Angiotensin II blockade and aortic-root dilation in Marfan's syndrome

Background: Progressive enlargement of the aortic root, leading to dissection, is the main cause of premature death in patients with Marfan's syndrome. Recent data from mouse models of Marfan's syndrome suggest that aortic-root enlargement is caused by excessive signaling by transforming growth factor (beta) (TGF-(beta)) that can be mitigated by treatment with TGF-(beta) antagonists, including angiotensin II-receptor blockers (ARBs). We evaluated the clinical response to ARBs in pediatric patients with Marfan's syndrome who had severe aortic-root enlargement. Methods: We identified 18 pediatric patients with Marfan's syndrome who had been followed during 12 to 47 months of therapy with ARBs after other medical therapy had failed to prevent progressive aortic-root enlargement. The ARB was losartan in 17 patients and irbesartan in 1 patient. We evaluated the efficacy of ARB therapy by comparing the rates of change in aortic-root diameter before and after the initiation of treatment with ARBs. Results: The mean (+/-SD) rate of change in aortic-root diameter decreased significantly from 3.54+/-2.87 mm per year during previous medical therapy to 0.46+/-0.62 mm per year during ARB therapy (P<0.001). The deviation of aortic-root enlargement from normal, as expressed by the rate of change in z scores, was reduced by a mean difference of 1.47 z scores per year (95% confidence interval, 0.70 to 2.24; P<0.001) after the initiation of ARB therapy. The sinotubular junction, which is prone to dilation in Marfan's syndrome as well, also showed a reduced rate of change in diameter during ARB therapy (P<0.05), whereas the distal ascending aorta, which does not normally become dilated in Marfan's syndrome, was not affected by ARB therapy. Conclusions: In a small cohort study, the use of ARB therapy in patients with Marfan's syndrome significantly slowed the rate of progressive aortic-root dilation. These findings require confirmation in a randomized trial

Altered Cerebellar Circuitry following Thoracic Spinal Cord Injury in Adult Rats

Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and maintaining parallel fiber-Purkinje cell synaptic integrity. Interestingly, this transsynaptic reorganizational pattern is consistent with that reported during development and in certain transgenic mouse models. To our knowledge, such a reorganizational event has not been described in response to SCI in adult rats. Regardless, the novel results of this study are important for understanding SCI-induced synaptic changes in the cerebellum, which may prove critical for strategies focusing on promoting functional recovery

Altered Cerebellar Circuitry Following Thoracic Spinal Cord Injury in Adult Rats

Cerebellar function is critical for coordinating movement and motor learning. However, events occurring in the cerebellum following spinal cord injury (SCI) have not been investigated in detail. We provide evidence of SCI-induced cerebellar synaptic changes involving a loss of granule cell parallel fiber input to distal regions of the Purkinje cell dendritic tree. This is accompanied by an apparent increase in synaptic contacts to Purkinje cell proximal dendrites, presumably from climbing fibers originating in the inferior olive. We also observed an early stage injury-induced decrease in the levels of cerebellin-1, a synaptic organizing molecule that is critical for establishing and maintaining parallel fiber-Purkinje cell synaptic integrity. Interestingly, this transsynaptic reorganizational pattern is consistent with that reported during development and in certain transgenic mouse models. To our knowledge, such a reorganizational event has not been described in response to SCI in adult rats. Regardless, the novel results of this study are important for understanding SCI-induced synaptic changes in the cerebellum, which may prove critical for strategies focusing on promoting functional recovery

5-level torque-hysteresis controller for DTC based IM drive

In the recent trade demand, the AC machines and drives are extensively utilized. Normally, the AC drives exploit with high efficacy as well as high performance. Among other things, one of the best control strategies is Direct torque control (DTC). For this article, the induction motor drive is projected very simple amended DTC scheme in accordance with the hysteresis controller. By the reason of its modest assembly &amp; effective execution, DTC is used for AC as well as DC drive as associated to other monitoring structures. The presence of high ripple content in output torque for DTC scheme is only an obstacle. This article approaches extenuation of the ripples in torque by varying the predictable 5-level torque hysteresis controller used in DTC. The expansion of distinctive switching approach has been generated for chosen voltage vector. On the basis of ripple content simulation outcomes fulfilled in MATLAB/SIMULINK for hysteresis torque controller to minimized the ripples

A seven-level cascaded multilevel inverter based on simplified SVPWM method

The multilevel converters are extremely widespread alternatives within megawatt power level as well as medium voltage level applications due to their excellent execution than the typical two-level converters. The widely applied control strategies aimed at inverters are Sine Pulse Width Modulation (SPWM) and Space Vector Pulse Width Modulation (SVPWM) strategies. In between these two PWM methods, the SVPWM strategy has excellent execution as compared to the SPWM strategy as a result of improved DC link voltage use as well as a decrease in Total Harmonic Distortion (THD) in output voltages. A traditional SVPWM strategy owns numerous weaknesses like computational complications in terms of identification of the reference voltage vector position, to identify sector, triangle and also it requires large memory for storing look up tables used for switching vectors. This paper presents, an innovative modified SVPWM strategy aimed at Cascaded H-Bridge Multilevel Inverter (CHBMLI). The novel modified SVPWM strategy has overwhelm the downsides of traditional SVPWM strategy. A seven-level CHBMLI is used for the implementation of this simplified SVPWM method to assess performance and as well to made comparison with the SPWM strategy. A MATLAB software is used for the simulation

Short term results of endoscopic discectomy in lumbar spine

A recent modification to lumbar discectomy involves the use of a micro-endoscope instead of an operating microscope for visualization. Percutaneous endoscopic lumbar discectomy (PELD) uses a rigid operating spinal endoscope that allows direct visualization and excision of contained and non-contained herniated disc fragments. The advantages of Endoscopic lumbar discectomy are remarkable due to minimal bone resection, no damage to paravertebral muscles, rapid recovery, minimally procedure related morbidity, cost-effectiveness and high patient satisfaction rate. Aims and objectives is to study and evaluate clinical and radiological outcomes of endoscopic lumbar discectomy over a period of 6 months.24 patients underwent endoscopic lumbar discectomy proven with MRI in a span of 3 years from 2018 to 2021. Every patient was followed up for 6 months in an observational, retrospective and prospective type of study and assessed on the basis of MacNab criteria, VAS pain score, Oswestry low back pain questionnaire. Mean preoperative Oswestry disability score (ODS) was 74.38 while mean postoperative ODS was found to be 29.25. Preoperative, while analyzing through Macnab criteria, poor results were seen in 95.83% of patients while fair results were seen in 4.17% of patients. Postoperatively excellent results were seen in 16.67% of patients while good results were seen in 83.34% of patients. Mean preoperative VAS was 7.33 while mean postoperative VAS was found to be 2.91. Endoscopic discectomy is a safe and effective procedure where patient satisfaction and pain relief are not compromised. It may be an effective and alternative treatment option for the upward migration of disc herniation in the upper lumbar area and offers additional advantage for early mobilization and faster improvement

Ameliorative Effects of Herbal Combinations in Hyperlipidemia

The roots of Glycyrrhiza glabra, Withania somnifera, Asparagus racemosus, and Chlorophytum borivilianum and seeds of Sesamum indicum are ayurvedic medicinal plants used in India to treat several ailments. Our previous studies indicated that these plants possess hypolipidemic and antioxidant potential. The present study was aimed at investigating the composite effects of these plants on hypercholesterolemic rats. Three different combinations (5 gm%, given for four weeks) used in this study effectively reduced plasma and hepatic lipid profiles and increased fecal excretion of cholesterol, neutral sterol, and bile acid along with increasing the hepatic HMG-CoA reductase activity and bile acid content in hypercholesterolemic rats. Further, all three combinations also improved the hepatic antioxidant status (catalase, SOD, and ascorbic acid levels) and plasma total antioxidant capacity with reduced hepatic lipid peroxidation. Overall, combination I had the maximum effect on hypercholesterolemic rats followed by combinations II and III due to varying concentrations of the different classes of phytocomponents

Locating Madhubani Painting in the Context of Cultural Tourism and Place Identity of Mithila Region

Art is often a reflection of culture and is considered to be the repository of a society’s collective memory.&nbsp; Researchers have long been interested in the relationship between art and culture. Art also has utilitarian influences on society and the times in which it is created in a cultural space is considered an integral component of culture. Different forms of art represent the diverse expressions of creative ideas in visual formats or performances that in turn, become an identity of a place. Madhubani paintings developed in the Mithilanchal region of Bihar are the perfect example of traditional art that maintained continuity through generations in the course of time and was assimilated gradually into the region's cultural setting. The tourism industry in India heavily banks on cultural tourism, and several communities have received a facelift by promoting places which are interesting for their heritage. Madhubani and nearby places in Bihar have a great tradition of paintings where visitors can find the authentic experience of these rich cultural features. The present study investigates the art tradition of Madhubani paintings, examining the challenges paused by commercialization and examining the scope of cultural tourism in the region.&nbsp; &nbsp

New classification of S1 pedicle morphometry impacting pedicle screw insertion technique

Background: The conventional entry point for the S1 pedicle screw insertion has been described as ‘at the base of and lateral to the superior S1 superior facet’. However, many orthopaedic surgeons complain that this technique is extremely demanding and is faced with many challenges in execution. Therefore, alternative entry points and modifications of existing techniques are explored for a greater convenience.Methods: We conducted a survey amongst 136 spine surgeons on the technical difficulties faced during insertion of the S1 pedicle screw. We also classified the S1 pedicles based by measuring their geometric parameters on 100 random computed tomography (CT) images.Results: The S1 pedicle entry technique was considered to be the most difficult and challenging by the orthopaedic surgeons in our survey due to an inadequate medial angulation due to paraspinal muscle mass tension and an overhanging iliac crest. This could be explained by the hourglass shaped pedicle (type 3) with a desired medial angle more 50 degrees (type III) observed as the most common S1 pedicle in the study population. To overcome this limitation, most of them preferred a tri-corticate approach.Conclusions: A more lateral entry point and a longer screw might be considered as solutions for a better and safer S1 pedicle entry. Also, the use of pre-operative CT can be considered to visualize the type of S1 pedicle and hence, decide on the most appropriate technique of screw insertion.