Potential neuroprotective role of astroglial exosomes against smoking-induced oxidative stress and HIV-1 replication in the central nervous system

Introduction: HIV-1-infected smokers are at risk of oxidative damage to neuronal cells in the central nervous system by both HIV-1 and cigarette smoke. Since neurons have a weak antioxidant defense system, they mostly depend on glial cells, particularly astrocytes, for protection against oxidative damage and neurotoxicity. Astrocytes augment the neuronal antioxidant system by supplying cysteine-containing products for glutathione synthesis, antioxidant enzymes such as SOD and catalase, glucose for antioxidant regeneration via the pentose-phosphate pathway, and by recycling of ascorbic acid.

Areas covered: The transport of antioxidants and energy substrates from astrocytes to neurons could possibly occur via extracellular nanovesicles called exosomes. This review highlights the neuroprotective potential of exosomes derived from astrocytes against smoking-induced oxidative stress, HIV-1 replication, and subsequent neurotoxicity observed in HIV-1-positive smokers.

Expert opinion: During stress conditions, the antioxidants released from astrocytes either via extracellular fluid or exosomes to neurons may not be sufficient to provide neuroprotection. Therefore, we put forward a novel strategy to combat oxidative stress in the central nervous system, using synthetically developed exosomes loaded with antioxidants such as glutathione and the anti-aging protein Klotho.     

Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome

Purpose: Fingertip injuries are common in industrial production activities as well as in domestic work. Loss of pulp hampers daily life activities. Functional and aesthetic aspects are important in fingertip reconstruction. The bone is usually exposed along with soft tissue loss. Therefore to reconstruct the pulp flap with adequate bulk is required. Methods: We reported a case series of 12 patients with the injury over the volar aspect of distal phalanx of the index or middle finger. In all cases, laterally based thenar flap was chosen. The flap donor site was closed primarily in most of cases, while 4 patients required skin graft. The flap was detached between 2-3 weeks. Functional assessment was done using static and dynamic 2-point discrimination and range of motion at each joint. The aesthetic outcome was assessed through questionnaire. The results were analyzed using the unpaired t-test (SPSS version 21). Results: Partial necrosis occurred in 2 cases while rest of flaps survived successfully. Static 2-point discrimination ranged from 6e10 mm, mean 8.6 mm; and dynamic 2-point discrimination ranged from 8-10 mm, mean 8.9 mm. The mean satisfaction score was (4.0 ± 0.55). Conclusion: Thenar flap is a good choice for reconstruction of the finger pulp as it provides the bulk with good functional and aesthetic outcome.     

Revealing the WEDM Process Parameters for the Machining of Pure and Heat-Treated Titanium (Ti-6Al-4V) Alloy

Ti-6Al-4V is an alloy that has a high strength-to-weight ratio. It is known as an alpha-beta titanium alloy with excellent corrosion resistance. This alloy has a wide range of applications, e.g., in the aerospace and biomedical industries. Examples of alpha stabilizers are aluminum, oxygen, nitrogen, and carbon, which are added to titanium. Examples of beta stabilizers are titanium–iron, titanium–chromium, and titanium–manganese. Despite the exceptional properties, the processing of this titanium alloy is challenging when using conventional methods as it is quite a hard and tough material. Nonconventional methods are required to create intricate and complex geometries, which are difficult with the traditional methods. The present study focused on machining Ti-6Al-4V using wire electrical discharge machining (WEDM) and conducting numerous experiments to establish the machining parameters. The optimal setting of the machining parameters was predicted using a multiresponse optimization technique. Experiments were planned using the response surface methodology (RSM) technique and analysis of variance (ANOVA) was used to determine the significance and contribution of the input parameters to changes in the output characteristics (cutting speed and surface roughness). The cutting speed obtained during the processing of the annealed titanium alloy using WEDM was quite large as compared to the cutting speed obtained in the case of processing the pure, quenched, and hardened titanium alloys using WEDM. The maximum cutting speed obtained while processing the annealed titanium alloy was 1.75 mm/min.     

Supernumerary teeth formation following subluxation of primary incisors

Supernumerary teeth are reported to occur in both primary and permanent dentitions, but their exact aetiology remains unclear. To date, there have been no documented reports of supernumerary teeth formation subsequent to traumatic dental injuries (TDIs) to the primary incisors. This case report illustrates such an unusual consequence where a supernumerary tooth developed subsequent to a subluxation injury to teeth 51 and 61 in a 4‐year‐old Caucasian girl. This emphasizes the importance of reviewing TDIs, as well as providing parents with sufficient information about possible sequelae at the time of trauma. Nevertheless, it also provides an excellent basis for future investigations, which are essential to establish this correlation and to prove causation.     

Impact of KCNJ11 rs5219, UCP2 rs659366, and MTHFR rs1801133 Polymorphisms on Type 2 Diabetes: A Cross-Sectional Study

OBJECTIVEType 2 diabetes (T2D) is a multifactorial disease. Its occurrence and prognosis are affected by many genes, including KCNJ11, UCP2, and MTHFR. The objective of this study was to investigate the distribution of various variants of these genes and evaluate their contribution to the outcome of T2D.METHODS80 females with T2D and class I-II obesity in the age of 40-65 years old underwent a genetic study, a biochemical blood test, and indirect calorimetry.RESULTSCarriers of C/T and T/T genotypes of the MTHFR gene had higher levels of cholesterol and triglycerides and lower levels of vitamin B6 and folate. The T/T genotype of the UCP2 gene was associated with higher levels of glycated hemoglobin, pre- and postprandial glycemia and lipid oxidation rate, lower carbohydrate oxidation, and lower serum vitamin C levels.CONCLUSIONSGenotyping UCP2 and probably KCNJ11 may help to select the optimal antidiabetic therapy and improve disease prognosis, whereas the MTHFR gene may determine the need to monitor group B vitamin status and the risk of dyslipidemia.     

Alveolar soft part sarcoma of the retroperitoneum: A case report

Alveolar soft part sarcoma is a rare soft tissue tumor with uncertain histogenesis. It is a slow growing tumor with a high rate of metastasis. The tumor is not easily identified as clinical symptoms are not pronounced. The retroperitoneum is a rare location of tumor, with a few cases published in literature. Surgical excision is the mainstay of treatment. Here we describe a rare case of a large retroperitoneal Alveolar soft part sarcoma in a young female with radiological and histopathological findings.     

The Impact of “COVID-19” and “Webinar Pandemic” on Plastic Surgery Practice in Teaching Institutes and Resident Training—A Multicentric Perspective

Introduction  The study was carried out to quantify the changes induced by the pandemic in plastic surgery practice and training and to study the impact of the webinars on plastic surgery education from a residents’ perspective. Methods  In this multicentric study, the number and type of surgeries, cause of injuries, and their regional variation during the coronavirus disease 2019 (COVID-19) period (February–September 2020) were compared with pre–COVID-19 time. An online survey on the impact of webinars was conducted for plastic surgery trainees across the country. Results  There was a significant reduction in total number of surgeries ( p = 0.003). The procedures for hand ( p = 0.156), faciomaxillary injuries ( p = 0.25), and replantations ( p = 0.46) were comparable; there was a significant reduction in combined orthopedic-plastic-surgical procedures ( p = 0.009) during the pandemic. There was a significant reduction in road accidents ( p = 0.007) and suicidal injuries ( p = 0.002) and increase in assault ( p = 0.03) and domestic accidents ( p = 0.01) during the COVID-19 period. A usefulness score of >8 was given for the webinars by 68.7% residents. There was no significant difference in perception of utility when correlated with the academic program at their institutes ( p = 0.109); 92% opined webinars should continue in post-COVID times. Conclusion  There was a drastic reduction in number of elective and emergency procedures during the COVID-19 time, negatively affecting resident training program. Majority of residents felt that webinars could prove a useful adjunct to training in formal training program in post-COVID-19 scenario.     

Reversal of hyperglycemia in mice by using human expandable insulin-producing cells differentiated from fetal liver progenitor cells

Beta-cell replacement is considered to be the most promising approach for treatment of type 1 diabetes. Its application on a large scale is hindered by a shortage of cells for transplantation. Activation of insulin expression, storage, and regulated secretion in stem/progenitor cells offers novel ways to overcome this shortage. We explored whether fetal human progenitor liver cells (FH) could be induced to differentiate into insulin-producing cells after expression of the pancreatic duodenal homeobox 1 (Pdx1) gene, which is a key regulator of pancreatic development and insulin expression in beta cells. FH cells possess a considerable replication capacity, and this was further extended by introduction of the gene for the catalytic subunit of human telomerase. Immortalized FH cells expressing Pdx1 activated multiple beta-cell genes, produced and stored considerable amounts of insulin, and released insulin in a regulated manner in response to glucose. When transplanted into hyperglycemic immunodeficient mice, the cells restored and maintained euglycemia for prolonged periods. Quantitation of human C-peptide in the mouse serum confirmed that the glycemia was normalized by the transplanted human cells. This approach offers the potential of a novel source of cells for transplantation into patients with type 1 diabetes.     

Data quality and clinical audit

Clinical audit has an increasingly important role in the quality of care being offered to patients. Only good-quality data can enable valid conclusions to be drawn, which in turn enable changes to be made for the better. More and more patient data are held on NHS computer systems, and increasingly these data are being used to facilitate the audit process. The quality of any such data needs to meet the highest standards. This article briefly defines the audit cycle and goes on to consider a typical data model. The various elements of the data model are defined, the understanding of which should enable individuals to avoid pitfalls in data collection and ensure that the data they collect for clinical audit are of the highest quality.