Subgroups 1A Research Articles

Study of effects of repeated administration and withdrawal of cannabinoids on brain tissue of adult male albino rats: histopathological and biochemical study

Introduction: Cannabis occupies the position of the most prevalent drug of abuse in Egypt. Chronic cannabis abuse may cause degenerative pathological changes in the brain, also the effect of cannabis on cognition, memory and learning is well known. The current work aimed to study the toxic effect of chronic repeated doses of cannabis on rat behavior, brain dopamine level and histopathological changes of the brain. Subjects and Methods: The study was conducted on 50 male albino rats weighing 180-200 gm. Rats were divided into 2 main groups: group 1 (control; each animal received 1ml/day 100% sunflower oil (used as a vehicle); group 2 (received cannabis daily for one month 40 mg cannabis/ 200 gm rat. At the end of the month this group was subdivided into 4 subgroups: subgroups 2a, 2b, 2c, and 2d and subjected to different periods of cannabis abstinence. The clinical manifestations due to the effect of long-term cannabis administration and withdrawal were recorded. After scarification, brain dopamine level was measured, and brain tissue was examined by light and electron microscope (EM). Results: Clinically; main manifestations of long-term cannabis administration found in subgroup 2a were CNS depression; while main manifestations in subgroup 2c were irritability and fighting aggression. Dopamine significantly increased in subgroup 2a compared to control group. Light and EM examination showed degenerative changes. Conclusion: Brain dopamine level was significantly high in subgroup 2a compared with control group. long-term cannabis administration causes degenerative pathological changes in the brain, which need long recovery periods.

Correlation of Pharyngeal Airway Dimensions with Maxillomandibular Skeletal Relation and Mandibular Morphology in Subjects with Skeletal Class I and Class II Malocclusions and Different Growth Patterns: A Cephalometric Study in Selected Local Population.

Objectives:To test the hypothesis that there is no positive correlation between skeletal Class II and mandibular morphology with pharyngeal dimensions in subjects with different growth patterns.Materials and Methods:Lateral cephalograms of 60 patients were collected and divided into 2 groups, comprising of 30 in each group. Group 1 consisted of cephalograms of patients having Class I malocclusion, and was further divided into subgroups. 1a) Class I with normal growth 1b) Class I with vertical growth. Group 2 consisted of cephalograms of patients having class II malocclusion and was further divided into subgroups 2a) Class II with normal growth, 2b) Class II with vertical growth.Results:The results showed that the estimated marginal mean for upper pharyngeal width in class I malocclusion group was 8.56 mm, for class II malocclusion group was 7.80 mm, for normal growth individuals was 9.73 mm and that for vertical growth individuals was 6.63 mm. The estimated marginal mean for lower pharyngeal width in class I malocclusion group was 9.62 mm, in class II malocclusion group was 9.10 mm, in normal growth individuals was 8.95 mm and that in vertical growth individuals was 9.77 mm. The estimated marginal mean for pharyngeal area in class I malocclusion group is 330.13 sq.mm, in class II malocclusion group is 308.17 sq.mm, in normal growth individuals is 328.47sq.mm and that in vertical growth individuals is 309.83 sq.mm.Conclusions:The null hypothesis for this study, as per the statistical analysis, has been rejected.

COMPLICATIONS IN SURGICAL TREATMENT OF PATIENTS WITH CHRONIC DACRYOCYSTITIS

Relevance. Effective treatment of chronic dacryocystitis (CD) remains an urgent problem of modern ophthalmology and rhinology. When studying this issue, not enough attention is always paid to complications.
 Objective – to analyze the existing complications in the surgical treatment of patients with СD.
 Material and methods. The study group (1st group) consisted of 45 patients with CD, who underwent endonasal endoscopic dacryocystorhinostomy (EEDCR) according to the developed own method, the comparison group (2nd group) included 36 patients who after performing the developed EEDCR a polyvinyl chloride (PVC) conductor was installed in the area of the dacryorhinostoma. The control group (3rd group) included 28 patients who underwent EEDCR according to the traditional method: with the preservation and plastic placement of mucous flaps and with the installation of PVC-conductor. Patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography (CT) of the lacrimal ducts in the preoperative period according to the developed method and patients of subgroups 1B and 2B – according to the traditional algorithm. Statistical analysis was performed using the licensed program MedCalc (MedCalc Software bvba, Ostend, Belgium; 2017).
 Results. In patients of subgroups 2A, 2B, and group 3 in the period of 1.5 months after surgery, local complications of the eyeball were recorded: epiphora during implant wearing, severe conjunctivitis, prolapse and displacement of the implant, granulation in the lower lacrimal duct, ectopia of the lower lacrimal point. No such complications were observed in patients of subgroups 1A and 1B. In patients of subgroups 1B, 2B, and group 3 in the early postoperative period were recorded varying degrees of swelling of the lower eyelid, as well as nosebleeds after removal of tampons. No such complications were observed in patients of subgroups 1A and 2A, and the difference between the groups was statistically significant (p <0.05).
 Conclusion. CT of the lacrimal ducts and EEDCR according to the developed methods are effective and allow their combined use to avoid local complications from the nasal cavity and eyeball.

ПЕРЕДОПЕРАЦІЙНЕ РЕНТГЕНОЛОГІЧНЕ ОБСТЕЖЕННЯ ХВОРИХ З ХРОНІЧНИМ ДАКРІОЦИСТИТОМ

Метою дослідження було розробити спосіб визначення топографо-анатомічного взаємозв’язку слізного мішка з оточуючими структурами та оцінити його ефективність при плануванні та виконанні ендоназальної ендоскопічної дакріоцисториностомії (ЕЕДЦРС). Досліджувану групу (1-а група) склали 45 пацієнтів з хронічним дакріоциститом (ХД), яким ЕЕДЦРС була здійснена за розробленою методикою, до групи порівняння (2-а група) було включено 36 хворих, яким після виконання ЕЕДЦРС за розробленою методикою в зону дакріориностоми встановлювали полівінілхлоридний провідник. До контрольної (3-ї) групи увійшли 28 пацієнтів, яким ЕЕДЦРС виконувалась за загальноприйнятою методикою. Для оцінки інформативності методик проведення комп’ютерної томографії (КТ) СВШ і можливості ефективного застосування отриманих КТ-даних, пацієнти 1-ї та 2-ї груп були розподілені на 2 підгрупи: до 1А і 2А були включені пацієнти, яким КТ СВШ проводили за розробленою методикою, а хворим підгруп 1В і 2В – за традиційним алгоритмом. Гіперпневматизація клітин agger nasi виявлена у 14,7% обстежених, запальна патологія в навколоносових пазухах – у 38,5% (p>0,05). Слізна ямка розташовувалась на рівні переднього кінця середньої носової раковини (СНР) в 39,4 % випадках, допереду від нього – у 32,1%, а дозаду – в 14,7 %. У 13,8 % спостереженнях визначити відношення слізної ямки до СНР було утрудненим, ці випадки були в підгрупах 1В, 2В та в 3-й групі (p<0,05). Візуалізація хірургічного поля 1-2 ступеня в групах 1А та 2А була у понад 90 % пацієнтів, у групах 1В та 2В – менш ніж у 50 %, а в групі 3 – у 25 % хворих (p<0,05). Таким чином, анатомо-топографічні особливості СВШ необхідно визначати та враховувати при хірургічному лікуванні та спостереженні хворих з ХД. Розроблена методика проведення КТ із контрастуванням СВШ є ефективнішою в порівнянні з традиційною, а виконання хірургічного втручання при її застосуванні – ощадливим.

Fish Community Responses to Human-Induced Stresses in the Lower Mekong Basin

The Mekong River is one of the world’s largest rivers and has an annual captured fish production of about 2.3 million tonnes, equivalent to around 11 billion USD. Although the Mekong provides important ecological and socioeconomic benefits to millions of people, it is facing intensive change due to anthropogenic stressors. Therefore, it is necessary to understand the changes to the spatiotemporal fish communities to inform sustainable fisheries management. Here, we aimed to characterize patterns of the fish communities and identify the ecological status of each fish community using daily catch data from 2007 to 2018 at 25 monitoring sites in the Lower Mekong Basin (LMB). The collected data were classified by a self-organizing map into four main groups. Group 4 represented the lower Vietnam Mekong Delta (VMD), while groups 1, 2, and 3 were subdivided into subgroups 1a (upper LMB), 1b (upper and middle LMB), 2a (Mekong River below the Khone Falls and Sesan River), 2b (Mekong River below the Khone Falls and Sekong, Sesan and Srepok (3S) Rivers), 3a (Floodplain-Tonle Sap and Songkhram) and 3b (upper VMD). Among the 571 species recorded, 119 were identified as indicator species. Based on the abundance and biomass comparison curves, the fish community of 2b was in a healthier condition with a positive W-statistic value while the rest had a negative W-statistic value. The highest species richness and diversity were observed in 3a and 2b, so these subgroups deserve high management and conservation priority. Likewise, 1a should also be considered as a high priority area since it harbors several endangered and long-distant migratory fishes. It was also noticed that the fish communities of groups 3 and 4, located far from the hydropower dams, remained mostly unchanged compared to those of groups 1 and 2, close to the mainstream and tributary dams in the upper LMB and 3S Rivers.

Exposure of Biomimetic Composite Materials to Acidic Challenges: Influence on Flexural Resistance and Elastic Modulus.

Acidic conditions of the oral cavity, including soft drinks and cariogenic bacteria, represent a damage for restorative biomimetic composite materials. The aim of this study is to assess the influence of two different acidic challenges on the flexural strength and elastic modulus of five composites: x-tra fil (Group 1, XTF), GrandioSO x-tra (Group 2, GXT), Admira Fusion x-tra (Group 3, AFX), VisCalor bulk (Group 4, VCB), and Enamel Plus HRi (Group 5, EPH). Thirty samples for each group were randomly divided and assigned to three different treatments: storage in distilled water as the controls (subgroups 1a–5a), 3 weeks distilled water + 1 week Coca-Cola (subgroups 1b-5b), and 4 weeks Coca-Cola (subgroups 1c–5c). For each subgroup, the flexural strength and elastic modulus were measured using an Instron universal testing machine, and data were submitted to statistical analysis. Considering subgroups B, no material showed a significant difference in the flexural strength with the controls (p > 0.05), whereas for subgroups C, only GXT and VCB showed significantly lower values (p < 0.05). AFX reported the lowest flexural strength among the materials tested. As regards the elastic modulus, no material showed a significant variation after acidic storages when compared with the respective control (p > 0.05). AFX and EPH reported the lowest elastic modulus compared to the other materials. All composites tested showed adequate flexural properties according to the standards, except for AFX. This biomimetic material, along with EPH, might be indicated for V class (cervical) restorations considering the lowest values of elasticity reported.

The effectiveness of the combined use of fractional microneedle rf-therapy and pharmacophoresis of hyaluronic acid in the treatment of patients with atrophic scars

Background. The formation of scar tissue is a fairly physiological process, in most cases aimed at closing the skin defect in order to preserve the bodys homeostasis. Correction methods for atrophic scars include laser technology, radiofrequency therapy, injection methods and topical therapy.&#x0D; Arm: the formation of scar tissue is a fairly physiological process, in most cases aimed at closing the skin defect in order to preserve the bodys homeostasis. Correction methods for atrophic scars include laser technology, radiofrequency therapy, injection methods and topical therapy.&#x0D; Methods. There were 56 patients with atrophic scar. Depending on the therapeutic complex for the correction of аtrophic scar, 3 groups were formed: group 1 ― the combined use of RF-therapy for the pharmacophoresis of hyaluronic acid, group 2 ― radio frequency microneedle therapy, group 3 ― the pharmacophoresis of hyaluronic acid. In the work, the Dermatological Symptom Scale Index (DSSI), which was assessed before and after treatment, was adapted to evaluate clinical symptoms.&#x0D; Results. In accordance with the total value of the DSSI, a more significant dynamics was observed in group 1, regardless of the type of AR (subgroups 1A and 1B). DSSI in the 1A subgroup decreased by 80.8% (p0.01), in the 1B group by 82.4% (p0.01). DSSI in the 2A subgroup decreased by 32.3% (p0.01), in the 2B group by 61.4% (p0.01). DSSI in the 3A subgroup decreased by 62.3% (p0.01), in the 3B group by 33.7% (p0.01). In group 1, where the combined treatment was carried out, a more pronounced efficacy was noted than when applying the components of the technique, which did not depend on the type of cicatricial deformity. In group 2, after the application of RF-therapy, the effectiveness was expressed to a much lesser extent, and the most significant results were obtained in patients with post-traumatic atrophic scars. In group 3, after a course of pharmacophoresis of a hyaluronic acid preparation, positive dynamics was observed to a greater extent with hormone-dependent scars.&#x0D; Conclusions. The results of the study showed that the most effective method is the combined use of RF-therapy and the pharmacology of hyaluronic acid, at the same time with post-inflammatory (post-traumatic) atrophic scars, monotherapy with the use of radiofrequency microneedles is possible, with hormone-dependent atrophic scars, monotherapy of pharmacophoresis of hyaluronic acid is possible.

Mortality prediction in chronic obstructive pulmonary disease comparing the GOLD 2015 and GOLD 2019 staging: a pooled analysis of individual patient data.

In 2019, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) modified the grading system for patients with COPD, creating 16 subgroups (1A–4D). As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aim to compare the mortality prediction of the 2015 and 2019 COPD GOLD staging systems.We studied 17 139 COPD patients from the 3CIA study, selecting those with complete data. Patients were classified by the 2015 and 2019 GOLD ABCD systems, and we compared the predictive ability for 5-year mortality of both classifications.In total, 17 139 patients with COPD were enrolled in 22 cohorts from 11 countries between 2003 and 2017; 8823 of them had complete data and were analysed. Mean±sd age was 63.9±9.8 years and 62.9% were male. GOLD 2019 classified the patients in milder degrees of COPD. For both classifications, group D had higher mortality. 5-year mortality did not differ between groups B and C in GOLD 2015; in GOLD 2019, mortality was greater for group B than C. Patients classified as group A and B had better sensitivity and positive predictive value with the GOLD 2019 classification than GOLD 2015. GOLD 2015 had better sensitivity for group C and D than GOLD 2019. The area under the curve values for 5-year mortality were only 0.67 (95% CI 0.66–0.68) for GOLD 2015 and 0.65 (95% CI 0.63–0.66) for GOLD 2019.The new GOLD 2019 classification does not predict mortality better than the previous GOLD 2015 system.

Genetic diversity analysis of Corynespora cassiicola isolates on the rubber tree (Hevea brasiliensis) in Vietnam using ribosomal DNA internal transcribed spacer (rDNA-ITS) sequences and sequence-related amplified polymorphism (SRAP)

A total of 76 Corynespora cassiicola isolates collected from 16 rubber clones in several geographic regions of Vietnam, were studied for genetic diversity by ribosomal DNA internal transcribed spacer (rDNA-ITS) sequences and sequence-related amplified polymorphism (SRAP) techniques. Results of rDNA-ITS sequence analysis indicated 2 nucleotide polymorphisms at the 135th (cytosine/thymine) and 474th (guanine/adenine) base pair positions of rDNA-ITS region, which differentiated the 76 studied isolates into 3 clusters. All isolates could be uniquely distinguished by 208 polymorphism bands which generated 93.3% polymorphic ratio with SRAP markers. A dendrogram produced from UPGMA analysis based on Nei and Li’s coefficient divided the 76 C. cassiicola isolates into 2 main clusters. Cluster one included 54 fungal isolates of which 51 and 3 were observed in subgroup 1A and 1B, respectively. There were 22 C. cassiicola isolates belonging to cluster 2 with subgroups 2A and 2B consisted of 20 and 2 fungal isolates, respectively. Bootstrap values for groups one and two were 61% and 100%, respectively and the grouping was reliable, with similarity coefficient between the two main groups at 67%. rDNA-ITS sequence analysis revealed a new genetic group, signifying at least three C. cassiicola genetic groups that infect rubber trees in Vietnam. SRAP markers divided the studied isolates into two distinct groups, which correlated with geographical location rather than host source. To the best of our knowledge, this is the first demonstration using SRAP markers on the systematics of C. cassiicola isolates which cause the Corynespora leaf fall disease on various rubber (Hevea brasiliensis) clones in Vietnam.

Forensic age estimation in living adolescents with CT imaging of the clavicula\u2014impact of low-dose scanning on readers\u2019 confidence

ObjectivesComputed tomography (CT) imaging of the clavicula displays the reference standard for forensic bone age diagnostics in adolescents and young adults. Consequently, highest efforts on radiation reduction are warranted. Therefore, the aim of this study was to investigate the feasibility of low-dose (LD) CT imaging of the clavicula for age estimation in living adolescents.MethodsA total of 207 non-contrast chest CT of 144 patients born between 1988 and 2012, performed in 2018 due to various clinical indications, were included in this retrospective study. The mean patient age was 16.9 ± 6.6 years. Patients were divided into a LD (n = 146) and standard-dose (SD; n = 61) group. Image quality, confidence levels, and ossification stages (using the 5-stage classification including the subgroups 2a–3c) were assessed by two radiologists independently. Radiation dose was determined via dosimetry software.ResultsDose simulation with z-axis reduction to depict the clavicula only resulted in a median exposure of 0.1 mSv (IQR: 0.0) in LD compared with 0.9 mSv (IQR: 0.6) in SD (p < 0.001). The median image quality was rated by both readers significantly worse in LD compared with SD on a Likert scale ranging from 1 to 4 with a median of 3 (IQR: 1) versus 4 (IQR: 0; p < 0.001 for both readers). There was an almost perfect agreement for the ossification stages between both readers with a Cohen’s kappa of 0.83 (p < 0.001). Median confidence levels of both readers were not significantly different between LD and SD in the decisive subgroups 2a–3c.ConclusionsLow-dose CT imaging of the clavicula for age estimation in living adolescents is possible without loss of readers’ confidence.Key Points• Radiological bone age diagnostics in young delinquents with unknown exact chronological age is important as the judicial systems differentiate between youths and adults.• Low-dose computed tomography scanning of the medial clavicular joint for forensic age estimation is feasible in living adolescents without loss of readers’ confidence.• Sufficient image quality of the medial clavicular joint for forensic bone age diagnostics in living adolescents is achievable using a median dose of 0.1 mSv.

Determinants of Clinical COPD Questionnaire in Patients with COPD: A Cross-Sectional Observational Study

Background: The Clinical COPD Questionnaire (CCQ) has been suggested by the Global Initiative of Chronic Obstructive Lung Disease (GOLD) as a comprehensive symptom measurement tool, which helps to classify patients in order to direct pharmacological treatment. Therefore, it is essential to understand its determinants. Objectives: To identify the determinants of the overall CCQ score and scores of its 3 subdomains among chronic obstructive pulmonary disease (COPD) patients from China. Methods: A total of 1,241 COPD patients in the outpatient department of the Second Xiangya Hospital in China were recruited. Basic information and clinical data were collected. Differences in the GOLD categories based on Modified Medical Research Council Dyspnea Scale (mMRC), COPD Assessment Test (CAT), and CCQ were compared. Multiple linear regression analyses were performed to evaluate determinant factors of the total CCQ and subdomain scores. Results: The total CCQ and/or separate domain scores significantly differed with sex, age, BMI, smoking status, biomass fuel exposure, exacerbation frequency, mMRC, CAT, and GOLD grades and groups. Subjects with asthma-COPD overlap (ACO) had worse health status based on CCQ than those with COPD alone. As for the 16 subgroups based on GOLD 2017, statistical differences in the total CCQ and functional domain scores were found among subgroups 1A–4A, 1B–4B, and 1D–4D. The mMRC classified much more patients into more symptom groups than CAT and CCQ. No significant difference was observed in the GOLD categories between the CAT and CCQ (cut point = 1.5). Multiple linear regression analysis showed that smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were independently associated with the total CCQ score. Only 3 variables were significantly associated with the symptom domain: ACO, exacerbations, and mMRC; for the functional domain, age ≥75 years, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were significant; female sex, underweight, frequent exacerbations (≥2), and mMRC were significantly associated with higher scores in the mental domain. Conclusions: The classification of COPD produced by mMRC, CAT, and CCQ was not identical. Smoking status, underweight, ACO, post-bronchodilator FEV1% predicted <50%, exacerbation history, and mMRC were associated with lower health-related quality of life assessed by the total CCQ score, while different subdomains of CCQ had different determinant factors.

Advantages of minimally invasive approach for carotid endarterectomy

To identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) - minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) - conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A - 48.4±9.5 scores, subgroup 1B - 52.4±9.2, group 2 - 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 - 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A - 37.2 scores, subgroup 1B - 40.0 scores, group 2 - 55.1 scores. Physical component of QOL: subgroup 1A - 51.63±6.31 scores, subgroup 1B - 46.01±7.53 scores, group 2 - 38.85±5.33 scores. Psychological component of QOL: subgroup 1A - 49.64±6.72 scores, subgroup 1B - 45.68±5.63 scores, group 2 - 48.6±7.36 scores (p<0.05). Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.

Пренатальный скрининг как предиктор гестационных осложнений

Objective.To analyze the course and outcomes of pregnancies in women at high risk of fetal chro-mosomal abnormalities, preeclampsia, fetal growth retardation, and preterm birth according to the results of prenatal screening. Patients and methods. This prospective study included 443 women with singleton pregnancies. Study participants were divided into two groups: Group 1 included women at high risk of complica-tions (n = 235), while Group 2 (control) comprised women at low risk of gestational complications (n = 208). Patients in Group 1 were further subdivided into 4 subgroups: subgroup 1A included women at risk of fetal chromosomal abnormalities (CA) (n = 69); subgroup 1B included women at risk of preeclampsia (PE) (n = 66); subgroup 1C included women at risk of fetal growth retardation (FGR) (n = 48); and subgroup 1D included women at risk of preterm birth (PB) (n = 52). Confirmed chromosomal abnormalities were considered as an exclusion criterion. Results. Threatened miscarriage (TM) and bleeding in the first trimester were significantly more common in patients from Group 1. In the second trimester, the risk of TM was increased among women from subgroups 1A, 1B, 1C, and particularly 1D. In the third trimester, we observed sig-nificant differences in the frequency of FGR between group 1 (subgroups 1A, 1С, 1D) and controls. In subgroups 1A, 1B, 1C, and 1D, the incidence of PE and FGR was higher in patients who did not receive aspirin. The frequency of threatened PB was higher in subgroups 1B, 1C, and 1D compared to Group 2 (p &lt; 0.05). Conclusion. High prenatal risk of fetal CA should be considered as a risk factor for PB, TM, FGR, and PE. Key words: prenatal screening, chromosomal abnormalities, preeclampsia, fetal growth retarda-tion, preterm birth, pregnancy, perinatal risk

Effectiveness of multistage surgical treatment of advanced proliferative diabetic retinopathy complicated with primary cataract

To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract. The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS. Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively. The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.

Fast-track multidisciplinary treatment versus conventional treatment for colorectal cancer: a multicenter, open-label randomized controlled study

BackgroundLaparoscopic surgery, fast-track perioperative treatment and XELOX chemotherapy are effective strategies for shortening the duration of hospital stay for cancer patients. This trial aimed to clarify the safety and efficacy of the fast-track multidisciplinary treatment (FTMDT) model compared to conventional surgery combined with chemotherapy in Chinese colorectal cancer patients.MethodsThis trial was a prospective randomized controlled study with a 2 × 2 balanced factorial design and was conducted at six hospitals. Patients in group 1 (FTMDT) received fast-track perioperative treatment and XELOX adjuvant chemotherapy. Patients in group 2 (conventional treatment) received conventional perioperative treatment and mFOLFOX6 adjuvant chemotherapy. Subgroups 1a and 2a had laparoscopic surgery and subgroups 1b and 2b had open surgery. The primary endpoint was total length of hospital stay during treatment.ResultsA total of 374 patients were randomly assigned to the four subgroups, and 342 patients were finally analyzed, including 87 patients in subgroup 1a, 85 in subgroup 1b, 86 in subgroup 2a, and 84 in subgroup 2b. The total hospital stay of group 1 was shorter than that of group 2 [13 days, (IQR, 11–17 days) vs. 23.5 days (IQR, 15–42 days), P = 0.0001]. Compared to group 2, group 1 had lower surgical costs, fewer in-hospital complications and faster recovery (all P < 0.05). Subgroup 1a showed faster surgical recovery than that of subgroup 1b (all P < 0.05). There was no difference in 5-year overall survival between groups 1 and 2 [87.1% (95% CI, 80.7–91.5%) vs. 87.1% (95% CI, 80.8–91.4%), P = 0.7420].ConclusionsThe FTMDT model, which integrates laparoscopic surgery, fast-track treatment, and XELOX chemotherapy, was the superior model for enhancing the recovery of Chinese patients with colorectal cancer.Trial registrationClinicalTrials.gov: NCT01080547, registered on March 4, 2010.

Prospective randomized comparison of repairing vesicovaginal fistula with or without the interposition flap: Result from a tertiary care Institute in Northern India.

Assessment of results of repairing vesicovaginal fistula (VVF) with or without the use of interposition flaps. This prospective randomized study was conducted between January 2012 to December 2017 in the Department of Urology, King George's Medical University, Lucknow, India. Obstetric and gynecological simple fistula of ≤4 cm were included for evaluation. Those with complex or complicated fistula or fistula due to malignancy were excluded. Patients were divided into two groups (group 1 and group 2) depending upon route of repair i.e., transvaginal or transabdominal, respectively, as per the characteristics and location of the fistula. These two groups of patients were randomized into two subgroups (1A, 1B and 2A, 2B) based on the inclusion or omission of the interposition flap during fistula repair. Perioperative and postoperative parameters (blood loss, mean operating time, hospital stay, and requirement of analgesics) and success rates of fistula repair were compared. All complications that occurred in the postoperative period till the last follow-up appointment were recorded. The Clavien-Dindo Classification was used to stratify the complications. Fifty-seven patients underwent transvaginal repair in group 1 (29 with Martius flap: group 1A; 28 without Martius flap: group 1B), while 69 patients underwent transabdominal repair in group 2 (35 with interposition flap: group 2A; 34 without flap: group 2B). Blood loss, mean operating time, hospital stay, and the requirement of analgesics were comparable between each subgroup-1A versus 1B and 2A versus 2B, respectively. The overall success rate of repair across all groups was 96.04% (121/126). The success rate was 93.1% in transvaginal repair with Martius flap versus 96.43% in transvaginal repair with no flap (p=1.0). Success rate was 97.1% in transabdominal repair with an omental flap versus 97.06% in without an omental flap (p=1.0). Mean follow-up period was 39.6 months (range: 6-68 months). Out of 29 patients with Martius flap interposition, 9 (31.03%) of them reported a significantly reduced sensation on the labia majora. Of these 9 patients, 5 reported numbness while the remaining 4 experienced pain as compared to the patients in subgroup IB, who did not report any altered sensation in the labia. (p=0.0019). The success rates are similar in simple VVF repair (fistula size less than 4 cm) irrespective of the use of interposition flaps. However, overall morbidities following repair with the interposition flap are higher when compared with repair without interposition flap, either by the transvaginal or by the transabdominal route.

Endothelial Cells Strengthening: Improving Functions in Management of Acute Coronary Syndrome (A Double Blind Randomized Interventional Control Trial)

Objective: Endothelial dysfunction/injury is the main reason for Acute Coronary Syndrome (ACS). Current therapy includes antiplatelet, lipid lowering and thrombus removal by drugs/ intervention. Endothelial strengthening in management of ACS is less narrated in literature. This study describes endothelial strengthening and clinical outcome in ACS with Triphala powder, a mixture of Amla (Phyllanthus emblica), Harad (Terminalia chebula), and Behda (Terminalia bellirica). Methods: This is a double blind randomized interventional control trial. 80 cases coming to the emergency department were selected for study, divided into two groups. Group 1 (n=40, control), group 2 (n=40, study). Further subdivided into subgroup 1A and 2A ST-Elevation Myocardial Infarction (STEMI) and subgroup 1B and 2B Unstable Angina (UA). All subgroups were given clopidogrel, aspirin and atorvastatin and subjected to thrombolysis or Coronary Angiography (CAG) according to requirement. In addition study group was given Triphala powder 10 grams in a cup of water. Outcome was observed for relief in chest pain, ECG, Echocardiography changes at 50 minutes; (SSR) Sympathetic Skin Response was done initially. Statistical analysis was done by SPSS 20 software. Results: In intervention subgroups 2A and 2B there was significant relief in chest pain, settling down of ECG changes, and improvement in regional wall motion in echocardiography (p&lt;0.001). There was increased sympathetic activity in all subgroups (spike response in SSR). Conclusion: Sudden mismatch in ATP (Adenosine Triphosphate) supply results in endothelial dysfunction. It occurs primarily due to increase in sympathetic discharge. Endothelial dysfunction results in UA/STEMI. Triphala increases ATP synthesis by increasing mitochondrial capacity to maximum; strengthens endothelium which behaves like normal endothelium and resolves symptoms and signs of ACS.

Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease.

Background and AimAcute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome.MethodsThis study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared.ResultsA total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% (n = 182) had stage 1, 20.95% (n = 62) had stage 2, and 17.57% (n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for end‐stage liver disease (MELD), MELD‐Na+, and child‐turcotte‐pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days.ConclusionOur study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28‐day and 90‐day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A.

Aqueous root extract of Chrysophyllum albidum caused dose and duration dependent increases in some reproductive hormones and spermatogenic arrest in the testes of male Wistar rats

Background aimIn ethnomedicine, different parts of Chrysophyllum albidum have been used as herbal remedies for the treatment and management of various ailments. This study was carried out to determine the dose and duration dependent effects of administration of aqueous root extracts of Chrysophyllum albidum on the serum concentrations of some reproductive hormones and testes of the experimental rats.MethodsForty-five adult male Wistar rats were used for this study. They were randomized into 3 groups (groups 1, 2 & 3) of 15 rats each, with each group further randomized into 3 subgroups (subgroups 1a, 1b, 1c; 2a, 2b, 2c; 3a, 3b, 3c) of 5 rats each, according to the dose and duration of extract administration.ResultsAt the 8th week of extract administration, there were significantly (P < 0.05) higher concentrations of FSH in the treated subgroups while at weeks 6 and 8, there were significant (p < 0.05) increases in the serum concentrations of LH of the treated subgroups as compared to those of the control subgroups. Also, at weeks 6 and 8, administration of the extract resulted in significant (P < 0.05) increases in the concentrations of serum testosterone in the treated subgroups. Photomicrograph of the testes revealed focal spermatogenic arrest in the area biopsied in the treated subgroups (with low and high doses) at weeks 6 and 8 of extract administration.ConclusionThe administration of aqueous root extract of Chrysophyllum albidum to male Wistar rats at increasing doses and time duration may affect their fertility and calls for caution in the prolonged use of the plant in folk medicine.

Efficacy of Transplantation of Combination of Noncultured Dermal and Epidermal Cell Suspension vs Epidermal Cell Suspension Alone in Vitiligo

Surgical interventions, notably noncultured epidermal suspension (NCES), are the next line of treatment in patients with vitiligo who fail to respond to medical therapy. Noncultured epidermal suspension is usually performed in patients with vitiligo with duration of clinical stability (DS) of 12 months or longer because DS is a vital parameter in determining outcome of NCES. In this pilot study, we planned to assess the efficacy of a novel combination of noncultured epidermal cell suspension and noncultured dermal cell suspension (NCES and NDCS) in patients with vitiligo with shorter DS (3-6 months). To compare the efficacy of transplantation of NCES and NDCS vs NCES alone in patients with vitiligo with DS of 3 to 6 months. A single-center randomized clinical trial including 40 patients with focal, segmental, or generalized vitiligo with DS of 3 to 6 months or more than 12 months was carried out. Based on DS, 2 groups including 20 patients each were recruited (DS in group 1, 3 to 6 months; DS in group 2, more than 12 months). Each group was further randomized into 2 subgroups, A and B. Patients in subgroups 1A and 2A underwent NCES alone, whereas patients in subgroups 1B and 2B underwent NCES and NDCS. Extent of repigmentation, color match, and pattern of repigmentation at 24 weeks. Of the 40 study participants, mean (SD) age was 24.9 (4.0) years and 24 (60%) were women; in group 1 with DS for 3 to 6 months, more than 75% repigmentation at 24 weeks was observed in all 10 patients in subgroup 1B (NCES and NDCS) compared with 3 of 10 patients in subgroup 1A (NCES) (100% vs 30%, P = .003). In group 2 (DS > 12 months), the same was observed in 6 of 10 patients in subgroup 2A and 7 of 10 patients in subgroup 2B (NCES) (60% vs 70%, P > .99). The 2 groups and subgroups did not show any significant differences with respect to color matching and pattern of repigmentation. Combination of NCES and NDCS resulted in excellent response in patients with vitiligo with shorter duration of clinical stability compared with NCES alone. This combination may be used early in the course of stable vitiligo without waiting for a period of 12 months or more since last clinical activity. ClinicalTrials.gov identifier: NCT03013049.