Ethics of iPSC-Based Clinical Research for Age-Related Macular Degeneration: Patient-Centered Risk-Benefit Analysis

The opportunity to undergo an induced pluripotent stem cell-based autologous transplant can strike patients as a chance for a cure from a debilitating condition with few options for respite. However, when clinical studies of this caliber present themselves, patients and researchers, each with their own set of motives, may find it difficult to take a balanced approach to evaluating them. We present a patient-centered risk-benefit analysis of the iPSC-based clinical research currently underway in Japan, including a survey of in vitro and in vivo tests that support this project, an in-depth discussion of risks, and further elucidation of considerations patients may wish to consider. The arguments presented will assist patients in undertaking a more informed decision-making process.     

Heated humidified high-flow nasal cannula versus low-flow nasal cannula as weaning mode from nasal CPAP in infants ≤28 weeks of gestation

Despite the paucity of evidence, the practice of weaning nasal continuous positive airway pressure (NCPAP) is widespread. However, the most clinically effective non-invasive ventilatory support strategy remains to be determined. We compared the outcome of very premature infants with respiratory distress syndrome treated with a combination of NCPAP and heated humidified high-flow nasal cannula (HHFNC) versus NCPAP and low-flow nasal cannula (LFNC). Between 2004 and 2008, patients ≤28 weeks of gestation and <1,250 g of birth weight were treated with NCPAP + HHFNC or NCPAP + LFNC. Their respiratory and non-respiratory outcome including cost-effectiveness was compared after matching for antenatal steroid doses, mode of delivery, birth plurality, gestational age, birth weight, gender, surfactant doses, length of mechanical ventilation and clinical risk index for babies-II (CRIB-II) score. Thirty-nine infants received HHFNC + NCPAP, and 40 received NCPAP + LFNC. Median gestational age and birth weight were 27 weeks and 930 g and 27 weeks and 980 g, respectively. The total number of NCPAP days was significantly reduced by 50 % in the HHFNC group. Thirteen percent of the patients on NCPAP suffered from nasal bridge lesions compared to none on HHFNC. Respiratory and non-respiratory outcome was not significantly different otherwise. Combination of NCPAP and HHFNC reduced costs by 33 %. Conclusions: HHFNC shortens NCPAP time without increasing overall length of non-invasive respiratory support in very preterm infants. Unlike NCPAP, HHFNC does not seem to increase the risk of nasal trauma and appears to improve cost-effectiveness whilst producing otherwise equal respiratory and non-respiratory outcomes.     

Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study

Objectives. To assess the changing mid-face fracture patterns using a computed tomography scan. Methodology: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21–30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). Conclusion. With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.     

INAUGURAL ARTICLE by a Recently Elected Academy Member:Plant immunity: Rice XA21-mediated resistance to bacterial infection

In this article, we describe the development of the plant immunity field, starting with efforts to understand the genetic basis for disease resistance, which ∼30 y ago led to the discovery of diverse classes of immune receptors that recognize and respond to infectious microbes. We focus on knowledge gained from studies of the rice XA21 immune receptor that recognizes RaxX (required for activation of XA21 mediated immunity X), a sulfated microbial peptide secreted by the gram-negative bacterium Xanthomonas oryzae pv. oryzae. XA21 is representative of a large class of plant and animal immune receptors that recognize and respond to conserved microbial molecules. We highlight the complexity of this large class of receptors in plants, discuss a possible role for RaxX in Xanthomonas biology, and draw attention to the important role of sulfotyrosine in mediating receptor–ligand interactions.

Perception of extracellular signals by cell-surface receptors is of central importance to eukaryotic development and immunity. For example, in the absence of an adaptive immune system, plants rely on a repertoire of innate immune receptors to recognize potential pathogens and initiate defensive responses. A key research focus of the P.R. laboratory is to understand the principles and mechanisms that underlie the processes governing the immune response.Here we describe our 30-y effort to dissect the genetic and molecular basis of the innate immune response in the staple food crop and model organism rice Oryza sativa.     

Transverse Aortic Arch to Descending Aorta Ratio: A New Echocardiographic Parameter for Management of Coarctation of the Aorta in the Infant

Objective. The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making. Methods. Echocardiograms of 47 patients <6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age‐matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA : DAO ratio) were calculated from the end‐systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm. Results. Both the proximal and distal TAA : DAO ratios were significantly lower in the study vs. control group (P= .001) and in patients who underwent patch reconstruction of the aorta vs. extended end‐to‐end anastomosis (P= .014; P= .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA : DAO <0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty‐six out of 47 patients were free from reintervention. Conclusion. The TAA : DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.     

Coronavirus disease (COVID‐19): An updated review based on current knowledge and existing literature for dermatologists

The world entered the year 2020 with reports of the emergence of a new viral illness in Wuhan city, Hubei province, China. In January 2020, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was identified to be the causative novel coronavirus for the cluster of patients suffering from pneumonia in China. The disease was later named as coronavirus disease (COVID‐19) and was declared a pandemic by the World Health Organization on March 11, 2020. Several studies, since then, have tried to study and explain the origin of SARS‐CoV‐2, its structure and pathogenicity, epidemiology, modes of transmission, spectrum of illness and causes of mortality and morbidity. The current management strategies focus on supportive care and prevention of complications. With no definite treatment, as of now, encouraging reports of some anti‐viral and anti‐malarial drugs in the management of COVID‐19 generate some hope. This review intends to cover the current known aspects of COVID‐19 and SARS‐CoV‐19, based on the available literature.     

Women’s Experiences with Intimate Partner Violence and Their Mental Health Status in India: A Qualitative Study of Sambalpur City

The intimate partner violence (IPV) against women has been identified as a violation of human rights and a serious public health concern. There is not only the immediate consequence of partner violence, such as injury or death but also the other long-term health consequences. IPV can be associated with psychological effects such as depressive disorder, posttraumatic stress disorder, and substance abuse. The study aims to explore the nature and causes of IPV on women’s life and their personal experiences to deal with. This is an NGO-based study. For better understanding of the issues, Purposive sampling was used in selecting women with clinically diagnosed mental illness who experienced IPV. The qualitative research methodology was employed to explore the experiences and impact of IPV on the mental health status of women. For analysis, we used a phenomenological approach and conducted in-depth interviews. Findings show the participating women were suffering from IPV in physical, psychological, and sexual forms. Majority of respondents felt that wife-beating and abusing was fairly common. Most of the women had to face violence on a frequent and occasional basis. IPV experienced women were facing a mental illness like anxiety, depression and sleeping-disorder. The women, who were facing mental illness due to IPV, have been and continue to be exposed to such violence. Despite being employed and suffering from IPV deeply, women choose to stay with their abusive partner because of their children future, lack of support, and social security. The mental health of victims’ was clinically diagnosed, including self-assessed symptoms. It means participants were aware that they are mentally ill because of IPV. The healthy and quick recovery treatment should be given according to the need of women, rather than providing comprehensive standardised treatment for all.