheral polyneuropathy leading to disease via reduced PDXK enzymatic activity and low PLP. We show that the biochemical profile can be rescued with PLP supplementation associated with clinical improvement. As B6 is a cofactor in diverse essential biological pathways, our findings may have direct implications for neuropathies of unknown etiology characterized by reduced PLP levels. ANN NEUROL 2019;86:225-240