Diagnostic Value of Pleural Fluid Bilirubin / Serum Bilirubin Ratio Versus Pleural Fluid Protein / Serum Protein Ratio to Differentiate Exudative from Transudative Pleural Effusion

INTRODUCTION: Pleural effusion is the abnormal and excess accumulation of serous fluid in the pleural space. The first step is to classify them as transudates or exudates which is essential for the management of pleural effusion. The lights criteria is the most used criteria as the test of time in classifying pleural effusions into transudates and exudates. But studies have shown that there is significant number of misclassification with the lights criteria. Several newer parameters are being postulated as an alternative to lights criteria for classifying effusions. Pleural fluid bilirubin and its ratio to serum bilirubin is one of the parameter AIMS AND OBJECTIVES: To study the diagnostic value of ratio of pleural fluid bilirubin to serum bilirubin ratio in differentiating exudative and transudative pleural effusion and compare with diagnostic value of pleural fluid protein / serum protein ratio. MATERIALS AND METHODS: This study is conducted at Kanyakumari Government Medical College Hospital for the period of 12 months. It is a Prospective Observational study. 100 patients with pleural effusion with known etiology were selected based on inclusion and exclusion criteria. Selected subjects were divided into transudates and exudates based on the etiology & clinical diagnosis. Pleural fluid bilirubin level and its ratio to serum bilirubin level, pleural fluid protein and its ratio to serum protein were estimated in all patients. Observations are analysed using SPSS software version 23. RESULTS: In this study, majority of the patients with pleural effusion is males contributing of 56% and female of 44%. According to clinical diagnosis, pleural effusion is divided into 58 cases as exudate and 42 as transudative effusion. In this study, ratio of pleural fluid bilirubin to serum bilirubin has a sensitivity of 93.22%, specificity of 92.68% for distinguishing exudative pleural effusion and transudative pleural effusion with the PPV of about 94.83% and 90.48% of NPV with Diagnostic accuracy of 93%. And the pleural fluid protein to serum protein ratio has a sensitivity of 96.23%, specificity of 85.11% for distinguishing exudative pleural effusion and transudative pleural effusion with the PPV of 87.93% and NPV of 95.24% with diagnostic accuracy being 91%. CONCLUSION: From our study we conclude that to classify an exudative pleural effusion from transudate, most sensitive test to classify is pleural fluid protein to serum protein ratio (96.23%) and most specific test is pleural fluid bilirubin / serum bilirubin ratio (92.68) with the cut off value of 0.6. This study observed that Pleural fluid bilirubin / serum bilirubin ratio has a good diagnostic ability in differentiating exudates from transudates. It is concluded that pleural fluid bilirubin to serum bilirubin is a simple, easy, cost effective and highly useful parameter to distinguish transudative from exudative pleural effusion

Inhibition of oxidative stress, inflammation and apoptosis by Terminalia arjuna against acetaminophen-induced hepatotoxicity in Wistar albino rats

51-57Overuse of therapeutic drugs such as acetaminophen often affects liver, and may lead to inflammatory mediated liver cell death. Here, we studied the effect of Terminalia arjuna (TA) bark against acetaminophen (APAP) induced liver cell death/injury by testing the antioxidant levels, oxidative stress, and inflammation and apoptosis markers. Wistar albino male rats weighing 180-280 mg/kg were made into 5 groups of 6 animals each and were treated as follows: Gr. I, control; Gr. II, acetaminophen (APAP); GR. III, N-acetylcysteine (NAC); Gr. IV & V, Terminalia arjuna (TA) 250 and mg/kg. The antioxidant glutathione (GSH), lipid peroxidation (MDA), interleukin 1β (IL-1β) levels, caspase-9 levels, and Protein kinase B (P-AKT) gene expression levels were assessed. The rGr. V animals pre-treated with Terminalia arjuna high dose bark showed increased glutathione (GSH) levels, but decreased malondialdehyde (MDA) levels; inhibited IL-1β and caspase-9 levels; and also elevated gene expression level of P-AKT to regulate the cell signaling pathway. Apparently, the results demonstrated that a high dose of TA 500 mg/kg ameliorated acetaminophen-induced hepatotoxicity

Towards video-based surgical workflow understanding in open orthopaedic surgery

Safe and efficient surgical training and workflow management play a critical role in clinical competency and ultimately, patient outcomes. Video data in minimally invasive surgery (MIS) have enabled opportunities for vision-based artificial intelligence (AI) systems to improve surgical skills training and assurance through post-operative video analysis and development of real-time computer-assisted interventions (CAI). Despite the availability of mounted cameras for the operating room (OR), similar capabilities are much more complex to develop for recording open surgery procedures, which has resulted in a shortage of exemplar video-based training materials. In this paper, we present a potential solution to record open surgical procedures using head-mounted cameras. Recorded videos were anonymised to remove patient and staff identifiable information using a machine learning algorithm that achieves state-of-the-art results on the OR Face dataset. We then propose a CNN-LSTM-based model to automatically segment videos into different surgical phases, which has never been previously demonstrated in open procedures. The redacted videos, along with the automatically predicted phases, are then available for surgeons and their teams for post-operative review and analysis. To our knowledge, this is the first demonstration of the feasibility of deploying camera recording systems and developing machine learning-based workflow analysis solutions for open surgery, particularly in orthopaedics

Global DNA methylation profiling of manganese-exposed human neuroblastoma SH-SY5Y cells reveals epigenetic alterations in Parkinson’s disease-associated genes

Manganese (Mn) is an essential trace element required for optimal functioning of cellular biochemical pathways in the central nervous system. Elevated exposure to Mn through environmental and occupational exposure can cause neurotoxic effects resulting in manganism, a condition with clinical symptoms identical to idiopathic Parkinson’s disease. Epigenetics is now recognized as a biological mechanism involved in the etiology of various diseases. Here, we investigated the role of DNA methylation alterations induced by chronic Mn (100 µM) exposure in human neuroblastoma (SH-SY5Y) cells in relevance to Parkinson’s disease. A combined analysis of DNA methylation and gene expression data for Parkinson’s disease-associated genes was carried out. Whole-genome bisulfite conversion and sequencing indicate epigenetic perturbation of key genes involved in biological processes associated with neuronal cell health. Integration of DNA methylation data with gene expression reveals epigenetic alterations to PINK1, PARK2 and TH genes that play critical roles in the onset of Parkinsonism. The present study suggests that Mn-induced alteration of DNA methylation of PINK1–PARK2 may influence mitochondrial function and promote Parkinsonism. Our findings provide a basis to further explore and validate the epigenetic basis of Mn-induced neurotoxicity

Boundary Terms and Junction Conditions for Generalized Scalar-Tensor Theories

We compute the boundary terms and junction conditions for Horndeski's panoptic class of scalar-tensor theories, and write the bulk and boundary equations of motion in explicitly second order form. We consider a number of special subclasses, including galileon theories, and present the corresponding formulae. Our analysis opens up of the possibility of studying tunnelling between vacua in generalized scalar-tensor theories, and braneworld dynamics. The latter follows because our results are independent of spacetime dimension.Comment: 13 pages, Equation corrected. Thanks to Tsutomu Kobayashi for informing us of the typ

Manganese exposure: linking down-regulation of miRNA-7 and miRNA-433 with α-synuclein overexpression and risk of idiopathic Parkinson's disease

Manganese is an essential trace element however elevated environmental and occupational exposure to this element has been correlated with neurotoxicity symptoms clinically identical to idiopathic Parkinson's disease. In the present study we chronically exposed human neuroblastoma SH-SY5Y cells to manganese (100 μM) and carried out expression profiling of miRNAs known to modulate neuronal differentiation and neurodegeneration. The miRNA PCR array results reveal alterations in expression levels of miRNAs, which have previously been associated with the regulation of synaptic transmission and apoptosis. The expressions of miR-7 and miR-433 significantly reduced upon manganese exposure. By in silico homology analysis we identified SNCA and FGF-20as targets of miR-7 and miR-433. We demonstrate an inverse correlation in expression levels where reduction in these two miRNAs causes increases in SNCA and FGF-20. Transient transfection of SH-SY5Y cells with miR-7 and miR-433 mimics resulted in down regulation of SNCA and FGF-20 mRNA levels. Our study is the first to uncover the potential link between manganese exposure, altered miRNA expression and parkinsonism: manganese exposure causes overexpression of SNCA and FGF-20 by diminishing miR-7 and miR-433 levels. These miRNAs may be considered critical for protection from manganese induced neurotoxic mechanism and hence as potential therapeutic targets

Pleosporales

One hundred and five generic types of Pleosporales are described and illustrated. A brief introduction and detailed history with short notes on morphology, molecular phylogeny as well as a general conclusion of each genus are provided. For those genera where the type or a representative specimen is unavailable, a brief note is given. Altogether 174 genera of Pleosporales are treated. Phaeotrichaceae as well as Kriegeriella, Zeuctomorpha and Muroia are excluded from Pleosporales. Based on the multigene phylogenetic analysis, the suborder Massarineae is emended to accommodate five families, viz. Lentitheciaceae, Massarinaceae, Montagnulaceae, Morosphaeriaceae and Trematosphaeriaceae