The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are imm...The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are immunological,and others associated as idiopathic,are undiagnosed by all possible means.Some of the rare diseases are congenital in nature,passing from the parent to the child.Many of the undiagnosed diseases are now being diagnosed as genetic and the genes have been implicated as a causative agent.There is a search for newer treatments for such diseases,which is called genomic medicine.Genomic medicine is an emerging medical discipline that involves the use of genomic information about an individual.This is used both for diagnostic as well as therapeutic decisions to improve the current health domain and pave the way for policymakers for its clinical use.In the developing era of precision medicine,genomics,epigenomics,environmental exposure,and other data would be used to more accurately guide individual diagnosis and treatment.Genomic medicine is already making an impact in the fields of oncology,pharmacology,rare,infectious and many undiagnosed diseases.It is beginning to fuel new approaches in certain medical specialties.Oncology is at the leading edge of incorporating genomics,as diagnostics for genetic and genomic markers are increasingly included in cancer screening,and to guide tailored treatment strategies.Genetics and genetic medicine have been reported to play a role in gastroenterology in several ways,including genetic testing(hereditary pancreatitis and hereditary gastrointestinal cancer syndromes).Genetic testing can also help subtype diseases,such as classifying pancreatitis as idiopathic or hereditary.Gene therapy is a promising approach for treating gastrointestinal diseases that are not effectively treated by conventional pharmaceuticals and surgeries.Gene therapy strategies include gene addition,gene editing,messenger RNA therapy,and gene silencing.Understanding genetic determinants,advances in genetics,have led to a better understanding of the genetic factors that contribute to human disease.Family-member risk stratification and genetic diagnosis can help identify family members who are at risk,which can lead to preventive treatments,lifestyle recommendations,and routine follow ups.Selecting target genes helps identify the gene targets associated with each gastrointestinal disease.Common gastrointestinal diseases associated with genetic abnormalities include-inflammatory bowel disease,gastroesophageal reflux disease,non-alcoholic fatty liver disease,and irritable bowel syndrome.With advancing tools and technology,research in the search of newer and individualized treatment,genes and genetic medicines are expected to play a significant role in human health and gastroenterology.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
Dear Editor,Lung cancer is a major global health concern,with 2.2 million patients diagnosed in 2020.Non-small cell lung cancer(NSCLC)accounts for 80%of these cases,primarily comprising two subtypes:lung adenocarcinom...Dear Editor,Lung cancer is a major global health concern,with 2.2 million patients diagnosed in 2020.Non-small cell lung cancer(NSCLC)accounts for 80%of these cases,primarily comprising two subtypes:lung adenocarcinoma(LUAD)and squamous cell carcinoma(LUSC)[1].Researchers use immunohisto-chemistry,next-generation sequencing,and single-cell RNA sequencing to study genetic alterations,tumor heterogeneity,and tumor microenvironments,aiming to identify potential therapeutic options for specific NSCLC subtypes[2].展开更多
Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant ...Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant challenges to timely detection.Consequently,GBC often presents late,making it one of the most challenging cancers to manage.Surgery offers the best chance for long-term survival;however,only 10%of GBC patients are candidates for upfront resection,with the majority presenting in locally advanced or metastatic stages.Further-more,GBC is generally resistant to chemotherapy and radiotherapy,limiting the effectiveness of systemic therapy.Therefore,early diagnosis is crucial to offer the best treatment through surgical resection and to improve the outcome.Recent advancements in imaging technologies,biomarker discovery,and molecular diagnostics offer promising avenues for enhancing detection rates.Though non-invasive,most of them lack specificity,and the majority fail as an early diagnostic tool.This review examines the current status of early detection strategies for GBC,addresses the limitations of existing approaches,and explores the newer emer-ging diagnostic tools and techniques and how they can be exploited in future for its early detection.展开更多
BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for e...BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for early detection of stomal complications is important to improve the outcome.A model including patients and disease related factors,intraoperative surgical techniques and biochemical markers would be a better determinant to anticipate early stomal complications.Incorporation of emerging tools and technology such as artificial intelligence(AI),will further improve the prediction.AIM To identify various risk factors and models for prediction of early post operative stomal complications in colorectal cancer(CRC)surgery.METHODS Published literatures on early postoperative stomal complications in CRC surgery were systematically reviewed between 1995 and 2024 from online search engines PubMed and MEDLINE.RESULTS Twenty-four observational studies focused on identifying various risk factors for early post operative stomal complications in CRC surgery were analyzed.Stomal complications in CRC are influenced by several factors such as disease factors,patient-specific characteristics,and surgical techniques.There are some biomarkers and tools loke AI which may play significant roles in early detection.CONCLUSION Careful analysis of these factors,changes in biochemical parameters,and application of AI,a predictive model for stomal complications can be generated,to help in early detection,prompt action to achieve better outcomes.展开更多
Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30...Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.展开更多
Values of individuals and organizations involved in decision-making processes form the basis for prioritizing outcomes in water governance.The novelty of this study lies in applying values to a specific decision-makin...Values of individuals and organizations involved in decision-making processes form the basis for prioritizing outcomes in water governance.The novelty of this study lies in applying values to a specific decision-making context.It aims to assess the prioritized water governance outcomes and the underlying value systems shaping the actions of the primary water utility responsible for water governance in Delhi,the Delhi Jal Board(DJB).The paper will critically examine the policies and acts of the DJB that drive water governance in Delhi at present,utilizing a values-based framework in conjunction with secondary literature and expert interviews,to draw a picture of the values reflected.The study does not substantiate the notion of economic values dominating the water-related deci-sions;rather,recent policy guidelines indicate prioritization of equitable and fair distribution of water.Findings of this paper show that making the values explicit is largely disregarded in formulating water acts and policies,and values are never elucidated in the public domain,doing which can encourage water policies and practices that are socially,economically,and ecologically viable in the long run.It is expected that this paper will generate a discussion on water values being an integral part of water governance discourses.展开更多
BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior ...BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior defect of the internal and external anal sphincter,and loss of the distal rectovaginal and/or anovaginal septum.The common chamber incorporating vagina and recto anal outlet ensues as cloaca.CASE SUMMARY We present a case of unmarried 15-year female,who developed hematometra and was diagnosed as cervical ostia obstruction at the age of 12 year.She underwent drainage of hematometra,and later some abdominal and perineal procedures elsewhere and subsequently developed fecal discharge from the vagina.Examination revealed absence of posterior wall of vagina and anterior wall of anorectum.In addition,the anterior half of the anal sphincter was also absent.She underwent vaginoplasty,anorectoplasty,sphincteroplasty with levatorplasty with creation of rectovaginal septum.CONCLUSION This case report highlights expert management of a case of mismanaged benign gynaecological condition in a young female that resulted in lifelong impairment of the patient's quality of life following hysterectomy and salpingo-oophorectomy,leading to the development of a common cloaca.展开更多
Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-...Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.展开更多
BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisit...BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.展开更多
There are various histological characteristics which have been proposed to predict the survival rate in colon cancer.However,there is no definitive model to accurately predict the survival.Therefore,it is important to...There are various histological characteristics which have been proposed to predict the survival rate in colon cancer.However,there is no definitive model to accurately predict the survival.Therefore,it is important to find out one model for the prediction of survival in colon cancer which may also include the preoperative,and operative factors in addition to histopathology.展开更多
Understanding the behaviour of composite marine propellers during operating conditions is a need of the present era since they emerge as a potential replacement for conventional propeller materials such as metals or a...Understanding the behaviour of composite marine propellers during operating conditions is a need of the present era since they emerge as a potential replacement for conventional propeller materials such as metals or alloys.They offer several benefits,such as high specific strength,low corrosion,delayed cavitation,improved dynamic stability,reduced noise levels,and overall energy efficiency.In addition,composite materials undergo passive deformation,termed as“bend-twist effect”,under hydrodynamic loads due to their inherent flexibility and anisotropy.Although performance analysis methods were developed in the past for marine propellers,there is a significant lack of literature on composite propellers.This article discusses the recent advancements in experimental and numerical modelling,state-of-the-art computational technologies,and mutated mathematical models that aid in designing,analysing,and optimising composite marine propellers.In the initial sections,performance evaluation methods and challenges with the existing propeller materials are discussed.Thereafter,the benefits of composite propellers are critically reviewed.Numerical and experimental FSI coupling methods,cavitation performance,the effect of stacking sequence,and acoustic measurements are some critical areas discussed in detail.A two-way FSI-coupled simulation was conducted in a non-cavitating regime for four advanced ratios and compared with the literature results.Finally,the scope for future improvements and conclusions are mentioned.展开更多
Despite exhaustive search, no drug is in sight for AD. Earlier, we reported that reserpine, an antihypertensive and antipsychotic drug, ameliorates Amyloid beta (Aβ-AD causing peptide) toxicity and confers several po...Despite exhaustive search, no drug is in sight for AD. Earlier, we reported that reserpine, an antihypertensive and antipsychotic drug, ameliorates Amyloid beta (Aβ-AD causing peptide) toxicity and confers several positive enhancements in the C. elegans model system. Here, we evaluate whether reserpine can provide protection against working memory and against AD in the mouse model. Reserpine (0.08 mg) was administered orally on alternate days to the non-Tg and accelerated Aβ deposition (at 2 months of age)and cognitive deficit (4 months of age) developing 5XFAD AD Tg mouse model expressing mutant human APP (3 familial mutations) and human Presenilin1(2 familial mutations) in the neurons, and follow their working memory for 2 months using the spontaneous Y-maze alteration behavioral paradigm. Reserpine enhanced working memory in non-Tg mice and improved the cognitive deficit in the 5XFAD AD Tg mice. Hence, reserpine can be considered for a detailed evaluation in the 3X Tg AD mouse model and a pilot study in AD patients.展开更多
Background: Health care workers are respected in every society and have a strong influence on the behaviour of the community. In order to reduce the shisha dependence in the Pakistani population, it is necessary to ev...Background: Health care workers are respected in every society and have a strong influence on the behaviour of the community. In order to reduce the shisha dependence in the Pakistani population, it is necessary to evaluate the perspective of future doctors and pharmacists regarding this addiction as they become role models for the future generations. Objective: The aim is to compare the knowledge, attitudes, and practices of shisha use among medical students and pharmacy students in order to assess their support in the anti-shisha campaigns of Pakistan. Methodology: Cross sectional study was performed in four major medical universities of Karachi, Pakistan through a modification of the WHO global health survey questionnaire. Result: 398 medical students and 470 pharmacy students were included in the study which showed that currently 9.6% pharmacy students and 4.8% medical students used shisha daily (p = 0.000). Pharmacy students started shisha use in less than 15 years of age while this number was 29.5% among medical students (P = 0.000). Moreover, 44.6% pharmacy students and 50% medical students were not planning to quit this addiction within the next six months. 14% of pharmacy students and 20.4% in medical students (P = 0.002) were unaware that passive smoking caused lung cancer, while 23.4% pharmacy students and 33.5% medical students rejected it as cause of heart diseases (p = 0.006). Conclusion: A significant number of medical and pharmacy students were unaware about some of the serious consequences of shisha smoking. Therefore, both groups of students need to be educated about the health hazards of shisha use, in order to control this growing menace.展开更多
The petroleum compounds were photocatalytically remediated from water using graphene (G)- titanium oxide (TiO<sub>2</sub>) nanocomposite material in visible light radiation. The G-TiO<sub>2</sub&g...The petroleum compounds were photocatalytically remediated from water using graphene (G)- titanium oxide (TiO<sub>2</sub>) nanocomposite material in visible light radiation. The G-TiO<sub>2</sub> nanocomposite was synthesized using sol-gel technique, and its structural & morphological properties were studied using scanning electron microscopy (SEM), X-ray diffraction (XRD), transmission electron microscopy (TEM), particle analyzer and UV-Visible spectroscopy (UV-Vis) measurement techniques. Various petroleum-based chemicals (toluene, naphthalene and diesel) were remediated, and samples were analyzed using optical and gas chromatography (GC) techniques. The mechanism of photocatalytic remediation of petroleum compounds using G-TiO<sub>2</sub> nanomaterials is understood and well compared with data available in literature.展开更多
Gallbladder cancer is a malignancy of biliary tract which is infrequent in developed countries but common in some specific geographical regions of developing countries. Late diagnosis and deprived prognosis are major ...Gallbladder cancer is a malignancy of biliary tract which is infrequent in developed countries but common in some specific geographical regions of developing countries. Late diagnosis and deprived prognosis are major problems for treatment of gallbladder carcinoma. The dramatic associations of this orphan cancer with various genetic and environmental factors are responsible for its poorly defined pathogenesis. An understanding to the relationship between epidemiology, molecular genetics and pathogenesis of gallbladder cancer can add new insights to its undetermined pathophysiology. Present review article provides a recent update regarding epidemiology, pathogenesis, and molecular genetics of gallbladder cancer. We systematically reviewed published literature on gallbladder cancer from online search engine Pub Med(http://www.ncbi.nlm.nih.gov/pubmed). Various keywords used for retrieval of articles were Gallbladder, cancer Epidemiology, molecular genetics and bullion operators like AND, OR, NOT. Cross references were manually searched from various online search engines(http://www.ncbi.nlm.nih.gov/pubmed,https://scholar.google.co.in/, http://www.medline.com/home.jsp). Most of the articles published from 1982 to 2015 in peer reviewed journals have been included in this review.展开更多
AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent management.METHODS:Retrospective analysis of data from 108 patients with re...AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent management.METHODS:Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection(LAR)to identify the various preoperative,operative,and post operative factors that might have influence on anastomotic leaks and strictures.RESULTS:There were 68 males and 40 females with an average of 47 years(range 21-75 years).The median distance of the tumor from the anal verge was 8 cm(range 3-15 cm).Sixty(55.6%)patients underwent handsewn anastomosis and 48(44.4%)were stapled.The median operating time was 3.5 h(range2.0-7.5 h).Sixteen(14.6%)patients had an anastomotic leak.Among these,11 patients required reexploration and five were managed expectantly.The anastomotic leak rate was similar in patients with and without diverting stoma(8/60,13.4%with stoma and 8/48;16.7%without stoma).In 15(13.9%)patients,resection margins were positive for malignancy.Ninteen(17.6%)patients developed anastomotic strictures at a median duration of 8 mo(range 3-20 mo).Among these,15 patients were successfully managed with per-anal dilatation.On multivariate analysis,advance age(>60 years)was the only risk factor for anastomotic leak(P=0.004).On the other hand,anastomotic leak(P=0.00),mucin positive tumor(P =0.021),and lower rectal growth(P=0.011)were found as risk factors for the development of an anastomotic stricture.CONCLUSION:Advance age is a risk factor for an anastomotic leak.An anastomotic leak,a mucin-secreting tumor,and lower rectal growth predispose patients to develop anastomotic strictures.展开更多
β-cryptoxanthin （CRY）, a major carotenoid of potential interest for health, is obtained naturally from orange vegetables and fruits. A few research studies have reported that CRY could decrease oxidative stress and...β-cryptoxanthin （CRY）, a major carotenoid of potential interest for health, is obtained naturally from orange vegetables and fruits. A few research studies have reported that CRY could decrease oxidative stress and germ cell apoptosis. The purpose of this study was to examine the effects of CRY on acute cadmium chloride （CdCl2）-induced oxidative damage in rat testes. For this study, 24 rats were divided into four groups, one of which serves as a control group that received intraperitoneal （i.p.） injections of corn oil and physiological saline. The other rats were i.p. injected with CRY （10 μg kg^-1） every 8 h, beginning 8 h before CdCI2 （2.0 mg kg^-1） treatment. The pathological and TUNEL findings revealed that CRY ameliorated the Cd-induced testicular histological changes and germ cell apoptosis in the rats, Furthermore, the Cd-induced decrease in the testicular testosterone （T） level was attenuated after CRY administration （P 〈 0.05）. The administration of CRY significantly reversed the Cd-induced increases in the lipid peroxide （LPO） and malondialdehyde （MDA） levels （P 〈 0.01）. The testicular antioxidants superoxide dismutase （SOD）, catalase （CAT） and glutathione （GSH） were decreased by treatment with Cd alone but were restored by CRY co-treatment. These results demonstrated that the application of CRY can enhance the tolerance of rats to Cd-induced oxidative damage and suggest that it has promised as a pharmacological agent to protect against Cd-induced testicular toxicity.展开更多
Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their cl...Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their clinical applicability.In this study,pristine magnesium was purified(P-Mg)using a melt self-purification approach and reinforced using indigenously synthesized nanohydroxyapatite(HAP,0.6 wt.%)and strontium substituted nanohydroxyapatite(SrHAP,0.6 wt.%)using a low-cost stir assisted squeeze casting method to control their degradation rate.Using electron back-scattered diffraction(EBSD)and X-ray diffraction(XRD)examinations,all casted materials were carefully evaluated for microstructure and phase analysis.Mechanical characteristics,in vitro degradation,and in vitro biocompatibility with murine pre-osteoblasts were also tested on the fabricated alloys.For in vivo examination of bone formation,osteointegration,and degradation rate,the magnesium-based alloys were fabricated as small cylindrical pins with a diameter of 2.7 mm and a height of 2 mm.The pins were implanted in a critical-sized defect in a rat femur shaft(2.7 mm diameter and 2 mm depth)for 8 weeks and evaluated by microCT and histological evaluation for bone growth and osteointegration.When compared to P-Mg and P-MgHAP,micro-CT and histological analyses revealed that the P-MgSrHAP group had the highest bone formation towards the periphery of the implant and hence maximum osteointegration.When the removed pins from the bone defect were analyzed using GIXRD,they displayed hydroxyapatite peaks that were consistent with bio-integration.For P-Mg,P-MgHAP,and P-MgSrHAP 8 weeks after implantation,in vivo degradation rates derived from micro-CT were around 0.6 mm/year,0.5 mm/year,and 0.1 mm/year,respectively.Finally,P-MgSrHAP possesses the requisite degradation rate as well as sufficient mechanical and biological properties,indicating that it has the potential to be used in the development/fabrication of biodegradable bioactive orthopaedic implants.展开更多
文摘The etiopathogenesis of gastrointestinal diseases is varied in nature.Various etiogenic factors described are infective,inflammatory,viral,bacterial,parasitic,dietary and lifestyle change.Rare causative agents are immunological,and others associated as idiopathic,are undiagnosed by all possible means.Some of the rare diseases are congenital in nature,passing from the parent to the child.Many of the undiagnosed diseases are now being diagnosed as genetic and the genes have been implicated as a causative agent.There is a search for newer treatments for such diseases,which is called genomic medicine.Genomic medicine is an emerging medical discipline that involves the use of genomic information about an individual.This is used both for diagnostic as well as therapeutic decisions to improve the current health domain and pave the way for policymakers for its clinical use.In the developing era of precision medicine,genomics,epigenomics,environmental exposure,and other data would be used to more accurately guide individual diagnosis and treatment.Genomic medicine is already making an impact in the fields of oncology,pharmacology,rare,infectious and many undiagnosed diseases.It is beginning to fuel new approaches in certain medical specialties.Oncology is at the leading edge of incorporating genomics,as diagnostics for genetic and genomic markers are increasingly included in cancer screening,and to guide tailored treatment strategies.Genetics and genetic medicine have been reported to play a role in gastroenterology in several ways,including genetic testing(hereditary pancreatitis and hereditary gastrointestinal cancer syndromes).Genetic testing can also help subtype diseases,such as classifying pancreatitis as idiopathic or hereditary.Gene therapy is a promising approach for treating gastrointestinal diseases that are not effectively treated by conventional pharmaceuticals and surgeries.Gene therapy strategies include gene addition,gene editing,messenger RNA therapy,and gene silencing.Understanding genetic determinants,advances in genetics,have led to a better understanding of the genetic factors that contribute to human disease.Family-member risk stratification and genetic diagnosis can help identify family members who are at risk,which can lead to preventive treatments,lifestyle recommendations,and routine follow ups.Selecting target genes helps identify the gene targets associated with each gastrointestinal disease.Common gastrointestinal diseases associated with genetic abnormalities include-inflammatory bowel disease,gastroesophageal reflux disease,non-alcoholic fatty liver disease,and irritable bowel syndrome.With advancing tools and technology,research in the search of newer and individualized treatment,genes and genetic medicines are expected to play a significant role in human health and gastroenterology.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
基金support through Manipal University Jaipur for the Enhanced Seed Grant under the Endowment Fund(Grant No.E3/2023-24/QE-04-05).
文摘Dear Editor,Lung cancer is a major global health concern,with 2.2 million patients diagnosed in 2020.Non-small cell lung cancer(NSCLC)accounts for 80%of these cases,primarily comprising two subtypes:lung adenocarcinoma(LUAD)and squamous cell carcinoma(LUSC)[1].Researchers use immunohisto-chemistry,next-generation sequencing,and single-cell RNA sequencing to study genetic alterations,tumor heterogeneity,and tumor microenvironments,aiming to identify potential therapeutic options for specific NSCLC subtypes[2].
文摘Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant challenges to timely detection.Consequently,GBC often presents late,making it one of the most challenging cancers to manage.Surgery offers the best chance for long-term survival;however,only 10%of GBC patients are candidates for upfront resection,with the majority presenting in locally advanced or metastatic stages.Further-more,GBC is generally resistant to chemotherapy and radiotherapy,limiting the effectiveness of systemic therapy.Therefore,early diagnosis is crucial to offer the best treatment through surgical resection and to improve the outcome.Recent advancements in imaging technologies,biomarker discovery,and molecular diagnostics offer promising avenues for enhancing detection rates.Though non-invasive,most of them lack specificity,and the majority fail as an early diagnostic tool.This review examines the current status of early detection strategies for GBC,addresses the limitations of existing approaches,and explores the newer emer-ging diagnostic tools and techniques and how they can be exploited in future for its early detection.
文摘BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for early detection of stomal complications is important to improve the outcome.A model including patients and disease related factors,intraoperative surgical techniques and biochemical markers would be a better determinant to anticipate early stomal complications.Incorporation of emerging tools and technology such as artificial intelligence(AI),will further improve the prediction.AIM To identify various risk factors and models for prediction of early post operative stomal complications in colorectal cancer(CRC)surgery.METHODS Published literatures on early postoperative stomal complications in CRC surgery were systematically reviewed between 1995 and 2024 from online search engines PubMed and MEDLINE.RESULTS Twenty-four observational studies focused on identifying various risk factors for early post operative stomal complications in CRC surgery were analyzed.Stomal complications in CRC are influenced by several factors such as disease factors,patient-specific characteristics,and surgical techniques.There are some biomarkers and tools loke AI which may play significant roles in early detection.CONCLUSION Careful analysis of these factors,changes in biochemical parameters,and application of AI,a predictive model for stomal complications can be generated,to help in early detection,prompt action to achieve better outcomes.
文摘Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.
基金Water Security and Sustainable Development Hub funded by the UK Research and Innovation's Global Challenges Research Fund(GCRF),Grant/Award Number:ES/S008179/1。
文摘Values of individuals and organizations involved in decision-making processes form the basis for prioritizing outcomes in water governance.The novelty of this study lies in applying values to a specific decision-making context.It aims to assess the prioritized water governance outcomes and the underlying value systems shaping the actions of the primary water utility responsible for water governance in Delhi,the Delhi Jal Board(DJB).The paper will critically examine the policies and acts of the DJB that drive water governance in Delhi at present,utilizing a values-based framework in conjunction with secondary literature and expert interviews,to draw a picture of the values reflected.The study does not substantiate the notion of economic values dominating the water-related deci-sions;rather,recent policy guidelines indicate prioritization of equitable and fair distribution of water.Findings of this paper show that making the values explicit is largely disregarded in formulating water acts and policies,and values are never elucidated in the public domain,doing which can encourage water policies and practices that are socially,economically,and ecologically viable in the long run.It is expected that this paper will generate a discussion on water values being an integral part of water governance discourses.
文摘BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior defect of the internal and external anal sphincter,and loss of the distal rectovaginal and/or anovaginal septum.The common chamber incorporating vagina and recto anal outlet ensues as cloaca.CASE SUMMARY We present a case of unmarried 15-year female,who developed hematometra and was diagnosed as cervical ostia obstruction at the age of 12 year.She underwent drainage of hematometra,and later some abdominal and perineal procedures elsewhere and subsequently developed fecal discharge from the vagina.Examination revealed absence of posterior wall of vagina and anterior wall of anorectum.In addition,the anterior half of the anal sphincter was also absent.She underwent vaginoplasty,anorectoplasty,sphincteroplasty with levatorplasty with creation of rectovaginal septum.CONCLUSION This case report highlights expert management of a case of mismanaged benign gynaecological condition in a young female that resulted in lifelong impairment of the patient's quality of life following hysterectomy and salpingo-oophorectomy,leading to the development of a common cloaca.
文摘Laparoscopic and endoscopic cooperative surgery(LECS)is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors.Several modifications of LECS—including inverted LECS,non-exposed endoscopic wall-inversion surgery,and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding.These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal(GI)lesions such as the duodenum,colon,and rectum.This minireview explores the evolution,current applications,and future potential of laparoendoscopic surgery in GI diseases.
文摘BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome.
文摘There are various histological characteristics which have been proposed to predict the survival rate in colon cancer.However,there is no definitive model to accurately predict the survival.Therefore,it is important to find out one model for the prediction of survival in colon cancer which may also include the preoperative,and operative factors in addition to histopathology.
基金Supporting by the project‘FILE NO.CRG/2022/001718’.
文摘Understanding the behaviour of composite marine propellers during operating conditions is a need of the present era since they emerge as a potential replacement for conventional propeller materials such as metals or alloys.They offer several benefits,such as high specific strength,low corrosion,delayed cavitation,improved dynamic stability,reduced noise levels,and overall energy efficiency.In addition,composite materials undergo passive deformation,termed as“bend-twist effect”,under hydrodynamic loads due to their inherent flexibility and anisotropy.Although performance analysis methods were developed in the past for marine propellers,there is a significant lack of literature on composite propellers.This article discusses the recent advancements in experimental and numerical modelling,state-of-the-art computational technologies,and mutated mathematical models that aid in designing,analysing,and optimising composite marine propellers.In the initial sections,performance evaluation methods and challenges with the existing propeller materials are discussed.Thereafter,the benefits of composite propellers are critically reviewed.Numerical and experimental FSI coupling methods,cavitation performance,the effect of stacking sequence,and acoustic measurements are some critical areas discussed in detail.A two-way FSI-coupled simulation was conducted in a non-cavitating regime for four advanced ratios and compared with the literature results.Finally,the scope for future improvements and conclusions are mentioned.
文摘Despite exhaustive search, no drug is in sight for AD. Earlier, we reported that reserpine, an antihypertensive and antipsychotic drug, ameliorates Amyloid beta (Aβ-AD causing peptide) toxicity and confers several positive enhancements in the C. elegans model system. Here, we evaluate whether reserpine can provide protection against working memory and against AD in the mouse model. Reserpine (0.08 mg) was administered orally on alternate days to the non-Tg and accelerated Aβ deposition (at 2 months of age)and cognitive deficit (4 months of age) developing 5XFAD AD Tg mouse model expressing mutant human APP (3 familial mutations) and human Presenilin1(2 familial mutations) in the neurons, and follow their working memory for 2 months using the spontaneous Y-maze alteration behavioral paradigm. Reserpine enhanced working memory in non-Tg mice and improved the cognitive deficit in the 5XFAD AD Tg mice. Hence, reserpine can be considered for a detailed evaluation in the 3X Tg AD mouse model and a pilot study in AD patients.
文摘Background: Health care workers are respected in every society and have a strong influence on the behaviour of the community. In order to reduce the shisha dependence in the Pakistani population, it is necessary to evaluate the perspective of future doctors and pharmacists regarding this addiction as they become role models for the future generations. Objective: The aim is to compare the knowledge, attitudes, and practices of shisha use among medical students and pharmacy students in order to assess their support in the anti-shisha campaigns of Pakistan. Methodology: Cross sectional study was performed in four major medical universities of Karachi, Pakistan through a modification of the WHO global health survey questionnaire. Result: 398 medical students and 470 pharmacy students were included in the study which showed that currently 9.6% pharmacy students and 4.8% medical students used shisha daily (p = 0.000). Pharmacy students started shisha use in less than 15 years of age while this number was 29.5% among medical students (P = 0.000). Moreover, 44.6% pharmacy students and 50% medical students were not planning to quit this addiction within the next six months. 14% of pharmacy students and 20.4% in medical students (P = 0.002) were unaware that passive smoking caused lung cancer, while 23.4% pharmacy students and 33.5% medical students rejected it as cause of heart diseases (p = 0.006). Conclusion: A significant number of medical and pharmacy students were unaware about some of the serious consequences of shisha smoking. Therefore, both groups of students need to be educated about the health hazards of shisha use, in order to control this growing menace.
文摘The petroleum compounds were photocatalytically remediated from water using graphene (G)- titanium oxide (TiO<sub>2</sub>) nanocomposite material in visible light radiation. The G-TiO<sub>2</sub> nanocomposite was synthesized using sol-gel technique, and its structural & morphological properties were studied using scanning electron microscopy (SEM), X-ray diffraction (XRD), transmission electron microscopy (TEM), particle analyzer and UV-Visible spectroscopy (UV-Vis) measurement techniques. Various petroleum-based chemicals (toluene, naphthalene and diesel) were remediated, and samples were analyzed using optical and gas chromatography (GC) techniques. The mechanism of photocatalytic remediation of petroleum compounds using G-TiO<sub>2</sub> nanomaterials is understood and well compared with data available in literature.
文摘Gallbladder cancer is a malignancy of biliary tract which is infrequent in developed countries but common in some specific geographical regions of developing countries. Late diagnosis and deprived prognosis are major problems for treatment of gallbladder carcinoma. The dramatic associations of this orphan cancer with various genetic and environmental factors are responsible for its poorly defined pathogenesis. An understanding to the relationship between epidemiology, molecular genetics and pathogenesis of gallbladder cancer can add new insights to its undetermined pathophysiology. Present review article provides a recent update regarding epidemiology, pathogenesis, and molecular genetics of gallbladder cancer. We systematically reviewed published literature on gallbladder cancer from online search engine Pub Med(http://www.ncbi.nlm.nih.gov/pubmed). Various keywords used for retrieval of articles were Gallbladder, cancer Epidemiology, molecular genetics and bullion operators like AND, OR, NOT. Cross references were manually searched from various online search engines(http://www.ncbi.nlm.nih.gov/pubmed,https://scholar.google.co.in/, http://www.medline.com/home.jsp). Most of the articles published from 1982 to 2015 in peer reviewed journals have been included in this review.
文摘AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent management.METHODS:Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection(LAR)to identify the various preoperative,operative,and post operative factors that might have influence on anastomotic leaks and strictures.RESULTS:There were 68 males and 40 females with an average of 47 years(range 21-75 years).The median distance of the tumor from the anal verge was 8 cm(range 3-15 cm).Sixty(55.6%)patients underwent handsewn anastomosis and 48(44.4%)were stapled.The median operating time was 3.5 h(range2.0-7.5 h).Sixteen(14.6%)patients had an anastomotic leak.Among these,11 patients required reexploration and five were managed expectantly.The anastomotic leak rate was similar in patients with and without diverting stoma(8/60,13.4%with stoma and 8/48;16.7%without stoma).In 15(13.9%)patients,resection margins were positive for malignancy.Ninteen(17.6%)patients developed anastomotic strictures at a median duration of 8 mo(range 3-20 mo).Among these,15 patients were successfully managed with per-anal dilatation.On multivariate analysis,advance age(>60 years)was the only risk factor for anastomotic leak(P=0.004).On the other hand,anastomotic leak(P=0.00),mucin positive tumor(P =0.021),and lower rectal growth(P=0.011)were found as risk factors for the development of an anastomotic stricture.CONCLUSION:Advance age is a risk factor for an anastomotic leak.An anastomotic leak,a mucin-secreting tumor,and lower rectal growth predispose patients to develop anastomotic strictures.
文摘β-cryptoxanthin （CRY）, a major carotenoid of potential interest for health, is obtained naturally from orange vegetables and fruits. A few research studies have reported that CRY could decrease oxidative stress and germ cell apoptosis. The purpose of this study was to examine the effects of CRY on acute cadmium chloride （CdCl2）-induced oxidative damage in rat testes. For this study, 24 rats were divided into four groups, one of which serves as a control group that received intraperitoneal （i.p.） injections of corn oil and physiological saline. The other rats were i.p. injected with CRY （10 μg kg^-1） every 8 h, beginning 8 h before CdCI2 （2.0 mg kg^-1） treatment. The pathological and TUNEL findings revealed that CRY ameliorated the Cd-induced testicular histological changes and germ cell apoptosis in the rats, Furthermore, the Cd-induced decrease in the testicular testosterone （T） level was attenuated after CRY administration （P 〈 0.05）. The administration of CRY significantly reversed the Cd-induced increases in the lipid peroxide （LPO） and malondialdehyde （MDA） levels （P 〈 0.01）. The testicular antioxidants superoxide dismutase （SOD）, catalase （CAT） and glutathione （GSH） were decreased by treatment with Cd alone but were restored by CRY co-treatment. These results demonstrated that the application of CRY can enhance the tolerance of rats to Cd-induced oxidative damage and suggest that it has promised as a pharmacological agent to protect against Cd-induced testicular toxicity.
基金the funding received from Ministry of Human Resource Development(MHRD),India and Indian Council of Medical Research(ICMR),India projects(IMPRINT-6714UAY/MHRD_IITK_006),MHRD,India project(SPARC/2018–2019/P612/S)+3 种基金Science and Engineering Research Board(SERB),India project(IPA/2020/000026)Department of Science and Technology(DST),Govt.of India project(DST/NM/NT-2018/48)Department of Biotechnology(DBT),Govt.of India project(DBT/IN/SWEDEN/08/AK/2017–18)Ortho Regenics Private Limited(ORPL)。
文摘Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their clinical applicability.In this study,pristine magnesium was purified(P-Mg)using a melt self-purification approach and reinforced using indigenously synthesized nanohydroxyapatite(HAP,0.6 wt.%)and strontium substituted nanohydroxyapatite(SrHAP,0.6 wt.%)using a low-cost stir assisted squeeze casting method to control their degradation rate.Using electron back-scattered diffraction(EBSD)and X-ray diffraction(XRD)examinations,all casted materials were carefully evaluated for microstructure and phase analysis.Mechanical characteristics,in vitro degradation,and in vitro biocompatibility with murine pre-osteoblasts were also tested on the fabricated alloys.For in vivo examination of bone formation,osteointegration,and degradation rate,the magnesium-based alloys were fabricated as small cylindrical pins with a diameter of 2.7 mm and a height of 2 mm.The pins were implanted in a critical-sized defect in a rat femur shaft(2.7 mm diameter and 2 mm depth)for 8 weeks and evaluated by microCT and histological evaluation for bone growth and osteointegration.When compared to P-Mg and P-MgHAP,micro-CT and histological analyses revealed that the P-MgSrHAP group had the highest bone formation towards the periphery of the implant and hence maximum osteointegration.When the removed pins from the bone defect were analyzed using GIXRD,they displayed hydroxyapatite peaks that were consistent with bio-integration.For P-Mg,P-MgHAP,and P-MgSrHAP 8 weeks after implantation,in vivo degradation rates derived from micro-CT were around 0.6 mm/year,0.5 mm/year,and 0.1 mm/year,respectively.Finally,P-MgSrHAP possesses the requisite degradation rate as well as sufficient mechanical and biological properties,indicating that it has the potential to be used in the development/fabrication of biodegradable bioactive orthopaedic implants.
