Allicin stimulates lymphocytes and elicits an antitumor effect: a possible role of p21ras

Allicin, the main organic allyl sulfur component in garlic, exhibits immune-stimulatory and antitumor properties. Allicin stimulated [(3)H]thymidine incorporation in mouse splenocytes and enhanced cell-mediated cytotoxicity in human peripheral mononuclear cells. Multiple administration (i.p.) of allicin elicited a marked antitumor effect in mice inoculated with B-16 melanoma and MCA-105 fibrosarcoma. The immune-stimulatory and antitumor effects of allicin are characterized by a bell-shaped curve, i.e. allicin at high, supra-optimal concentrations is less effective or inhibitory. Allicin induced activation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) in human peripheral mononuclear cells, and also in wild-type Jurkat T-cells. Allicin failed to activate ERK1/2 in Jurkat T cells that express p21(ras), in which Cys118 was replaced by Ser. These cells are not susceptible to redox-stress modification and activation. We postulate that the immune stimulatory effect of allicin is mediated by redox-sensitive signaling such as activation of p21(ras). It is suggested that the antitumor effect of allicin is related to its immune-stimulatory properties.     

Approach to the difficult transseptal: diathermy facilitated left atrial access

Percutaneous transseptal left atrial (LA) access is increasingly becoming a routine procedure in the electrophysiology and cardiac catheterisation laboratories. Our aim was to review an unselected large series of this procedure performed over a period of five years. We clinically characterised difficult cases and presented a method of safe and expeditious LA access. Overall, 543 transseptal punctures were performed. Of those, 10 were classified as difficult, with failure to access the LA in three or more attempts. In all 10 cases, surgical electrocautery was successfully used to facilitate needle puncture of the septum. All patients subsequently underwent an uncomplicated procedure. In conclusion, we describe a method to trouble-shoot the difficult transseptal access procedure, outlining the clinical characteristics, echocardiographic features and special precautions that need to be considered when utilising this method.     

OSAS and upper pharynx surgery: Does basilingual collapsus always rhyme with failure?

ObjectiveDrug-induced-sedation endoscopy (DISE) has proved superior to awake clinical examination for diagnosis of upper-airway obstruction sites and surgical planning. Our question is: does multilevel obstruction on DISE systematically entail failure for surgery limited to the upper pharynx?Material & methodsWe conducted a retrospective single-center study in patients with obstructive sleep apnea syndrome (OSAS) treated by single-level surgery of the upper pharynx (tonsillectomy with or without pharyngoplasty). Preoperative assessment included polysomnography (PSG) and DISE. Surgical efficacy was assessed on postoperative PSG. Treatment response was defined by postoperative apnea-hypopnea index (AHI) < 20 events/h with 50% reduction, and cure by AHI < 10 (patients with preoperative AHI ≤ 10 being excluded). Efficacy was compared between groups without (group A) and with basilingual or laryngeal collapsus on DISE (group B).ResultsWe analyzed 63 patients, with mean preoperative AHI 33.8 ± 17.9 events/h. The two groups (A, n = 36; B, n = 27) were clinically comparable. Postoperative PSG took place at a mean 8.5 ± 11.5 months. The success rate was 66.7% in group A (mean reduction in AHI, 57.3 ± 36.2%) and 59.3% in group B (mean reduction, 53.9 ± 39.2%). Cure rates were respectively 48.5% and 48.1%. There was no statistically significant difference between the two groups (P > 0.1).ConclusionsOropharyngeal surgery can alleviate associated obstructive sites found on DISE in the lower pharynx, and step-by-step treatment shows efficacy equal to that of single-step multilevel surgery.     

A prospective controlled evaluation of Class II division 1 malocclusions treated with fixed lingual mandibular growth modificator

Objective: To assess the net dentofacial effects of the fixed lingual mandibular growth modificator (FLMGM).Materials and Methods:The study sample comprised 38 patients with Class II/1 malocclusion and retrognathic mandible. All were in the pubertal growth spurt. Whereas FLMGM was applied to the treatment group (n  =  21, mean age  =  13.2 years), no treatment was performed on the control group (n  =  17, mean age  =  12.5 years). Skeletal and dentoalveolar changes were assessed on digital lateral cephalograms obtained at the beginning and end of the treatment/observation period of 8 months. Paired and independent t-tests were used to assess the differences within and between groups.Results:Maxillary growth was not affected by FLMGM treatment, which resulted in a significant overjet reduction of 4.1 mm, an increase in total mandibular length (Co-Gn) of 2.3 mm, chin advancement of 1.6°, and upper incisor retroclination of 4.0°. A reduction of 2.4° in ANB was largely due to an increase of 1.8° in SNB. Favorably, the lower incisors were obviously retroclined by 4.5°. The changes in the vertical skeletal relationships were negligible.Conclusion:FLMGM was effective in treating growing Class II/1 patients and produced favorable dentofacial effects, with the matched untreated sample showing minimal changes. Lower incisor retroclination was a benefit of FLMGM treatment.     

Mechanical Properties,Crack Width,and Propagation of Waste Ceramic Concrete Subjected to Elevated Temperatures: A Comprehensive Study

Waste ceramic concrete (WOC) made from waste ceramic floor tiles has several economic and environmental benefits. Fire is one of the most common disasters in buildings, and WOC is a brittle construction material; therefore, the mechanical properties of WOC structures under high temperatures should be considered. According to previous studies, hybrid fiber can further reduce damage to concrete under high temperatures. Meanwhile, crack width and propagation are among the key characteristics of concrete materials that need to be considered, but few studies have focused on their behavior when subjected to elevated temperatures. The new concrete materials proposed by the authors are WOC and WOC-Hybrid. WOC was prepared with Natural Coarse Aggregates (NCA), Natural Fine Aggregate (NFA), Ordinary Portland Cement (OPC 43 grade), and ceramic waste tiles with 20% replacements for coarse aggregates, 10% replacements for fine aggregates, and 10% replacement for cement. In contrast, WOC-Hybrid was prepared with the addition of hybrid fiber (1% crimped steel fiber and 1% polyvinyl alcohol fiber) in WOC. The specimens were exposed to temperatures of 100–300 °C, and then the specimens were tested for tensile and compressive strength. The present study aims to find a new method to improve concrete resistance to elevated temperatures at the lowest costs by experimental and computational analysis via machine learning models. The application of machine learning models such as artificial neural networks (ANN) and multiple linear regression (MLR) was employed in this study to predict the compressive and tensile strength of concrete. The linear coefficient correlation (R²) and mean square error (MSE) were evaluated to investigate the performance of the models. Based on the experimental analysis, the results show that the effect of hybrid fiber on the crack width and propagation is greater than that on the crack width and propagation of WOC and PC after exposure to high temperatures. However, the enhanced effect of hybrid fiber on the mechanical properties, rack width, and propagation decreases after subjecting it to a high-temperature treatment, owing to the melting and ignition of hybrid fibers at high temperatures. Regarding the computational analysis, it was found that the developed MLR model shows higher efficiency than ANN in predicting the compressive and tensile strength of PC, WOC, and WOC-Hybrid concrete.     

Prediction of Rockfill Materials’ Shear Strength Using Various Kernel Function-Based Regression Models—A Comparative Perspective

The mechanical behavior of the rockfill materials (RFMs) used in a dam’s shell must be evaluated for the safe and cost-effective design of embankment dams. However, the characterization of RFMs with specific reference to shear strength is challenging and costly, as the materials may contain particles larger than 500 mm in diameter. This study explores the potential of various kernel function-based Gaussian process regression (GPR) models to predict the shear strength of RFMs. A total of 165 datasets compiled from the literature were selected to train and test the proposed models. Comparing the developed models based on the GPR method shows that the superlative model was the Pearson universal kernel (PUK) model with an R-squared (R²) of 0.9806, a correlation coefficient (r) of 0.9903, a mean absolute error (MAE) of 0.0646 MPa, a root mean square error (RMSE) of 0.0965 MPa, a relative absolute error (RAE) of 13.0776%, and a root relative squared error (RRSE) of 14.6311% in the training phase, while it performed equally well in the testing phase, with R² = 0.9455, r = 0.9724, MAE = 0.1048 MPa, RMSE = 0.1443 MPa, RAE = 21.8554%, and RRSE = 23.6865%. The prediction results of the GPR-PUK model are found to be more accurate and are in good agreement with the actual shear strength of RFMs, thus verifying the feasibility and effectiveness of the model.     

Colour Change of Sustainable Concrete Containing Waste Ceramic and Hybrid Fibre: Effect of Temperature

Construction and demolition (C&D) waste was considered as zero value materials and, as a result, most C&D waste materials ended up in landfills, eventually constituting environmental issues. Therefore, it is important to explore the potential of such C&D waste materials for concrete production. Thus, this research effort aims to find a new method to improve sustainable concrete properties exposed to elevated temperatures at the lowest costs and identify the relationship between temperature change and a change in colour in a heat-exposed concrete structure. Therefore, this study explored the behaviour of three types of concrete: plain concrete (PC), waste ceramic optimal concrete (WOC), and waste ceramic optimal concrete reinforced by hybrid fibre (WOC-Hybrid) in ambient and elevated temperature. The study shows that colour change in a concrete structure exposed to high temperature has a consistent relationship, where it has been found that the colour alteration is of great interest because its appearance usually coincides with the onset of a significant loss of concrete strength as a result of elected temperatures. Overall, it can be considered that waste ceramic materials reinforced by hybrid fibres can be used for concrete production, and by doing so, the negative impact of these wastes on the environment can be controlled as well as fortify the mechanical properties.     

Intraoperative angioedema induced by angiotensin II receptor blocker: a case report

Background

Angiotensin II receptor blockers are a class of antihypertensive agent that is developed to exclude the adverse effects of angiotensin converting enzyme inhibitors. However, as angiotensin II receptor blockers have begun to be more widely prescribed, cases of angiotensin II receptor blocker-induced angioedema have been reported. Rare cases of angioedema following surgery in patients using angiotensin converting enzyme inhibitors have been published.

Case presentation

A 38-year-old man with past history of hypertension was admitted for an elective lumbosacral spine surgery. He had been taking Valsartan 160 mg a day for the past 4 years.At the end of the surgical procedure and turning the patient into supine position, we noticed severe swelling in the neck and the face with.an edematous tongue, floor of the mouth, glottis, and supraglottic areas. A diagnosis of drug induced angioedema was made and intravenous dexamethasone, diphenhydramine and ranitidine were given. The patient remained intubated and was transferred to the intensive care unit. The valsartan was suspected to be the precipitating factor for the angioedema and was therefore discontinued.The swelling started to regress after 2 h, and resolved completely by the third day.

Conclusion

The precise mechanism of angiotensin II receptor blocker-induced angioedema is still unknown and should be thoroughly investigated. This report demonstrates a unique case of intraoperative angiotensin II receptor blocker-induced angioedema. Potential differential diagnoses of postoperative facial edema are discussed in detail, including the prolonged prone positioning for posterior spine surgery. Anesthesiologists should be aware of such rare, but potentially dangerous, perioperative adverse reaction that can occur with angiotensin II receptor blockers use.

     

Active pulmonary tuberculosis manifesting with idiopathic thrombocytopenic purpura: a rare presentation

A 17-year-old girl presented with a 3-day history of epistaxis, vaginal bleeding and petechiae over the lower extremities. The patient had been feeling unwell with productive cough, fever, chills, poor appetite and weight loss for 2 months. Laboratory findings revealed anemia and thrombocytopenia, whereas bone marrow examination was unremarkable. She was diagnosed as having idiopathic thrombocytopenic purpura (ITP) in association with active tuberculosis (TB). The patient was treated with intravenous immunoglobulin (IVIg) and corticosteroid along with anti-TB drugs. During the follow-up period there was no recurrence of thrombocytopenia or TB. It is important to consider TB in the differential diagnosis of ITP, particularly in high TB-burden areas.