Evaluation of preoperative carbohydrate loading compared to preoperative fasting for enhanced recovery after elective gynecological surgeries

Background: This study aimed to evaluate the impact of preoperative carbohydrate loading on insulin resistance and clinical outcomes in patients undergoing elective gynecological surgeries. Methods: A single-center, parallel-group, randomized controlled study was conducted at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. Thirty-nine patients were randomized into two groups: the carbohydrate loading group (CHO, n=20) received 600 ml of a carbohydrate-rich drink the day before surgery and 200 ml two hours before surgery; the control group (CO, n=19) fasted overnight. Results: Baseline serum insulin, blood glucose, and insulin resistance levels were similar between the groups. Two hours before surgery, the CO group had significantly higher serum insulin levels (7.5±5.6 IU/ml) compared to the CHO group (4.5±2.9 IU/ml) (t=2.08, p=0.04). Insulin resistance was also higher in the CO group (1.9±1.6) compared to the CHO group (0.9±0.6) (t=2.40, p=0.02). Seventy-five percent of the CHO group regained bowel sounds within 24 hours post-surgery, compared to seventy-three percent of the CO group, who achieved bowel sounds after 24 hours (χ²=9.24, p=0.02). No significant differences were observed in postoperative mobilization, urinary catheter removal, fever, nausea, vomiting, length of hospital stay, or surgical site infections. Conclusions: Preoperative carbohydrate loading reduces insulin resistance and facilitates faster bowel recovery without increasing postoperative complications in elective gynecological surgery

On-Device Language Identification of Text in Images using Diacritic Characters

Diacritic characters can be considered as a unique set of characters providing us with adequate and significant clue in identifying a given language with considerably high accuracy. Diacritics, though associated with phonetics often serve as a distinguishing feature for many languages especially the ones with a Latin script. In this proposed work, we aim to identify language of text in images using the presence of diacritic characters in order to improve Optical Character Recognition (OCR) performance in any given automated environment. We showcase our work across 13 Latin languages encompassing 85 diacritic characters. We use an architecture similar to Squeezedet for object detection of diacritic characters followed by a shallow network to finally identify the language. OCR systems when accompanied with identified language parameter tends to produce better results than sole deployment of OCR systems. The discussed work apart from guaranteeing an improvement in OCR results also takes on-device (mobile phone) constraints into consideration in terms of model size and inference time

Therapeutic potential of Emblica officinalis L. fruit extract on ischemia reperfusion Injury induced acute renal failure in rat

The present study was designed to explore the ameliorative effect of hydroalcoholic extract of Emblica officinalis (HAE) on renal ischemia reperfusion (I/R) injury induced acute renal failure (ARF). Rats were subjected to administration of HAE (250 and 500 mg/kg, p.o. for 10 days) before one hour of the ischemia (30 min) reperfusion (24 h) process on the 10th day of experiment. For evaluating the effect of HAE on acute renal failure, Blood urea nitrogen (BUN) and creatinine (Cr) were estimated in serum sample whereas, N-acetyl β-d-glucosaminidase (NAG) was estimated in urine sample. Further, renal tissue was used to evaluate the oxidative stress markers and histopathological changes. The results demonstrated that I/R caused marked changes in various biomarker levels. However, treatment with HAE significantly attenuated these changes. Histopathological evaluation also revealed protective role of HAE on renal cortex and tubular cells. These effects clearly indicated that HAE produced renoprotective effect against I/R induced acute renal failureColegio de Farmacéuticos de la Provincia de Buenos Aire

Necrotizing fasciitis caused by Pseudomonas aeruginosa: a rare case report and recent concepts in diagnosis and management

Necrotizing fasciitis caused by Pseudomonas aeruginosa is an extremely rare and life threatening bacterial soft tissue infection. Here we report a case study of fully established necrotizing fasciitis associated with monomicrobial pseudomonas infection in a 34 years old male. The patient presented with painful, necrosed areas of skin and soft tissue over right gluteal region which rapidly progressed to right upper back. Aggressive supportive measures and early debridement lead to a full recovery with no functional deficits

Integrated genomic characterization of oesophageal carcinoma

Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies.ope

Blast resilience of composite sandwich panels with hybrid glass-fibre and carbon-fibre skins

The development of composite materials through hybridisation is receiving a lot of interest; due to the multiple benefits, this may bring to many industries. These benefits include decreased brittle behaviour, which is an inherent weakness for composite materials, and the enhancement of mechanical properties due to the hybrid effect, such as tensile and flexural strength. The effect of implementing hybrid composites as skins on composite sandwich panels is not well understood under high strain rate loading, including blast loading. This paper investigates the blast resilience of two types of hybrid composite sandwich panel against a full-scale explosive charge. Two hybrid composite sandwich panels were mounted at a 15 m stand-off distance from a 100 kg nitromethane charge. The samples were designed to reveal whether the fabric layup order of the skins influences blast response. Deflection of the sandwich panels was recorded using high-speed 3D digital image correlation (DIC) during the blast. It was concluded that the combination of glass-fibre reinforced polymer (GFRP) and carbon-fibre reinforced polymer (CFRP) layers in hybrid laminate skins of sandwich panels decreases the normalised deflection compared to both GFRP and CFRP panels by up to 41 and 23%, respectively. The position of the glass-fibre and carbon-fibre layers does not appear to affect the sandwich panel deflection and strain. A finite element model has successfully been developed to predict the elastic response of a hybrid panel under air blast loading. The difference between the maximum central displacement of the experimental data and numerical simulation was ca. 5% for the hybrid panel evaluated

Integrated genomic characterization of oesophageal carcinoma

Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies

Integrative Genomic Analysis of Cholangiocarcinoma Identifies Distinct IDH -Mutant Molecular Profiles

Cholangiocarcinoma (CCA) is an aggressive malignancy of the bile ducts, with poor prognosis and limited treatment options. Here, we describe the integrated analysis of somatic mutations, RNA expression, copy number, and DNA methylation by The Cancer Genome Atlas of a set of predominantly intrahepatic CCA cases and propose a molecular classification scheme. We identified an IDH mutant-enriched subtype with distinct molecular features including low expression of chromatin modifiers, elevated expression of mitochondrial genes, and increased mitochondrial DNA copy number. Leveraging the multi-platform data, we observed that ARID1A exhibited DNA hypermethylation and decreased expression in the IDH mutant subtype. More broadly, we found that IDH mutations are associated with an expanded histological spectrum of liver tumors with molecular features that stratify with CCA. Our studies reveal insights into the molecular pathogenesis and heterogeneity of cholangiocarcinoma and provide classification information of potential therapeutic significance

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes