Prevention of stillbirths: impact of a two-stage screening for vasa previa

Objectives: To examine the feasibility and effectiveness of a two-stage ultrasound screening strategy for detection of vasa previa and estimate the potential impact of screening on prevention of stillbirth. Methods: This was a retrospective examination of data from prospective screening for vasa previa in singleton pregnancies undertaken at the Fetal Medicine Centre at Medway Maritime Hospital, UK between 2012 and 2018. Women booked for prenatal care and delivery in our hospital had routine ultrasound examinations at 11-13 and 20-22 weeks’ gestation. Those with velamentous cord insertion at the inferior part of the placenta at the first-trimester scan and those with low-lying placenta at the second-trimester scan were classified as high-risk for vasa previa and had transvaginal sonography specifically searching for vasa previa at the time of the 20-22 weeks scan. The management and outcome of cases with suspected vasa previa is described. We excluded cases of miscarriage or termination at <24 weeks’ gestation. Results: The study population of 26,830 singleton pregnancies, included 21 (0.08% or 1 in 1,278) with vasa previa. In all cases of vasa previa the diagnosis was made at the 20-22 weeks scan and confirmed by gross and histological examination of the placenta postnatally. At the 11-13 weeks scan the cord insertion was classified as central in 25,071 (93.4%) cases, marginal in 1,680 (6.3%), and velamentous in 79 (0.3%). In 16 (76.2%) of the 21 cases of vasa previa, the cord insertion at the first-trimester scan was classified as velamentous at the inferior part of the placenta, in 2 (9.5%) as marginal and in 3 (14.3%) as central. The 21 cases of vasa previa were managed on an outpatient basis with serial scans for measurement of cervical length and elective cesarean section at 34 weeks’ gestation; all babies were liveborn but there was one neonatal death. In the study population there were 83 stillbirths and postnatal examination showed no evidence of vasa previa in any of the cases. On the assumption that if we had not diagnosed prenatally all 21 cases of vasa previa in our population half of these cases would have resulted in stillbirth, then the potential impact of screening is prevention of 9.6% (10/104) of stillbirths. Conclusion: A two-stage strategy of screening for vasa previa can be incorporated into routine clinical practice and such strategy could potentially reduce the rate of stillbirth

Carnosol induces ROS-mediated beclin1-independent autophagy and apoptosis in triple negative breast cancer

Background: In this study we investigated the in vitro and in vivo anticancer effect of carnosol, a naturally occurring polyphenol, in triple negative breast cancer.Results: We found that carnosol significantly inhibited the viability and colony growth induced G2 arrest in the triple negative MDA-MB-231. Blockade of the cell cycle was associated with increased p21/WAF1 expression and downregulation of p27. Interestingly, carnosol was found to induce beclin1-independent autophagy and apoptosis in MDA-MB-231 cells. The coexistence of both events, autophagy and apoptosis, was confirmed by electron micrography. Induction of autophagy was found to be an early event, detected within 3 h post-treatment, which subsequently led to apoptosis. Carnosol treatment also caused a dose-dependent increase in the levels of phosphorylated extracellular signal-regulated kinase 1 and 2 (pERK1/2). Moreover, we show that carnosol induced DNA damage, reduced the mitochondrial potential and triggered the activation of the intrinsic and extrinsic apoptotic pathway. Furthermore, we found that carnosol induced a dose-dependent generation of reactive oxygen species (ROS) and inhibition of ROS by tiron, a ROS scavenger, blocked the induction of autophagy and apoptosis and attenuated DNA damage. To our knowledge, this is the first report to identify the induction of autophagy by carnosol.Conclusion: In conclusion our findings provide strong evidence that carnosol may be an alternative therapeutic candidate against the aggressive form of breast cancer and hence deserves more exploration.Scopu

Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon

Objective. The purpose of this study is to evaluate antibiotic-prescribing practices and adherence to IDSA guidelines for the treatment of uncomplicated urinary tract infections in Lebanon. Methods. This observational prospective study was conducted in 15 community pharmacies in Lebanon over 1 year in adult females. A regimen of nitrofurantoin 100 mg bid for 5 days or fosfomycin 3 grams single dose were considered appropriate. For the bivariate analysis, the chi-square test was used. Results. A total of 376 patients were included in this study. The prescribed antibiotic was appropriate in 35 percent of the patients. Age (more than 50 years) did not significantly affect the appropriateness of the prescribed antibiotic (p=0.508). The frequency of attacks per year (more than 3) negatively affected the choice of antibiotic (p=0.025). The dose and duration of the prescribed antibiotic was appropriate in 73 and 58 percent of the patients, respectively, with a significant inappropriate dose and duration with fluoroquinolones as compared to nitrofurantoin and fosfomycin (p<0.001 for the dose and p=0.014 for the duration of therapy). Conclusions. In an era of increasing bacterial resistance, interventions that improve physicians’ prescribing practices for uncomplicated urinary tract infections are needed

Iron Intermetallic Compounds (IMCs) Formation Mechanism in the Molten Aluminium Zinc (Al-Zn) Coating Alloy

To prevent corrosion of steel products, the steel industry often relies on Al-Zn based alloy coatings, applied through hot-dip coating technology. Despite this, a long-standing problem in the galvanizing industry involves the formation of Fe-based intermetallic compounds (IMCs) in the Al-Zn coating bath, caused by iron dissolution from steel products. Such IMCs are the primary source of dross formation in the Al-Zn bath, which inevitably leads to metal spot defects in the coated steel products and bottom dross build-up in the Al-Zn bath. The present research aims to investigate the mechanism of Fe transformation into IMCs. To achieve this, Fe saturated and unsaturated Al-Zn alloys were doped with low carbon steel at a temperature of 600 °C. The samples were collected at regular intervals and quenched in water. The optical microscopy (OM) and scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS) were used to study the transformation of steel strips into Fe-IMCs particles in molten Al-Zn alloys. The study findings suggest that the Fe transformation into Fe-IMCs is a complex process, where the steel strip surface is initially oxidized, and Al5Fe2 and Al3Fe are formed, which finally transform into Al8Fe2Si(Zn) (τ5c) IMCs particles. These results can assist galvanizers in understanding formation of Fe-IMCs and bottom dross build up in the costing pots

Measures of insulin sensitivity, leptin, and adiponectin concentrations in cats in diabetic remission compared to healthy control cats

Objectives: Firstly, to compare differences in insulin, adiponectin, leptin, and measures of insulin sensitivity between diabetic cats in remission and healthy control cats, and determine whether these are predictors of diabetic relapse. Secondly, to determine if these hormones are associated with serum metabolites known to differ between groups. Thirdly, if any of the hormonal or identified metabolites are associated with measures of insulin sensitivity. Animals: Twenty cats in diabetic remission for a median of 101 days, and 21 healthy matched control cats. Methods: A casual blood glucose measured on admission to the clinic. Following a 24 h fast, a fasted blood glucose was measured, and blood sample taken for hormone (i.e., insulin, leptin, and adiponectin) and untargeted metabolomic (GC-MS and LC-MS) analysis. A simplified IVGGT (1 g glucose/kg) was performed 3 h later. Cats were monitored for diabetes relapse for at least 9 months (270 days). Results: Cats in diabetic remission had significantly higher serum glucose and insulin concentrations, and decreased insulin sensitivity as indicated by an increase in HOMA and decrease in QUICKI and Bennett indices. Leptin was significantly increased, but there was no difference in adiponectin (or body condition score). Several significant correlations were found between insulin sensitivity indices, leptin, and serum metabolites identified as significantly different between remission and control cats. No metabolites were significantly correlated with adiponectin. No predictors of relapse were identified in this study. Conclusion and clinical importance: Insulin resistance, an underlying factor in diabetic cats, persists in diabetic remission. Cats in remission should be managed to avoid further exacerbating insulin resistance

Synthesis of quinone-based heterocycles of broad-spectrum anticancer activity

A synthesis of benzo[e][1,2,4]triazines and 1,2,4-triazolospiro[4,5]deca-2,6,9-trien-8-ones has been developed from reactions of amidrazones with 2-chloro-1,4-benzoquinone in EtOAc containing 0.5 mL of piperidine. This highly regioselective and one-pot process provided rapid access to 1,2,4-triazolospiro[4,5]deca-2,6,9-trien-8-ones (60%–70%) and benzo[e][1,2,4]triazines (11%–18%). On reacting amidrazones with 5-hydroxy-1,4-naphthoquinone in an EtOAc/piperidine mixture, the reaction proceeded to give 5-hydroxy-2-(piperidin-1-yl)naphthalene-1,4-dione. The structures of the isolated products were proved by infrared, NMR (2D-NMR), mass spectra, and elemental analyses in addition to X-ray structure analysis. The reaction mechanisms are discussed. The anticancer screening of selected compounds showed broad-spectrum anticancer activity against most melanoma cancer cell lines, ovarian cancer OVCAR-3, central nervous system cancer SF-295 and U251, non-small cell lung cancer NCI-H23, renal cancer SN12C, and colon cancer HCT-15 and HCT-116. The selected compounds exhibited moderate to weak anticancer activity to other cell lines

Synthesis of quinone-based heterocycles of broad-spectrum anticancer activity

A synthesis of benzo[e][1,2,4]triazines and 1,2,4-triazolospiro[4,5]deca-2,6,9-trien-8-ones has been developed from reactions of amidrazones with 2-chloro-1,4-benzoquinone in EtOAc containing 0.5 mL of piperidine. This highly regioselective and one-pot process provided rapid access to 1,2,4-triazolospiro[4,5]deca-2,6,9-trien-8-ones (60%-70%) and benzo[e][1,2,4]triazines (11%-18%). On reacting amidrazones with 5-hydroxy-1,4-naphthoquinone in an EtOAc/piperidine mixture, the reaction proceeded to give 5-hydroxy-2-(piperidin-1-yl)naphthalene-1,4-dione. The structures of the isolated products were proved by infrared, NMR (2D-NMR), mass spectra, and elemental analyses in addition to X-ray structure analysis. The reaction mechanisms are discussed. The anticancer screening of selected compounds showed broad-spectrum anticancer activity against most melanoma cancer cell lines, ovarian cancer OVCAR-3, central nervous system cancer SF-295 and U251, non-small cell lung cancer NCI-H23, renal cancer SN12C, and colon cancer HCT-15 and HCT-116. The selected compounds exhibited moderate to weak anticancer activity to other cell lines.Peer reviewe

Biocompatibility and Gene Expression Associated with Streptococcus Infection in Myocarditis

Abstract Myocardial inflammation is a nonspecific response to various triggers such as viral and bacterial infection. This study was designed to examine the Streptococcus induction of myocarditis in rat and induction of CRP, SAP, LBP and Cytokines on the transcriptional activity of the inflammation / related genes expression using a semi-quantitative RT-PCR in liver and heart tissues. Experimental myocarditis was established with intra-peritoneal injection of 10 8 CFU/ ml of Streptococcus faecalis in three groups of rats and sacrificed after one, two and seven days post infection, respectively. Heart and liver functions were highly elevated while kidney functions were not affected. Histopathological examination for heart and liver showed damage effect for the bacterial infection. Expression pattern of CRP, SAP, LBP &amp; IL6 genes were investigated, in liver these genes were highly expressed while some of them showed no expression pattern in heart tissues

GINGER ETHANOLIC EXTRACT, GINGER OIL OR RICE BRAN OIL INDUCED HEPATOPROTECTIVE EFFECT AGAINST FATTY LIVER IN RATS

Hepatoprotective effect of ethanol extract of ginger, ginger oil or rice bran oil against fatty liver disease which induced by ethanol stress was investigated in the present study. Thirty six (36) male albino rats were classified into 6 groups as follows: 1- Normal control (NC), 2- Positive control (induced fatty liver by ethanolic stress) (PC+), 3- rats group administered ethanol and ginger extract (GE group), 4- rats group administered ethanol and ginger oil (GO group), 5- rats group administered ethanol and rice bran oil (RBO group) and 6- rats group administered ethanol and DMSO (DMSO  control group, because GE, GO and RBO were dissolved in DMSO as a vehicle). Results revealed that hepatic triglycerides was significantly (p≤0.05) raised to 80.7 mg/g liver, in positive control (PC+), compared to 15.98 mg/g liver in normal control (NC). Also significant increase (p≤0.05) in levels of ALT (69.41 U/L), AST (62.98 U/L) and ALP (121.65 U/L) in PC+, compared to their levels in NC (23.35 U/L), (27.95 U/L) and (73.45 U/L) respectively. In addition, high significant level was observed in serum triglycerides (214.37 mg/dl), total cholesterol (TC) (99.81 mg/dl) and LDL cholesterol (47.75 mg/dl) in PC+, compared with its values in NC group: (74.22 mg/dl), (31.45 mg/dl), (4.21 mg/dl) respectively. However, significant (p≤0.05) decrease was noticed in HDL cholesterol level (9.18 mg/dl) in PC+, compared to NC (12.39 mg/dl). On the other hand, treatment by ethanolic ginger extract (200 mg/kg body weight) showed a hepatoprotective effect which confirmed by remediation the values of hepatic TG, ALT, AST, ALP, TP, Alb, besides serum TG, TC, HDL-C and LDL-C in GE group as compared with their values in NC and PC+. Moreover, treatment by ginger oil (200 mg/kg body weight) and rice bran oil (200 mg/kg body weight) displayed a protective effect in GO or RBO groups, but lower than GE. In addition, ethanol extract of ginger disclosed very high antioxidant activity (IC50 = 18.25 µg/ml) compared to both ginger oil (IC50 = 6714.38 µg/ml) or rice bran oil (IC50 = 1409.57 µg/ml). Finally the present study indicates that ethanol extract of ginger showed hepatoprotective effect more than either ginger oil or rice bran oil