Chronic patellofemoral instability and pain treated effectively by anteromedial tibial tubercle transfer (Fulkerson osteotomy) with or without medial patellofemoral ligament reconstruction

Background-Chronic patellar instability (subluxation and dislocation) and pain is a debilitating knee condition that frequently involves young, active patients. Bony malalignment and soft tissue injury (torn or stretched MPFL) is considered as a surgical indication for distal realignment in the form of Anteromedial tibial tubercle transfer(Fulkerson osteotomy) with or without MPFL reconstruction that effectively prevents the patella from tracking laterally and thus unloads the lateral patella while making the patellofemoral joint more congruous , stable and pain free.Materials and method - It is a prospective study of 22 patients of chronic patellar instability and pain. Follow up ranged from 24 to 36(average 30) months. Preoperative assessment included clinical examination, Lysholm, IKDC score and Radiological examination (X-ray, CT scan and MRI). 18 patients with history of dislocation and pain having bony malalignment and torn MPFL were treated with Fulkerson osteotomy and MPFL reconstruction and 4 patients with history of subluxation and pain having bony malalignment only were treated with Fulkerson osteotomy alone. Patients were followed up with the help of X-rays at regular interval and the clinical outcome was measured using scoring system. Results-There was a significant improvement in postoperative assessment with regards to scoring system (Lysholm and IKDC) and knee pain. Union at osteotomy site for all patients was seen. None of the patients had further episode of dislocation or subluxation. Pain at femoral site of MPFL reconstruction in 2 cases persisted for 3 months followed by resolution of their symptoms. One of our patients had profuse swelling at the site of operation postoperatively which was treated with Rest, Ice Pack, Compression and Limb elevation. Out of 22 patients undertaken infection at osteotomy site was seen in 1 patient for which implant removal was done from osteotomy site after union. Conclusion-Anteromedial Tibial tuberosity osteotomy and MPFL reconstruction is a successful procedure to treat patellofemoral pain and instability

A comparative study between manual vacuum aspiration and electronic suction for surgical treatment of abortion

Background: Present study is done to study the safety, efficacy and complications of using manual vacuum aspiration (MVA) for surgical management of first trimester abortion in comparison to electronic suction.Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at tertiary care hospital. Out of 100 cases taken, 50 abortions were terminated by MVA and 50 were terminated by electric suction/vacuum aspiration (EVA).Results: In this study, majority of the patients were primigravida (60%). Most of the patients had period of gestation between 7 to 9 weeks (40%) followed by up to 6 weeks (33%) in both groups. Time taken for the procedure was less in MVA (5-9 min.) than electronic suction (7-11 min.). In terms of complications, blood loss ≥100 ml was more with EVA (18%) compared to MVA (6%). Uterine perforation was seen with EVA (4%) and none with MVA. As far as success rate is concerned, EVA got 98% while MVA got 90%. Post-operative hospital stay was less with MVA (≤12 hours) than EVA (up to 24 hours). Post-operative pain perception was less with MVA (18% severe pain) while with EVA, 36% with severe pain.Conclusions: Both the evacuation techniques are almost equally effective and safe, still duration; post-operative pain and hospital stay are less with MVA. Success rate is better with EVA

Anticancer and Cytotoxic Potential of Aqueous Extract of Triticum aestivum on Colorectal Carcinoma

Introduction: Cancer is caused by abnormalities in genetic material of the transformed cells. Cancer may also be initiated by carcinogens, tobacco, smoke, radiation, chemicals or infectious agents, especially some viruses. Cancers cause annually more than 13% of all human deaths. More than 70% of all cancer deaths occurred in low and middle income countries. Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030 (WHO estimate). Natural products have been used as traditional medicines in many parts of the world like Egypt, China, Greece, and India from ancient times. It is from these medicinal plants, the modern drugs been developed known to be free of the deleterious effects, are inexpensive and effective. One of these herbs is Wheatgrass, the young grass of Triticum aestivum Linn., family: Poeaceae. Objectives: Objective of the study was to analyze anticancer property of leaves of Triticum aestivum on HCT-15 cells. Materials and methods: The young grass of Triticum aestivum is was collected. The aqueous extract was prepared by using standard protocols. The antiproliferative effect of the aqueous extract was evaluated in vitro by employing MTT assay. The potency of plant extract was calculated in terms of percent decrease in viable HCT-15 cells as compared to the control. Result and conclusion: The extract showed dose dependent antitumor activity. The MTT assay showed an anti proliferative activity (IC50) at 258.8 μg/ml of crude extract. Keywords: Triticum aestivum, CRC, HCT-15, IC50, MTT Assay

Ergonomics in the operating room

Background: Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence. Methods: An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands. Results: There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. O

LOng-term follow-up after liVE kidney donation (LOVE) study: A longitudinal comparison study protocol

Background: The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods: The "LOng-term follow-up after liVE kidney donation" (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmus University Medical Center in Rotterdam, The Netherlands. In this time period, 1092 individuals donated a kidney and contact information is available for all individuals. Each participating donor will be matched (1:4) to non-donors derived from the population-based cohort studies of the Rotterdam Study and the Study of Health in Pomerania. Matching will be based on baseline age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, the use of alcohol and highest education degree. Follow-up data is collected on kidney function, kidney-related comorbidity, mortality, quality of life and psychological outcomes in all participants. Discussion: This study will provide evidence on the long-term consequences of live kidney donation for the donor compared to matched non-donors and evaluate the current donor eligibility criteria. Trial registration: Dutch Trial Register NTR3795

Long-term prognosis after kidney donation: a propensity score matched comparison of living donors and non-donors from two population cohorts

Background: Live donor nephrectomy is a safe procedure. However, long-term donor prognosis is debated, necessitating high-quality studies. Methods: A follow-up study of 761 living kidney donors was conducted, who visited the outpatient clinic and were propensity score matched and compared to 1522 non-donors from population-based cohort studies. Primary outcome was kidney function. Secondary outcomes were BMI (kg/m2), incidences of hypertension, diabetes, cardiovascular events, cardiovascular and overall mortality, and quality of life. Results: Median follow-up after donation was 8.0 years. Donors had an increase in serum creatinine of 26 μmol/l (95% CI 24–28), a decrease in eGFR of 27 ml/min/1.73 m2 (95% CI − 29 to − 26), and an eGFR decline of 32% (95% CI 30–33) as compared to non-donors. There was no difference in outcomes between the groups for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and mortality. A lower risk of new-onset hypertension (OR 0.45, 95% CI 0.33–0.62) was found among donors. The EQ-5D health-related scores were higher among donors, whereas the SF-12 physical and mental component scores were lower. Conclusion: Loss of kidney mass after live donation does not translate into negative long-term outcomes in terms of morbidity and mortality compared to non-donors. Trial registration: Dutch Trial Register NTR3795

IL-4 Amplifies the Pro-Inflammatory Effect of Adenosine in Human Mast Cells by Changing Expression Levels of Adenosine Receptors

Adenosine inhalation produces immediate bronchoconstriction in asthmatics but not in normal subjects. The bronchospastic effect of adenosine is largely mediated through adenosine-induced mast cell activation, the mechanism of which is poorly understood due to limitations in culturing human primary mast cells. Here, we show that human umbilical cord blood -derived mast cells incubated with the Th2 cytokine IL-4 develop increased sensitivity to adenosine. Potentiation of anti-IgE- induced and calcium ionophore/PMA-induced degranulation was augmented in mast cells cultured with IL-4, and this effect was reduced or abolished by pre-treatment with A2BsiRNA and selective A2B receptor antagonists, respectively. IL-4 incubation resulted in the increased expression of A2B and reduced expression of A2A adenosine receptors on human mast cells. These results suggest that Th2 cytokines in the asthmatic lung may alter adenosine receptor expression on airway mast cells to promote increased responsiveness to adenosine

Genome-Wide Fitness and Expression Profiling Implicate Mga2 in Adaptation to Hydrogen Peroxide

Caloric restriction extends lifespan, an effect once thought to involve attenuation of reactive oxygen species (ROS) generated by aerobic metabolism. However, recent evidence suggests that caloric restriction may in fact raise ROS levels, which in turn provides protection from acute doses of oxidant through a process called adaptation. To shed light on the molecular mechanisms of adaptation, we designed a series of genome-wide deletion fitness and mRNA expression screens to identify genes involved in adaptation to hydrogen peroxide. Combined with known transcriptional interactions, the integrated data implicate Yap1 and Skn7 as central transcription factors of both the adaptive and acute oxidative responses. They also identify the transcription factors Mga2 and Rox1 as active exclusively in the adaptive response and show that Mga2 is essential for adaptation. These findings are striking because Mga2 and Rox1 have been thought to control the response to hypoxic, not oxidative, conditions. Expression profiling of mga2Δ and rox1Δ knockouts shows that these factors most strongly regulate targets in ergosterol, fatty-acid, and zinc metabolic pathways. Direct quantitation of ergosterol reveals that its basal concentration indeed depends on Mga2, but that Mga2 is not required for the decrease in ergosterol observed during adaptation