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Narrow band red-emitting phosphors based on organo-Eu(III) complexes prove their energetic features with surprising performance in smart red/white LEDs, sensing, and biological fields. In this report, a series of unique Eu(III) complexes have been synthesized with coumarin integrated with a class of phenanthroline(Phen)/thiabendazole(TBZ) based ancillary ligands and dibenzoyl methane (DBM)/2-theonyl trifluoroacetone (TTA) as an anionic ligand. The computational study reveals that the TBZ/Phen-based neutral ligands are superior energy harvesters to those other reported analogue neutral ligands. All the Eu-complexes demonstrated outstanding red emission due to electric dipole (ED) transition (5D0 → 7F2) in solid, solution, and thin film with high quantum yield (QY). Theoretical analysis (TD-DFT) and experimental findings describe that the energy transfer (ET) from the ligand's triplet level to the Eu(III) ion is completely occurring. The Eu(III) complexes can potentially be used to fabricate intense hybrid white and red LEDs. All of the fabricated red LEDs revealed high luminous efficiency of radiation (LER) values. The fabricated blue LED based hybrid white LEDs displayed remarkable performance with a low correlated color temperature (5634 K), high color rendering index 88%, and CIE values (x = 0.33; y = 0.342) for 3Eu. By interaction with acid-base vapors, Eu-complexes displayed effectively alterable on-off-on luminescence. Further, cellular imaging shows that Eu-complexes can be a potential biomarker for cancer cell lines.

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The goal of the study was to investigate the changes in the gut microbiota during the advancement of gastric cancer (GC) and identify pertinent taxa associated with the disease. We used a public fecal amplicon gastric cancer dataset from the Sequence Retrieval Archive (SRA), of patients with GC, gastritis, and healthy individuals. We did sequence pre-processing, including quality filtering of the sequences. Then, we performed a diversity analysis, evaluating α- and ß-diversity. Next, taxonomic composition analysis was performed and the relative abundances of different taxa at the phylum and genus levels were compared between GC, gastritis, and healthy controls. The obtained results were subsequently subjected to statistical validation. To conclude, metagenomic function prediction was carried out, followed by correlation analysis between the microbiota and KEGG pathways. α analysis revealed a significant difference between male and female categories, while ß analysis demonstrated significant distinctions between GC, gastritis, and healthy controls, as well as between sexes within the GC and gastritis groups. The statistically confirmed taxonomic composition analysis highlighted the presence of the microbes Bacteroides and Veillonella. Furthermore, through metagenomic prediction analysis and correlation analysis with pathways, three taxa, namely Akkermansia, Gammaproteobacteria, and Veillonella, were identified as potential biomarkers for GC. Additionally, this study reports, for the first time, the presence of two bacteria, Desulfobacteriota and Synergistota, in GC, necessitating further investigation. Overall, this research sheds light on the potential involvement of gut microbiota in GC pathophysiology; however, additional studies are warranted to explore its functional significance.

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In recent years, advancements in chemistry have allowed the tailoring of materials at the nanoscopic level as needed. There are mainly four main types of nanomaterials used as drug carriers:metal-based nanomaterials, organic nanomaterials, inorganic nanomaterials, and polymer nanomaterials. The nanomaterials as a drug carrier showed advantages for decreased side effects with a higher therapeutic index. The stability of the drug compounds is increased by encapsulation of the drug within the nano-drug carriers, leading to decreased systemic toxicity. Nano-drug carriers are also used for controlled drug release by tailoring system-made solubility characteristics of nanoparticles by surface coating with surfactants. The review focuses on the different types of nanoparticles used as drug carriers, the nanoparticle synthesis process, techniques of nanoparticle surface coating for drug carrier purposes, applications of nano-drug carriers, and prospects of nanomaterials as drug carriers for biomedical applications.

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PURPOSE: This study aims to decellularized caprine pericardium tissue with varied non-ionic surfactant and anionic detergent concentrations. METHODS: Protocol A consists of 1%, 0.5%, and 0.25% (w/v) sodium dodecyl sulphate (SDS). Protocol B uses 1%, 0.5%, and 0.25% (w/v) Triton X-100. Protocol C comprised 0.5% SDS + 0.5% Triton X-100, 0.5% + 0.25%, and 0.25% SDS + 0.5% Triton X-100. RESULTS: Protocol B left a few countable cells in the pericardium tissue, but treatments A and C removed all cells. DNA quantification also demonstrated that protocol B had the most leftover DNA after decellularization. The pericardium tissue treated with an equal combination of anionic detergent and non-ionic surfactant preserves the matrix. However, changing the anionic detergent-non-ionic surfactant ratio disrupted the microstructure. Protocol A decreased pericardium tissue secant modulus (p < 0.05). Protocol B-treated pericardium tissue matched native tissue secant modulus and ultimate tensile stress. Protocol C strengthened pericardium tissue. CONCLUSION: The intact extracellular matrix and biomechanical properties like native tissues require optimal chemical doses and combinations.

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BACKGROUND: The development of polymeric-based drug delivery has seen faster growth in the past two decades. In polymers, copolymers as drug carriers are increasing to decrease the drug compounds' side effects and dosage-related toxicity. OBJECTIVES: The study's primary objective is to utilize computational resources to design drug molecules and perform in silco physicochemical property analysis. In our study, we designed new copolymers based on N-(2-Hydroxypropyl) methacrylamide (HPMA) as backbone along with polyethylene glycol (PEG) and lauryl methacrylate (LMA). METHODS: Different functional groups were selected for attaching to the side chain of the copolymers through a random trial and error approach. In order to predict the pharmacokinetic properties (absorption, distribution, metabolism, excretion, and toxicity), the designed copolymer molecules were evaluated utilizing ADME and PkCSM pharmacokinetics servers. Molecular interaction between the designed copolymer molecules and human serum albumin (HSA) was performed using AutoDock Vina and PatchDock server. RESULTS: The designed molecules are shown to be soluble in water and have high gastrointestinal absorption. Only one molecule is predicted to pass through the blood-brain barrier. Two designed molecules have been shown to have carcinogenic properties. Lethal dose 50 (LD50), cytochrome P450, and permeability glycoprotein Enzyme's substrate formation were also analyzed for toxicity and metabolism. CONCLUSION: Our study will provide insight for designing new drug compounds or carriers and analyzing their physicochemical properties to help further optimize compounds for clinical studies.

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Biodegradable drug-eluting stents (DESs) are gaining importance owing to their attractive features, such as complete drug release to the target site. Magnesium (Mg) alloys are promising materials for future biodegradable DESs. However, there are few explorations using biodegradable Mg for cardiovascular stent application. In this present study, sirolimus-loaded poly D, L-lactic-co-glycolic acid (PLGA)-coated/ sirolimus-fixed/AZ91 Mg alloy-based substrate was developed via a layer-by-layer approach for cardiovascular stent application. The AZ91 Mg alloy was prepared through the squeeze casting technique. The casted AZ91 Mg alloy (Mg) was alkali-treated to provide macroporous networks to hold the sirolimus and PLGA layers. The systematic characterization was investigated via electrochemical, optical, physicochemical, and in-vitro biological characteristics. The presence of the Mg17 Al12 phase in the Mg sample was found in the x-ray diffraction system (XRD) spectrum which influences the corrosion behavior of the developed substrate. The alkali treatment increases the substrate's hydrophilicity which was confirmed through static contact angle measurement. The anti-corrosion characteristic of casted-AZ91 Mg alloy (Mg) was slightly less than the sirolimus-loaded PLGA-coated alkali-treated AZ91 Mg alloy (Mg/Na/S/P) substrate. However, dissolution rates for both substrates were found to be controlled at cell culture conditions. Radiographic densities of AZ91 Mg alloy substrates (Mg, Mg/Na, and Mg/Na/S/P) were measured to be 0.795 ± 0.015, 0.742 ± 0.01, and 0.712 ± 0.017, respectively. The star-shaped structure of 12% sirolimus/PLGA ensures the bioavailability of the drugs. Sirolimus release kinetic was fitted up to 80% with the "Higuchi model" for Mg samples, whereas Mg/Na/S/P showed 45% fitting with a zero-order mechanism. The Mg/Na/S/P substrate showed a 70% antithrombotic effect compared to control. Further, alkali treatment enhances the antibacterial characteristic of AZ91 Mg alloy. Also, the alkali-treated sirolimus-loaded substrates (Mg/Na/S and Mg/Na/S/P) inhibit the valvular interstitial cell's growth significantly in in-vitro. Hence, the results imply that sirolimus-loaded PLGA-coated AZ91 Mg alloy-based substrate can be a potential candidate for cardiovascular stent application.

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Importance: When a ProSeal laryngeal mask airway (PLMA) is removed with the child in a deep plane of anesthesia, the upper airway muscle tone and protective upper airway reflexes may be obtunded. Objective: To determine whether the supine or lateral position is safer for the removal of a PLMA in deeply anesthetized children by comparing the incidence of upper airway complications. Methods: This randomized single-blind comparative trial was conducted at a tertiary care hospital between January 2020 and September 2020. Forty children of the American Society of Anesthesiologists class I/II of ages 1-12 years age undergoing surgery under general anesthesia with PLMA used as the definitive airway device were recruited. Patients were randomly allocated to lateral group or supine group for PLMA removal in a deep plane of anesthesia in the lateral or supine position. The primary outcome was the number of patients experiencing one or more upper airway complications and the secondary outcomes were incidence of individual respiratory adverse effects and of severe airway complications. Results: The incidence of airway complications was 30% in the supine group and 20% in the lateral group (P = 0.6641). Incidence of laryngospasm, immediate stridor, and excessive secretions were similar. Early stridor and oxygen desaturation were higher in the supine group (P = 0.0374, P = 0.0183 respectively). Interpretation: The overall incidence of upper airway complications was similar with the removal of a PLMA in the supine or lateral position in deeply anesthetized children. The incidence of oxygen desaturation and stridor were higher with PLMA removal in the supine as compared to the lateral position.

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AIM: This study aimed to evaluate the demineralizing effect of commonly used pediatric syrup formulations on primary teeth and the efficacy of two readily available remineralizing agents in treating this effect. MATERIALS AND METHODS: Ninety primary teeth were used for sample preparation and divided into three groups: antibiotic syrup (group A), cough syrup (group B), and control (group C) groups. These groups were further categorized into intragroups according to the treatment with remineralizing agents: groups A1, B1, and C1 received GC Tooth Mousse (casein phosphopeptide-amorphous calcium phosphate, CPP-ACP paste) and groups A2, B2, and C2 received Clinpro Tooth Crème. The samples were subjected to a series of demineralization cycles for 14 days, and remineralization cycles until 30 days were performed using two remineralizing agents, that is, GC Tooth Mousse (CPP-ACP paste) and Clinpro Tooth Crème and were evaluated using Vicker's microhardness test. RESULTS: Antibiotic syrup (group A) and cough syrup (group B) showed a significant decrease in surface microhardness compared with control (group C). All intragroups showed an increase in surface microhardness after treatment with remineralizing agents, which was significantly higher in intragroups A1, B1, and C1 treated with GC Tooth Mousse (CPP-ACP paste). CONCLUSIONS: Oral liquid medications showed definite demineralization potential. CPP-ACP paste was found to be better than Clinpro Tooth Crème for demineralized teeth. CLINICAL SIGNIFICANCE: The use of over-the-counter drugs has increased among the average Indian population, especially for the treatment of fever, cold, and cough. Unwise use of medications by the present population without proper medical guidance will lead to irreparable changes in future generations.

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Millions of people globally suffer from issues related to chronic wounds due to infection, burn, obesity, and diabetes. Nanocomposite with antibacterial and anti-inflammatory properties is a promising material to promote wound healing. This investigation primarily aims to synthesize reduced graphene oxide and titanium dioxide (rGO@TiO2) nanocomposite for wound healing applications. The rGO@TiO2 nanocomposite was synthesized by the one-step hydrothermal technique, and the physicochemical characterization of synthesized nanocomposite was performed by X-ray diffraction, Fourier transforms infrared spectroscopy, Raman spectroscopy, scanning electron microscopy, transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy, and dynamic light scattering. Further, the nanocomposite antibacterial, cytotoxicity, and wound-healing properties were analyzed by disc diffusion method, MTT assay, and in vitro scratch assay, respectively. Based on the TEM images, the average particle size of TiO2 nanoparticles was around 9.26 ± 1.83 nm. The characteristics peak of Ti-O-Ti bonds was observed between 500 and 850 cm-1 in the Fourier transforms infrared spectrum. The Raman spectrum of graphene oxide (GO) was obtained for bands D and G at 1354 cm-1 and at 1593 cm-1, respectively. This GO peak intensity was reduced in rGO, revealing the oxygen functional group reduction. Moreover, the rGO@TiO2 nanocomposite exhibited dose-dependent antibacterial properties against the positive and negative bacterium. The cytotoxicity for 5-100 µg/mL of rGO@TiO2 nanocomposite was above the half-maximal inhibitory concentration value. The in vitro scratch assay for rGO@TiO2 indicates that the nanocomposite promotes cell proliferation and migration. The nanocomposite recovered the wound within 48 h. The rGO@TiO2 nanocomposite shows potential materials for wound healing applications.

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SETTING: Kerala State, India, implemented decentralising reforms of healthcare institutions 25 years ago through transfer of administrative control and a sizeable share of the financial allocation. OBJECTIVE: To describe the main impacts of decentralisation in Kerala on local policy formulation, programme implementation and service delivery for sustainable health systems. DESIGN: This was part of a broader qualitative study on decentralisation and health in Kerala. We conducted 25 in-depth interviews and reviewed 31 government orders or policy documents, five related transcripts and five thematic reports from the main study. RESULTS: Liaising between health system and local governments has improved over time. A shift from welfare-centric projects to infrastructure, human resources and services was evident. Considerable heterogeneity existed due to varying degrees of involvement, capacity, resources and needs of the community. State-level discourse and recent augmentation efforts for moving towards the UN Sustainable Development Goals (SDGs) strongly uphold the role of local governments in planning, financing and implementation. CONCLUSION: The 25-year history of decentralised healthcare administration in Kerala indicates both successes and failures. Central support without disempowering the local governments can be a viable option to allow flexible decision-making consistent with broader system goals.

CONTEXTE: L'État du Kerala, en Inde, a mis en œuvre des réformes de décentralisation des établissements de santé il y a 25 ans, en transférant le contrôle administratif et une part importante de l'allocation financière. OBJECTIF: Décrire les principaux impacts de la décentralisation au Kerala sur la formulation de politiques locales, la mise en œuvre de programmes et la prestation de services pour des systèmes de santé durables. MÉTHODE: Cette étude faisait partie d'une étude qualitative plus vaste sur la décentralisation et la santé au Kerala. Nous avons mené 25 entretiens approfondis et examiné 31 décrets ou documents de politique du gouvernement, cinq transcriptions connexes et cinq rapports thématiques de l'étude principale. RÉSULTATS: La liaison entre le système de santé et les gouvernements locaux s'est améliorée au fil du temps. Une réorientation des projets centrés sur le bien-être vers les infrastructures, les ressources humaines et les services était évidente. Une hétérogénéité considérable existe en raison des différents degrés d'implication, de capacité, de ressources et de besoins de la communauté. Le discours au niveau de l'État et les récents efforts d'augmentation en vue d'atteindre les objectifs de développement durable (SDG) de l'ONU soutiennent fortement le rôle des gouvernements locaux dans la planification, le financement et la mise en œuvre. CONCLUSION: Les 25 ans d'histoire de l'administration décentralisée des soins de santé au Kerala révèlent à la fois des réussites et des échecs. Un soutien central sans déresponsabiliser les gouvernements locaux peut être une option viable pour permettre une prise de décision flexible et cohérente avec les objectifs plus larges du système.

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INTRODUCTION: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care. METHODS: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema. RESULTS: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed. CONCLUSION: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

INTRODUCTION: Dans le contexte des Objectifs de développement durable (SDG), l'État du Kérala, Inde, a transformé ses centres de soins primaires (PHC) existants en centres de santé familiale (FHC) conviviaux afin de fournir des soins primaires complets dans le cadre d'une initiative mandatée en mission ('Aardram'). Il était prévu que la mise en œuvre et le fonctionnement de cette mission fassent appel à la gouvernance décentralisée. Cette étude a examiné l'influence de la gouvernance décentralisée sur la réorganisation des soins primaires. MÉTHODES: L'étude a eu recours à une approche exploratoire, en utilisant des méthodes qualitatives : entretiens avec des informateurs clés (n=8), entretiens approfondis (n=20) et analyses documentaires. Une analyse thématique a été réalisée selon un codage déductif et les thèmes identifiés ont été structurés sous forme de schéma. RÉSULTATS: Les résultats peuvent être résumés en cinq thèmes principaux. Un engagement politique fort, associé à des compétences bureaucratiques, ont facilité la mise en œuvre et le fonctionnement des soins primaires de la mission 'Aardram'. Les connaissances acquises grâce à la formation multisectorielle ont aidé les gouvernements locaux (LG) à s'impliquer et à s'engager dans le système de santé en tant qu'équipe afin de planifier et de mettre en place des interventions. Les structures de gouvernance décentralisées ont permis de réorganiser les PHC en mobilisant des ressources financières, en fournissant des ressources humaines, en modifiant les infrastructures et en renforçant la participation communautaire à différents niveaux. Parmi les lacunes observées figurent le manque d'uniformité de l'engagement, l'engagement sous-optimal des LG urbains et les questions de durabilité et de suivi. CONCLUSION: La gouvernance décentralisée a joué un rôle positif dans la réorganisation des PHC, qui a été utilisée comme une plateforme pour illustrer les bonnes pratiques en matière de gouvernance sanitaire par le biais d'une approche participative. Cette étude met en évidence l'importance de l'autonomisation des LG au travers du renforcement des capacités afin de relever les défis liés à la réalisation des SDG en matière de soins primaires.

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Collagen plays a key role in the strength of aortic walls, so studying micro-structural changes during disease development is critical to better understand collagen reorganization. Second-harmonic generation microscopy is used to obtain images of human aortic collagen in both healthy and diseased states. Methods are being developed in order to efficiently determine the waviness, that is, tortuosity and amplitude, as well as the diameter, orientation, and dispersion of collagen fibers, and bundles in healthy and aneurysmal tissues. The results show layer-specific differences in the collagen of healthy tissues, which decrease in samples of aneurysmal aortic walls. In healthy tissues, the thick collagen bundles of the adventitia are characterized by greater waviness, both in the tortuosity and in the amplitude, compared to the relatively thin and straighter collagen fibers of the media. In contrast, most aneurysmal tissues tend to have a more uniform structure of the aortic wall with no significant difference in collagen diameter between the luminal and abluminal layers. An increase in collagen tortuosity compared to the healthy media is also observed in the aneurysmal luminal layer. The data set provided can help improve related material and multiscale models of aortic walls and aneurysm formation.

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BACKGROUND: The use of high-flow nasal cannula (HFNC) in coronavirus disease-2019 (COVID-19) patients is debated due to its uncertain benefits and risks of aerosol dispersion. This retrospective study was aimed to assess the outcome of treatment with HFNC therapy in adult COVID-19 patients with acute hypoxemic respiratory failure (AHRF) admitted in intensive care units (ICU) and to assess the factors affecting outcome. MATERIAL AND METHODS: We retrieved electronic medical records of all COVID-19 patients who received HFNC for respiratory support after failure to maintain adequate oxygenation with conventional oxygen devices, between June 1 and August 31, 2020. The data retrieved were statistically analyzed. RESULTS: A total number of 558 COVID-19 patients were admitted to ICUs, out of which 139 patients were identified to be on HFNC and 85 met the inclusion criteria for the study. The success rate of 48.2% with HFNC was observed in these patients. The patients recorded to experience HFNC success were of young age and having higher baseline oxygen saturation compared to those who had its failure. The ROX indices post-initiation were observed to be significantly higher in the success group (p ≤0.001). Awake-prone positioning while receiving HFNC was followed by around more patients in the success group (p <0.001). On multivariate logistic regression analysis, baseline oxygen saturation, awake-prone positioning, and number of days on HFNC were found to be independently affected outcome with HFNC. CONCLUSION: Almost half of the cases of moderate-to-severe COVID-19 pneumonia can be managed successfully with HFNC, without the need of mechanical ventilation. HOW TO CITE THIS ARTICLE: Kerai S, Singh R, Saxena KN, Desai SD, Bhalotra AR. A Retrospective Study on Experience of High-flow Nasal Cannula Oxygen in Critically Ill COVID-19 Adult Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2022;26(1):62-66.

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Natural phosphate (NP) and synthetic fluorapatite phosphate (SFAP) were proposed as stable, inexpensive, readily available and recyclable catalysts for the condensation of 1,2-diamines with 1,2-dicarbonyls in methanol to afford quinoxaline at room temperature. NP provided as high as 92-99% yield for quinoxalines in short reaction times (i.e., 1-45 min), while SFAP created quinoxalines with 87-97% yield in 60-120 min. From the chemical analyses, X-ray fluoresecency, X-ray diffraction, energy dispersive X-ray and Fourier-transform infrared spectroscopy methods, two main phases (CaO, P2O5) appeared in NP together with other low content phases (SiO2, Fe2O3). Compared to other phases, apatite (CaO and P2O5 as Ca10(PO4)6) played a major role in the catalytic activity of NP. SFAP with similar Ca/P atomic ratio showed a relatively lower catalytic activity than NP for the condensation of 1,2-diamine with 1,2-dicarbonyl in methanol at ambient temperature. To investigate the recyclability of catalysts, the surface properties of NP and 6-recycled NP were investigated using scanning electron microscopy, energy dispersive X-ray and Brunauer-Emmett-Teller and Barrett-Joyner-Halenda methods. Some differences were observed in NP and 6-recycled NP's particle size, surface area, the volume and size of pores, and the content of elements; nevertheless, the use-reuse process did not noticeably change the catalytic property of NP.

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The leaflets of the atrioventricular heart valves (AHVs) regulate the one-directional flow of blood through a coordination of the extracellular matrix components, including the collagen fibers, elastin, and glycosaminoglycans. Dysfunction of the AHVs, such as those caused by unfavorable microstructural remodeling, lead to valvular heart diseases and improper blood flow, which can ultimately cause heart failure. In order to better understand the mechanics and remodeling of the AHV leaflets and how therapeutics can inadvertently cause adverse microstructural changes, a systematic characterization of the role of each constituent in the biomechanical properties is appropriate. Previous studies have quantified the contributions of the individual microstructural components to tissue-level behavior for the semilunar valve cusps, but not for the AHV leaflets. In this study, for the first time, we quantify the relationships between microstructure and mechanics of the AHV leaflet using a three-step experimental procedure: (i) biaxial tension and stress relaxation testing of control (untreated) porcine AHV anterior leaflet specimens; (ii) enzyme treatment to remove a portion of either the collagen or elastin constituent; and (iii) biaxial tensile and stress relaxation testing of the constituent-removed (treated) specimens. We have observed that the removal of ∼100% elastin resulted in a ∼10% decrease in the tissue extensibility with biaxial tension and a ∼10% increase in the overall stress reduction with stress relaxation. In contrast, removal of 46% of the collagen content insignificantly affected tissue extensibility with biaxial tension and significantly increased stress decay (10%) with stress relaxation. These findings provide an insight into the microstructure-mechanics relationship of the AHVs and will be beneficial for future developments and refinements of microstructurally informed constitutive models for the simulation of diseased and surgically intervened AHV function. STATEMENT OF SIGNIFICANCE: This study presents, for the first time, a thorough mechanical characterization of the atrioventricular heart valve leaflets before and after enzymatic removal of elastin and collagen. We found that the biaxial tensile properties of elastin-deficient tissues and collagen-deficient are stiffer. The fact of elastin supporting low-stress valve function and collagen as the main load-bearing component was evident in a decrease in the low-tension modulus for elastin-deficient tissues and in the high-tension modulus for collagen-deficient tissues. Our quantification and experimental technique could be useful in predicting the disease-related changes in heart valve mechanics. The information obtained from this work is valuable for refining the constitutive models that describe the essential microstructure-mechanics relationship.

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INTRODUCTION: Extranodal (EN) involvement in diffuse large B-cell lymphoma (DLBCL) carries poor prognosis. Both the number and the specific sites of EN involvement are important in predicting prognosis. Given that the epidemiologic pattern of DLBCL in India is different from the rest of the world and such data correlations are scarce from developing countries, we aimed to find out if specific site and number of EN involvement could predict survival in DLBCL. METHODS: Patients with DLBCL treated with combination chemotherapy plus rituximab were included. Site and number of EN involvement were noted. Univariate analysis for survival was performed for EN involvement or not, specific site of involvement, and number of EN involvement (0/1 vs. ≥2). RESULTS: Among a total of 177 patients, 92 (52%) patients had EN disease. When patients with 2 or more EN sites were compared against patients with 0 or 1 site, there was significant reduction in both progression-free survival (PFS) and overall survival (OS) (3-year OS of 55% vs. 79%, P = 0.001, 3-year PFS of 42% vs. 65%, P = 0.001). When specific EN sites were studied for correlation with survival, involvement of skin/soft tissue, and serosa were associated with significant reduction in 3-year OS (33% vs. 74%, P = 0.011, and 63% vs. 75%, P = 0.03, respectively) and 3-year PFS (25% vs. 62%, P < 0.001, and 46% vs. 62%, P = 0.01, respectively). CONCLUSION: Two or more EN sites in DLBCL predicted inferior survival. Serosal and skin/soft tissue involvement also predicted poor survival.

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As the motivation to potentially allow for a more expansive role of opioid-sparing anaesthesia in various surgical specialities transpire with new zeal, promising evidence needs to be accumulated to substantiate the same. Appropriate to this context, the index case series highlight the beneficial effects of an intraoperative magnesium sulphate infusion on perioperative hemodynamic profile and postoperative recovery in patients undergoing intracranial cerebral aneurysm surgery.

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INTRODUCTION: The impact of rapid reduction in paraprotein levels, with induction chemotherapy in myeloma, on treatment outcomes is less clear. There are very few studies in transplant ineligible patients treated with novel agents, correlating an early reduction in paraprotein with survival duration. METHODS: In this retrospective analysis of newly diagnosed multiple myeloma, ineligible for stem cell transplant, paraprotein levels at baseline and 3 months were noted with percentage reduction. Survival analysis was performed with Kaplan-Meier curves and Cox proportional hazard model. RESULTS: Among a total of 121 patients, 42 (35%), 29 (24%), and 50 (41%) had paraprotein reduction of 100%, 90%-99%, and <90%, respectively from baseline levels at 3 months. Patients with complete disappearance of paraprotein (100% reduction) when compared against those with <100% reduction at 3 months had a trend toward higher overall survival (OS) (3-year OS of 81% vs. 69%, hazard ratio [HR] = 0.54, P = 0.182). However, the progression-free survival (PFS) was significantly higher when these two groups were compared (median PFS of 51 vs. 17 months, HR = 0.33, P ≤ 0.001). When patients with ≥90% reduction were compared with <90% reduction at 3 months, there was significant improvement in both OS and PFS (3-year OS of 80% vs. 48%, HR = 0.24, P = 0.001, median PFS of 38 vs. 14 months, HR = 0.13, P < 0.001). CONCLUSIONS: Achieving a faster and deeper reduction in paraprotein as early as 3 months could lead to significant improvement in PFS.

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