The purpose of this prospective, randomized, double blind study was to assess the effect of tranexamic acid on blood loss, quality of surgical field and duration of surgery in adolescent orthognathic surgery patients. 50 consecutive patients, scheduled for orthognathic surgery were included. The study group (n=25) received tranexamic acid 10mg/kg as a bolus preoperatively followed by 1mg/kg as a maintenance dose intra operatively; the control group (n=25) received placebo (normal saline). All patients received moderate hypotensive anaesthesia with nitroglycerin and had surgery according to a standard protocol. Intra operative blood loss, duration of surgery, quality of surgical field, blood transfusion and complications, if any, were recorded. The mean total blood loss was 166.1±65.49ml in the study group and 256.4±77.80ml in the control group. The results showed statistically significant reduction in blood loss (p<0.001) and improved quality of surgical field (p<0.001) in the study group. There was no significant difference in duration of surgery and transfusion requirements between the two groups. In conclusion, preoperative and intra operative administration of the antifibrinolytic agent, tranexamic acid, is effective in controlling blood loss and improving the quality of the surgical field.

Background: Mental foramen (MF) is an anatomical structure of particular importance in local anesthesia and surgical procedures in terms of achieving effective mandibular nerve blocks and avoiding injuries to the neurovascular bundles. Aim: To determine the morphometry and morphology of MF in south Andhra population of India, hitherto unreported. Materials and Methods: Ninety dry dentulous mandibles of both sexes were examined for position, size, shape and number of MF. Results: Various parameters investigated are, the horizontal distance between (1) symphysis menti and MF was 27.2 mm on right and 27.7 mm on the left,(2) MF and posterior border of ramus was 70.7 mm on both sides, vertical distance between (3) MF and inferior border of mandible was16.5 mm on right and 14.3 mm on left,(4) alveolar crest and MF was 13.7 mm on right and 16.4 on left,(5) distance between the MF and below the apex of premolar socket was +2.8 mm on right and +3.5 mm on left and above the socket was -2.8 mm on right and -2.7 mm on left. Occurrence of MF below the second premolar tooth was found to be highest (73.2%). Average size of MF was larger on left and its way of exit was in postero-superior direction. Shape of MF was round in 79% and oval in 21% and double MF was found in 8.9% of mandibles. Conclusions: In the present study, most common position of MF was found below the apex of second premolar in 73.2% and between the second premolar and first molar in 19% of mandibles. The other morphometrical findings of this study may be implicated by dental practitioners and maxillofacial surgeons.

BackgroundRapid HIV testing is not permitted in Australia at the point of care. The authors evaluate the expected net effect of rapid HIV testing compared with standard serology diagnostic tests in terms of onward HIV transmission.MethodsThe authors used data for 174 men who had sex with men testing HIV-positive at the Melbourne Sexual Health Centre, Australia, in an agent-based mathematical model. Time of diagnosis is simulated according to conventional enzyme immunoassays or rapid HIV tests, with different window periods. The authors calculated the expected number of additional/averted transmissions due to missed or earlier diagnoses.ResultsFourth generation rapid tests were simulated to miss ∼2-3% of diagnoses compared with conventional fourth generation enzyme immunoassay tests. However, in the remaining 97-98% of cases the rapid test would result in earlier detection of HIV. Overall, the rapid test would reduce time to patients receiving results by a median of ∼12 days. Assuming no changes in testing rates, the introduction of rapid testing diagnostic technologies would prevent one in every 2000-5000 HIV transmissions compared with the conventional diagnostic test.ConclusionsRapid tests would have a marginal benefit in reducing HIV transmission between men compared with conventional tests under assumptions of no changes in testing frequencies.

Gastroschisis is the herniation of abdominal viscera through a paramedian abdominal wall fusion defect without involvement of the umbilical cord. Evisceration usually contains intestinal loops and has no surrounding membrane. Rarely, herniation of other major viscera such as stomach and liver occurs, which makes the prognosis worse. Gastroschisis is usually not associated with sacrococcygeal teratoma. In the present report, a very rare case of gastroschisis associated with sacrococcygeal teratoma is described. The gastroschisis had complete evisceration of the stomach, bowel and extracorporeal liver. A large sacrococcygeal mass was located on the posteroinferior part of the trunk and gluteal region, and was completely external. The fetus also showed a malrotated lower limb and talipes equinovarus.

In humans, hypertension is considered a state of oxidative stress that can contribute to the development of atherosclerosis and other hypertension-induced organ damages. The objective of this study was to evaluate oxidative status, antioxidant activities, and oxidative stress by-products among Indian patients with various stages of hypertension. Lipid profile, enzymatic and non-enzymatic antioxidants, lipid peroxidation as thiobarbituric acid reactive substances (TBARS), C-reactive protein, electrolytes, and minerals were analyzed in the blood of newly diagnosed prehypertensives, stage I and II hypertensives (n = 20 in each group) and were compared to their age-matched normotensives. Elevated levels of lipid profile (except high density lipoprotein cholesterol [HDL-C]) were observed in stage I and II hypertensive patients. Enzymatic and non-enzymatic antioxidants were significantly (P < 0.05) lower, while TBARS and C-reactive protein were higher in prehypertensives, and stage I and II hypertensives. Significant (P <0.05) changes were also observed in the plasma Na(+) and K(+) concentrations among the hypertensive groups. Serum levels of zinc, copper, and magnesium were significantly (P < 0.05) lower in prehypertensives, and stage I and II hypertensives as compared to normotensives. The study indicated a strong association between blood pressure (BP) and oxidative stress-related parameters and suggests a possible role of oxidative stress in the development of elevated BP.

Although it is known that resident gut flora contribute to immune system function and homeostasis, their role in the progression of the autoimmune disease type 1 diabetes (T1D) is poorly understood. Comparison of stool samples isolated from Bio-Breeding rats, a classic model of T1D, shows that distinct bacterial populations reside in spontaneous Bio-Breeding diabetes-prone (BBDP) and Bio-Breeding diabetes-resistant animals. We have previously shown that the oral transfer of Lactobacillus johnsonii strain N6.2 (LjN6.2) from Bio-Breeding diabetes-resistant to BBDP rodents conferred T1D resistance to BBDP rodents, whereas Lactobacillus reuteri strain TD1 did not. In this study, we show that diabetes resistance in LjN6.2-fed BBDP rodents was correlated to a Th17 cell bias within the mesenteric lymph nodes. The Th17 bias was not observed in the non-gut-draining axillary lymph nodes, suggesting that the Th17 bias was because of immune system interactions with LjN6.2 within the mesenteric lymph node. LjN6.2 interactions with the immune system were observed in the spleens of diabetes-resistant, LjN6.2-fed BBDP rats, as they also possessed a Th17 bias in comparison with control or Lactobacillus reuteri strain TD1-fed rats. Using C57BL/6 mouse in vitro assays, we show that LjN6.2 directly mediated enhanced Th17 differentiation of lymphocytes in the presence of TCR stimulation, which required APCs. Finally, we show that footpad vaccination of NOD mice with LjN6.2-pulsed dendritic cells was sufficient to mediate a Th17 bias in vivo. Together, these data suggest an interesting paradigm whereby T1D induction can be circumvented by gut flora-mediated Th17 differentiation.

BACKGROUND: The intestinal epithelium is a barrier that composes one of the most immunologically active surfaces of the body due to constant exposure to microorganisms as well as an infinite diversity of food antigens. Disruption of intestinal barrier function and aberrant mucosal immune activation have been implicated in a variety of diseases within and outside of the gastrointestinal tract. With this model in mind, recent studies have shown a link between diet, composition of intestinal microbiota, and type 1 diabetes pathogenesis. In the BioBreeding rat model of type 1 diabetes, comparison of the intestinal microbial composition of diabetes prone and diabetes resistant animals found Lactobacillus species were negatively correlated with type 1 diabetes development. Two species, Lactobacillus johnsonii and L. reuteri, were isolated from diabetes resistant rats. In this study diabetes prone rats were administered pure cultures of L. johnsonii or L. reuteri isolated from diabetes resistant rats to determine the effect on type 1 diabetes development. METHODOLOGY/PRINCIPAL: Findings Results Rats administered L. johnsonii, but not L. reuteri, post-weaning developed type 1 diabetes at a protracted rate. Analysis of the intestinal ileum showed administration of L. johnsonii induced changes in the native microbiota, host mucosal proteins, and host oxidative stress response. A decreased oxidative intestinal environment was evidenced by decreased expression of several oxidative response proteins in the intestinal mucosa (Gpx1, GR, Cat). In L. johnsonii fed animals low levels of the pro-inflammatory cytokine IFNgamma were correlated with low levels of iNOS and high levels of Cox2. The administration of L. johnsonii also resulted in higher levels of the tight junction protein claudin. CONCLUSIONS: It was determined that the administration of L. johnsonii isolated from BioBreeding diabetes resistant rats delays or inhibits the onset of type 1 diabetes in BioBreeding diabetes prone rats. Taken collectively, these data suggest that the gut and the gut microbiota are potential agents of influence in type 1 diabetes development. These data also support therapeutic efforts that seek to modify gut microbiota as a means to modulate development of this disorder.

In this paper, a novel fast method for modeling mammograms by deterministic fractal coding approach to detect the presence of microcalcifications, which are early signs of breast cancer, is presented. The modeled mammogram obtained using fractal encoding method is visually similar to the original image containing microcalcifications, and therefore, when it is taken out from the original mammogram, the presence of microcalcifications can be enhanced. The limitation of fractal image modeling is the tremendous time required for encoding. In the present work, instead of searching for a matching domain in the entire domain pool of the image, three methods based on mean and variance, dynamic range of the image blocks, and mass center features are used. This reduced the encoding time by a factor of 3, 89, and 13, respectively, in the three methods with respect to the conventional fractal image coding method with quad tree partitioning. The mammograms obtained from The Mammographic Image Analysis Society database (ground truth available) gave a total detection score of 87.6%, 87.6%, 90.5%, and 87.6%, for the conventional and the proposed three methods, respectively.

Four simple and sensitive methods for the assay of prazosin hydrochloride (PRH) are developed. These methods are based on the formation of coloured species by treating it either with excess N-bromosuccinimide (NBS) and determining the unconsumed NBS with p-N-methyl aminophenol sulphate (metol)-sulphanilamide (SA) reagent (method A, lambda(max) 520 nm): with 3-methyl-2-benzothiazolinone hydrazone hydrochloride (MBTH) in the presence of eerie ammonium sulphate (CAS)(method B, lambda(max) 620 nm) or with acidic dyes such as orange-II (O-II)(method C, lambda(max) 490 nm) and alizarin violet 3B (AV-3B)(method D, lambda(max) 570 nm) under the specified experimental conditions. Regression analysis of Beer's law plot showed good correlation in the concentration range of 1.0-10.0, 2.5-25.0, 1.0-17.5 and 2.5-30.0 mug ml for methods A, B, C and D respectively.

The study was undertaken to investigate the effect of sesame oil in hypertensive patients who were on antihypertensive therapy either with diuretics (hydrochlorothiazide) or ss-blockers (atenolol). Thirty-two male and 18 female patients aged 35 to 60 years old were supplied sesame oil (Idhayam gingelly oil) and instructed to use it as the only edible oil for 45 days. Blood pressure, anthropometry, lipid profile, lipid peroxidation, and enzymic and non-enzymic antioxidants were measured at baseline and after 45 days of sesame oil substitution. Substitution of sesame oil brought down systolic and diastolic blood pressure to normal. The same patients were asked to withdraw sesame oil consumption for another 45 days, and the measurements were repeated at the end of withdrawal period. Withdrawal of sesame oil substitution brought back the initial blood pressure values. A significant reduction was noted in body weight and body mass index (BMI) upon sesame oil substitution. No significant alterations were observed in lipid profile except triglycerides. Plasma levels of sodium reduced while potassium elevated upon the substitution of sesame oil. Lipid peroxidation (thiobarbituric acid reactive substances [TBARS]) decreased while the activities of superoxide dismutase (SOD), catalase (CAT), and the levels of vitamin C, vitamin E, ss-carotene, and reduced glutathione (GSH) were increased. The results suggested that sesame oil as edible oil lowered blood pressure, decreased lipid peroxidation, and increased antioxidant status in hypertensive patients.