A Study on Hepatic Trauma: Single Centre Experience in Rajiv Gandhi Government General Hospital, Chennai

INTRODUCTION: Liver injuries are common in any high volume trauma center. Our knowledge in its management has improved in the past three decades. Recent advances and minimally invasive techniques play a vital role in the conservative approach. It is very difficult for a trauma surgeon to control massive bleeding occurring in the liver following trauma. The bleeding structure is very tough to find out, and the crucial period of time to save the trauma victim before the onset of hypothermia, acidosis, and coagulopathy—the markers of an irreversible physiologic insult. Usual techniques of elective hepato-biliary surgery like segmental resection do not apply in hostile environment where the timing of intervention is a major factor in saving the life of the patient. It is very clear that the management of hepatic trauma has been a formidable challenge to all surgeons. The evolvement of the management of hepatic trauma over the recent years is a reflection of the rapid understanding of the key parameters deciding the line of management in hepatic trauma. There were poor outcomes in patients where resection was done but future learning of the injured patient’s patho-physiology paved way for the concept of damage control that has been the key in modern trauma management. Meanwhile better learning of the outcome of various liver injuries in clinically stable patients has increased the conservative line of approach by using the modern imaging and minimally invasive procedures. AIMS AND OBJECTIVES: 1. To identify clinical and imaging parameters to decide upon the line of management in hepatic trauma. 2. To study the clinical course of patients managed conservatively. 3. To study the profile of various other associated injuries in liver trauma. MATERIALS AND METHODS: Sample Size: 35 cases. Study Design: Observational study (Prospective & Retrospective). Study Population: 35 cases. Study period: Oct 2015 to Sep 2016. Study Centre: Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai. Subject Selection: Inclusion Criteria: All trauma victims sustaining blunt and penetrating trauma to the liver with or without associated injuries. Exclusion criteria: Abdominal trauma with isolated injury to the extra hepatic biliary tree or other visceral structures without liver trauma . ASSESSMENT OF PARAMETERS: All Patients who fit the inclusion criteria were observed and following data collected 1. Routine blood investigations, Hemoglobin, Hematocrit, Liver Function Test. All these were done serially. 2. USG Abdomen. 3. CECT Abdomen (i.v. contrast)/plain CT for all cases. 4. AAST grading system was the standard methodology to assess severity of liver injury. 5. Patients managed conservatively were followed up prospectively and till discharge. 6. Conclusions were drawn based on the above parameters. CONCLUSION: From this study it is clear that all hemodynamically stable patients can be subjected to conservative line of management irrespective of the grade of the injury. • Those managed conservatively must be subjected to serial monitoring. If there are findings of sepsis like biloma, infected necrosis, liver abscess at any point of time the first option of intervention will be minimally invasive procedures like image guided drainage. • If there are features of peritonitis then laparotomy must be considered without any delay. • Non operative management is employed for hemodynamically unstable patients. • The first step will always be a Pringles maneuver to identify the possible source of bleeding which can be from either the portal vein or hepatic artery and hemostasis can be achieved by topical hemostatic agents like gel foam etc. • If the patients hemodynamic status is in jeopardy then Perihepatic packing serves as the best operative intervention in reversing the patients hemodynamic status to normalcy

Clinical Profile and Outcome Oclinical of Neonatal Sepsis in a Tertiary Care Centre, Trichy, Tamil Nadu

INTRODUCTION: Neonatal septicemia refers to a clinical syndrome characterized by systemic signs and symptoms due to generalized bacterial infection with a positive blood culture in the first four weeks of life. Bacterial infections are the commonest cause of morbidity and mortality during the neonatal period. Fulminant and fatal course of infection may result from complications such as shock, disseminated intravascular coagulation and multi-system organ failure, mandating early diagnosis of this life-threatening condition for a timely treatment and a favourabIe outcome. Sepsis is the commonest cause of mortality responsible for 30-50% of the 5 million total neonatal deaths each year. The reported incidence of neonatal sepsis varies from 7.1 to 38 per 1000 live births in Asia. National Neonatal Perinatal Database (NNPD, 2002- 2003) from India has reported an incidence varying from 0.1% to 4.5%1. Sepsis to be one of the commonest causes of neonatal mortality contributing to19% of all neonatal deaths. Gram negative organisms are found to be more frequently than Gram positive organisms as evidenced by many Indian studies2,3. The clinical presentation is often subtle or nonspecific and usually mimicked by several other disorder. AIMS AND OBJECTIVES: 1. Neonatal mortality remains high in our country in spite of the decline in the infant mortality rate. One third of the neonatal mortality is reported to be due to sepsis and related illness. 2. Hence this study was planned to understand the clinical parameters, role of investigations and the outcome in neonatal sepsis. 3. To analyze the causative organisms and their sensitivity pattern. 4. To identify the perinatal risk factors in the causation and outcome of neonatal sepsis. 5. To identify modifiable risk factors in order to develop appropriate strategies to address them. 6. To identify laboratory investigations for early diagnosis of sepsis. DISCUSSION: Sepsis is the commonest cause of neonatal morbidity and mortality. It is responsible for about 30-50% of total neonatal deaths.23 Sepsis related morbidity and mortality is largely either preventable or treatable with rational antimicrobial and supportive therapy. LBW is a strong risk factor for neonatal sepsis due to multiple reasons. Unsafe delivery or unclean delivery at inappropriate place is another important predisposing factor for sepsis. Earliest clinical features of neonatal sepsis are often subtle and non specific therefore a high index of suspicion is needed for early diagnosis specially so if risk factors are also present. In the present study majority of neonates presented with refusal to feeds (91.2%) lethargy (86.4%) tachyphea (75%) and fever (50.4%) which is comparable to various other study5. In this study documented hypothermia (12%) were apnea in (10.4%), convulsions (12.8%) which is correlated well with various study.24 Male neonates were reported to be affected more with sepsis as compared to females in some studies.8,25 This is in concordance with our study as well (p < 0.05) Bias for male sex, place of study, sample including other factors may be responsible for increased number of male cases in these studies. There was statistically significant difference (p < 0.05) in sepsis cases born in the study institution (inborn) as compared to those brought from outside (out born). In inborn category (62.4%) had sepsis as compared to (37.6%) in out born group. CONCLUSION: Blood culture was positive in 50(20%) neonates. About 84% of infections were caused by gram negative organisms, Klebsiella being the commonest organism causing sepsis. For most of the gram-negative organisms, Amikacin and third generation cephalosporins were effective. The common clinical presentations are lethargy (65.8%), refusal to suck (65.8%), tachypnea (98.3%) and fever (58.3%). When clinical signs like chest retractions, grunt and Abdominal distension, bulging fontanelle were present the likelihood of proven sepsis is high. The incidence of sepsis was shown to be higher among neonates with Perinatal risk factors such as risk factors, multiple vaginal examination during labour, lowbirthweight and preterm neonates. CRP has a high negative predictive value but low positive predictive value with sensitivity and specificity of 83% and 37.2% respectively. The specificity of combinations of hematological parameters were higher than that of CRP. The positive predictive value and specificity was high when two or more tests were combined together. Neonatal septicemia is still a leading cause of mortality and morbidity in developing countries like India. It is more common among males, low birth weight and preterm neonates. It is also found to be more common among the hospital inborn neonates with spontaneous vaginal delivery. Early onset septicemia is more common compared to late onset septicemia. Gramnegative organisms are the predominant causative agents in neonatal septicemia. Infections are a major threat to the premature and low birth weight neonates with multidrug resistant microorganisms emerging as a major problem. Blood culture is still the “Gold standard” for the diagnosis of septicemia in neonates and should be done in all cases of suspected septicemia. In view of the changing spectrum of the causative agents of neonatal septicemia and their antibiotic susceptibility patterns from time to time and from one hospital to another, a positive blood culture and the antibiotic susceptibility testing of the isolates are the best guide in choosing the appropriate antimicrobial therapy in treating neonatal septicemia

Multi-omic Profiling Reveals Dynamics of the Phased Progression of Pluripotency

Pluripotency is highly dynamic and progresses through a continuum of pluripotent stem cell states. The two states that bookend the pluripotency continuum, naive and primed, are well characterized, but our understanding of the intermediate states and transitions between them remains incomplete. Here, we dissect the dynamics of pluripotent state transitions underlying pre- to post-implantation epiblast differentiation. Through comprehensive mapping of the proteome, phosphoproteome, transcriptome, and epigenome of embryonic stem cells transitioning from naive to primed pluripotency, we find that rapid, acute, and widespread changes to the phosphoproteome precede ordered changes to the epigenome, transcriptome, and proteome. Reconstruction of the kinase-substrate networks reveals signaling cascades, dynamics, and crosstalk. Distinct waves of global proteomic changes mark discrete phases of pluripotency, with cell-state-specific surface markers tracking pluripotent state transitions. Our data provide new insights into multi-layered control of the phased progression of pluripotency and a foundation for modeling mechanisms regulating pluripotent state transitions (www.steamcellatlas.org)

Review on Carbon Dioxide Utilization for Cycloaddition of Epoxides by Ionic Liquid-Modified Hybrid Catalysts: Effect of Influential Parameters and Mechanisms Insight

The storage, utilization, and control of the greenhouse (CO2) gas is a topic of interest for researchers in academia and society. The present review article is dedicating to cover the overall role of ionic liquid-modified hybrid materials in cycloaddition reactions. Special emphasis is on the synthesis of various cyclic carbonate using ionic liquid-based modified catalysts. Catalytic activity studies have discussed with respect to process conditions and their effects on conversion and product selectivity for the reaction of cycloaddition of CO2 with styrene oxide. The reaction temperature and the partial pressure of CO2 have found to play a key role in cyclic carbonate formation. The role of other influential parameter (solvent effect) is also discussed for the conversion of cyclic/aromatic oxides to polycarbonate production. Our own research work that deals with ionic liquid-based halide-modified mesoporous catalyst (MCM-41 type) derived from rice husk waste has also been discussed. Finally, the role of carbon dioxide activation and ring-opening mechanisms involved in the cyclic carbonate product formation from CO2 have been discussed

DIMA 3.0: Domain Interaction Map

Domain Interaction MAp (DIMA, available at http://webclu.bio.wzw.tum.de/dima) is a database of predicted and known interactions between protein domains. It integrates 5807 structurally known interactions imported from the iPfam and 3did databases and 46 900 domain interactions predicted by four computational methods: domain phylogenetic profiling, domain pair exclusion algorithm correlated mutations and domain interaction prediction in a discriminative way. Additionally predictions are filtered to exclude those domain pairs that are reported as non-interacting by the Negatome database. The DIMA Web site allows to calculate domain interaction networks either for a domain of interest or for entire organisms, and to explore them interactively using the Flash-based Cytoscape Web software

A self-organized model for cell-differentiation based on variations of molecular decay rates

Systemic properties of living cells are the result of molecular dynamics governed by so-called genetic regulatory networks (GRN). These networks capture all possible features of cells and are responsible for the immense levels of adaptation characteristic to living systems. At any point in time only small subsets of these networks are active. Any active subset of the GRN leads to the expression of particular sets of molecules (expression modes). The subsets of active networks change over time, leading to the observed complex dynamics of expression patterns. Understanding of this dynamics becomes increasingly important in systems biology and medicine. While the importance of transcription rates and catalytic interactions has been widely recognized in modeling genetic regulatory systems, the understanding of the role of degradation of biochemical agents (mRNA, protein) in regulatory dynamics remains limited. Recent experimental data suggests that there exists a functional relation between mRNA and protein decay rates and expression modes. In this paper we propose a model for the dynamics of successions of sequences of active subnetworks of the GRN. The model is able to reproduce key characteristics of molecular dynamics, including homeostasis, multi-stability, periodic dynamics, alternating activity, differentiability, and self-organized critical dynamics. Moreover the model allows to naturally understand the mechanism behind the relation between decay rates and expression modes. The model explains recent experimental observations that decay-rates (or turnovers) vary between differentiated tissue-classes at a general systemic level and highlights the role of intracellular decay rate control mechanisms in cell differentiation.Comment: 16 pages, 5 figure

Prioritizing orphan proteins for further study using phylogenomics and gene expression profiles in Streptomyces coelicolor

BACKGROUND:Streptomyces coelicolor, a model organism of antibiotic producing bacteria, has one of the largest genomes of the bacterial kingdom, including 7825 predicted protein coding genes. A large number of these genes, nearly 34%, are functionally orphan (hypothetical proteins with unknown function). However, in gene expression time course data, many of these functionally orphan genes show interesting expression patterns.RESULTS:In this paper, we analyzed all functionally orphan genes of Streptomyces coelicolor and identified a list of "high priority" orphans by combining gene expression analysis and additional phylogenetic information (i.e. the level of evolutionary conservation of each protein).CONCLUSIONS:The prioritized orphan genes are promising candidates to be examined experimentally in the lab for further characterization of their functio

A new, fast algorithm for detecting protein coevolution using maximum compatible cliques

<p>Abstract</p> <p>Background</p> <p>The MatrixMatchMaker algorithm was recently introduced to detect the similarity between phylogenetic trees and thus the coevolution between proteins. MMM finds the largest common submatrices between pairs of phylogenetic distance matrices, and has numerous advantages over existing methods of coevolution detection. However, these advantages came at the cost of a very long execution time.</p> <p>Results</p> <p>In this paper, we show that the problem of finding the maximum submatrix reduces to a multiple maximum clique subproblem on a graph of protein pairs. This allowed us to develop a new algorithm and program implementation, MMMvII, which achieved more than 600× speedup with comparable accuracy to the original MMM.</p> <p>Conclusions</p> <p>MMMvII will thus allow for more more extensive and intricate analyses of coevolution.</p> <p>Availability</p> <p>An implementation of the MMMvII algorithm is available at: <url>http://www.uhnresearch.ca/labs/tillier/MMMWEBvII/MMMWEBvII.php</url></p