A case of Guillain-Barre syndrome presenting at third trimester of pregnancy complicated with pre-eclampsia and acute kidney injury

Guillain-Barre syndrome (GBS) is immune mediated injury of the peripheral nerves. This condition can affect any individuals with some trigger. Here the disease affected the lady in her last trimester of pregnancy which was complicated with pre-eclampsia and acute kidney injury. Later she recovered by multimodal treatment approach, with a prolonged intensive care unit stay. Currently she and her baby are stable with frequent follow up. This case highlights the fact that GBS can affect any trimester of pregnancy and her pregnancy could be a trigger. Further, treatment approach involves multiple specialties including internal medicine, nephrologist, neurologist, physiotherapist and psychiatrist

Efficient Format Preserving Encrypted Databases

We propose storage efficient SQL-aware encrypted databases that preserve the format of the fields. We give experimental results of storage improvements in CryptDB using FNR encryption scheme

Role of USG in thyroid diseases

One of the most distinctive glands in the body is the thyroid gland. It is the only gland in the body that gets its iodine directly from outside sources, making it unique among glands. It is the only gland in the body that is able to make, store, and expel its own products when the body has a need for those goods. It has a very abundant blood supply that can be compared to that of the kidneys. Additionally, it is the only gland that can be compared to that of the kidneys. Therefore, the regulation that it has is extraordinary. It is quite superficially situated, and as a result, high frequency probes may be utilised to study it with relative ease. There have been investigations in which a straightforward transvaginal probe served as an effective research tool for examining the gland. The primary reason for this is that it is extremely superficially situated, and as a result, high frequency probes may be utilised effectively to analyse such structures in great detail. In this work, an effort was made to investigate the function that USG plays in thyroid illnesses

Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

BACKGROUND: Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings. METHODS: This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis. RESULTS: Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually. CONCLUSIONS: Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision. TRIAL REGISTRATION: ISRCTN reference 27989430

Group clinics for young adults living with diabetes in an ethnically diverse, socioeconomically deprived population: mixed-methods evaluation

Background Our research was based on the expressed need to evaluate the potential for group clinics to enhance care within the NHS for people with long-term conditions. Objectives We aimed to explore the scope, feasibility, impact and potential scalability of group clinics for young adults with diabetes who have poor experiences of care and clinical outcomes. We applied a participatory approach to the entire research process, where appropriate. Setting Four NHS trusts delivering diabetes care to young adults in ethnically diverse and socioeconomically deprived communities. Participants We involved 135 young adults as participants in our research (73 at two intervention sites and 62 at two control sites). Methods A realist review synthesised existing evidence for group clinics to understand ‘what works, for whom, under what circumstances’. Using the realist review findings and a scoping exercise, we used co-design to develop a model of group clinic-based care, which we then implemented and evaluated using primarily qualitative methods, with quantitative and costs analyses to inform future evaluations. Results Young adults reported positive experiences from the group clinics. However, across the group clinics delivered, only one-third (on average) of those invited to specific clinics attended, despite substantial efforts to encourage attendance, and only 37 out of 73 (51%) participants attended any group clinics. Social learning helped the acquisition of new knowledge and normalisation of experiences. Group clinics met previously unreached emotional needs, and the relationships that formed between young adults, and between them and the staff facilitating the clinics, were key. Clinical staff delivered the clinics using a facilitatory approach, and a youth worker helped to ensure that the care model was developmentally appropriate. Existing organisational structures presented substantial challenges to the delivery of group clinics, and there was considerable hidden work required by the staff delivering them. Group clinics may augment one-to-one care but do not necessarily replace it. The average cost of each group clinic, per participant, was £127–58. Limitations Engagement in co-design and the research process and participation in the group clinics was challenging, and limited our quantitative data analysis. These limitations had implications for the fidelity of the intervention and generalisability of our findings. During the research, we established that group clinics would not replace existing care, and that further work is required to understand the theoretical base of ‘blended’ models of care, and the potential of digital offers, before a definitive evaluation (a cluster-randomised trial) can be designed. Conclusions Our findings show that young adults with diabetes, including those in deprived and ethnically diverse settings, have positive experiences of group-based care, and it may augment existing one-to-one care. However, engagement with group-based care is challenging despite the participatory design. Future work Future research is needed to develop the group clinic model prior to definitive evaluation. Study registration This study is registered as CRD42017058726 and ISRCTN83599025. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 25. See the NIHR Journals Library website for further project information

Spermatogonial stem cell sensitivity to capsaicin: An in vitro study

<p>Abstract</p> <p>Background</p> <p>Conflicting reports have been published on the sensitivity of spermatogenesis to capsaicin (CAP), the pungent ingredient of hot chili peppers. Here, the effect of CAP on germ cell survival was investigated by using two testis germ cell lines as a model. As CAP is a potent agonist of the transient receptor potential vanilloid receptor 1 (TRPV1) and no information was available of its expression in germ cells, we also studied the presence of TRPV1 in the cultured cells and in germ cells in situ.</p> <p>Methods</p> <p>The rat spermatogonial stem cell lines Gc-5spg and Gc-6spg were used to study the effects of different concentrations of CAP during 24 and 48 h. The response to CAP was first monitored by phase-contrast microscopy. As germ cells appear to undergo apoptosis in the presence of CAP, the activation of caspase 3 was studied using an anti activated caspase 3 antibody or by quantifying the amount of cells with DNA fragmentation using flow cytometry. Immunolocalization was done with an anti-TRPV1 antibody either with the use of confocal microscopy to follow live cell labeling (germ cells) or on Bouin fixed paraffin embedded testicular tissues. The expression of TRPV1 by the cell lines and germ cells was confirmed by Western blots.</p> <p>Results</p> <p>Initial morphological observations indicated that CAP at concentrations ranging from 150 uM to 250 uM and after 24 and 48 h of exposure, had deleterious apoptotic-like effects on both cell lines: A large population of the CAP treated cell cultures showed signs of DNA fragmentation and caspase 3 activation. Quantification of the effect demonstrated a significant effect of CAP with doses of 150 uM in the Gc-5spg cell line and 200 uM in the Gc-6spg cell line, after 24 h of exposure. The effect was dose and time dependent in both cell lines. TRPV1, the receptor for CAP, was found to be expressed by the spermatogonial stem cells in vitro and also by premeiotic germ cells in situ.</p> <p>Conclusion</p> <p>CAP adversely affects spermatogonial survival in vitro by inducing apoptosis to those cells and TRPV-1, a CAP receptor, may be involved in this effect as this receptor is expressed by mitotic germ cells.</p

Energy dissipation via acoustic emission in ductile crack initiation

The final publication is available at Springer via http://dx.doi.org/10.1007/s10704-016-0096-8.This article presents a modeling approach to estimate the energy release due to ductile crack initiation in conjunction to the energy dissipation associated with the formation and propagation of transient stress waves typically referred to as acoustic emission. To achieve this goal, a ductile fracture problem is investigated computationally using the finite element method based on a compact tension geometry under Mode I loading conditions. To quantify the energy dissipation associated with acoustic emission, a crack increment is produced given a pre-determined notch size in a 3D cohesive-based extended finite element model. The computational modeling methodology consists of defining a damage initiation state from static simulations and linking such state to a dynamic formulation used to evaluate wave propagation and related energy redistribution effects. The model relies on a custom traction separation law constructed using full field deformation measurements obtained experimentally using the digital image correlation method. The amount of energy release due to the investigated first crack increment is evaluated through three different approaches both for verification purposes and to produce an estimate of the portion of the energy that radiates away from the crack source in the form of transient waves. The results presented herein propose an upper bound for the energy dissipation associated to acoustic emission, which could assist the interpretation and implementation of relevant nondestructive evaluation methods and the further enrichment of the understanding of effects associated with fracture

Deletion of Wntless in myeloid cells exacerbates liver fibrosis and the ductular reaction in chronic liver injury

Background: Macrophages play critical roles in liver regeneration, fibrosis development and resolution. They are among the first responders to liver injury and are implicated in orchestrating the fibrogenic response via multiple mechanisms. Macrophages are also intimately associated with the activated hepatic progenitor cell (HPC) niche or ductular reaction that develops in parallel with fibrosis. Among the many macrophage-derived mediators implicated in liver disease progression, a key role for macrophage-derived Wnt proteins in driving pro-regenerative HPC activation towards a hepatocellular fate has been suggested. Wnt proteins, in general, however, have been associated with both pro-and anti-fibrogenic activities in the liver and other organs. We investigated the role of macrophage-derived Wnt proteins in fibrogenesis and HPC activation in murine models of chronic liver disease by conditionally deleting Wntless expression, which encodes a chaperone essential for Wnt protein secretion, in LysM-Cre-expressing myeloid cells (LysM-Wls mice)