Intraoperative Measurement of Intracranial Pressure During Cranial Vault Remodeling in Children with Craniosynostosis

Purpose In this study, we analyzed the utility of intracranial pressure (ICP) monitoring intraoperatively for deciding height reduction and need for cerebrospinal fluid (CSF) diversion during cranial vault remodeling in children with multisutural craniosynostosis (CS). Methods This is a retrospective observational study of children who underwent surgery for CS and ICP monitoring during surgery. The ICP was monitored using an external ventricular drainage catheter. The ICP monitoring was continued during the entire procedure. Results A total of 28 (19 boys) children with the involvement of two or more sutures underwent ICP monitoring during surgery. The commonest pattern of suture involvement was bicoronal seen in 16 (57.1%) children followed by pancraniosynostoses in eight (28.6%) cases. The mean opening ICP was 23 mm Hg, which dropped to 10.9 mm Hg after craniotomy. The ICP increased transiently to 19.5 mm Hg after height reduction, and the mean ICP at closure was 16.2 mm Hg. The ICP recordings helped in undoing the height reduction in two children and ventriculoperitoneal shunt after surgery in two children. Conclusions Intraoperative monitoring of ICP helps in deciding the type of cranial vault remodeling and the need for CSF diversion after surgery.

Traditional Marriage in Rural Bangladesh: An Ethical Consideration

One of the common arguments to justify the traditional arrangement to marry off daughters in rural Bangladesh is that through this procedure they get a secured life under their husband’s supervision. It is a well-known proposition that if parents really care about daughters, searching for a bridegroom from a well-off family is the best option. Typically, daughters’ families mainly the father arrange such marriage, and the girl’s consent is hardly taken into account. However, I argue this traditional system values only girls’ caregiving and reproductive roles, ignoring all other life-affirming values. If daughters are not free to decide whether to marry or not to marry, their autonomy as human beings are violated. Moreover, considering marriage as a responsibility shifting process could objectify and commodify women in such a way that would destroy potentials to flourish life and make them a victim of violence. There are strong theoretical and empirical reasons to believe that the entire procedure of marriage is ethically blameworthy and detrimental for women. Sufficient ground can be found to put more priority on developing daughters’ competency to make them economically and socially independent so that they can choose when to marry, whom to marry or not to marry.

Enhancing Agricultural Product Supply Chain Management Using Blockchain Technology: Concept

In traditional agricultural supply chain management, due to involvement of many stakeholders in the entire procedure ranging from farmers, retailers to final vendors, it is merely the producer of the agricultural products i.e., farmers get its direct benefit. The middle stakeholders are always more beneficial than farmers and hence, the conditions of farmers are always the same though they sometimes get good earning and it is becoming a very serious concern in India. The major reason behind it, the transparency and traceability of the entire supply chain of this agricultural products journey from farm to vendor shop. In addition, consumers are becoming more conscious of where their food and food products come from. Block chains have distributed ledger technology (DLT) which has potential to provide transparency and trust for agricultural product supply chains at its different stages and even useful for improving its efficiency. This can boost confidence of all stakeholders who are involved in this farming supply chain. This research paper proposes the same concept in its subsequent sections.

Chemoenzymatic Stereodivergent Synthesis of All the Possible Stereoisomers of the 2,3-Dimethylglyceric Acid Ethyl Ester

2,3-dihydroxy-2-methylbutyric acid, also known as 2,3-dimethylglyceric acid, constitutes the acyl and/or the alcoholic moiety of many bioactive natural esters. Herein, we describe a chemoenzymatic methodology which gives access to all the four possible stereoisomers of the 2,3-dimethylglyceric acid ethyl ester. The racemic ethyl α-acetolactate, produced by the N-heterocycle carbene (NHC)-catalyzed coupling of ethyl pyruvate and methylacetoin was employed as the starting material. The racemic mixture was resolved through (S)-selective reductions, promoted by the acetylacetoin reductase (AAR) affording the resulting ethyl (2R,3S)-2,3-dimethylglycerate; the isolated remaining (S)-ethyl α-acetolactate was successively treated with baker’s yeast to obtain the corresponding (2S,3S) stereoisomer. syn-2,3-Dimethylgliceric acid ethyl ester afforded by reducing the rac-α-acetolactate with NaBH4 in the presence of ZnCl2 was kinetically resolved through selective acetylation with lipase B from Candida antarctica (CAL-B) and vinyl acetate to access to (2S,3R) stereoisomer. Finally, the (2R,3R) stereoisomer, was prepared by C3 epimerization of the (2R,3S) stereoisomer recovered from the above kinetic resolution, achieved through the TEMPO-mediated oxidation, followed by the reduction of the produced ketone with NaBH4. The resulting 2,3-dimethylglycertate enriched in the (2R,3R) stereoisomer was submitted to stereospecicific acetylation with vinyl acetate and CAL-B in order to separate the major stereoisomer. The entire procedure enabled conversion of the racemic α-acetolactate into the four enantiopure stereoisomers of the ethyl 2,3-dihydroxy-2-methylbutyrate with the following overall yields: 42% for the (2R,3S), 40% for the (2S,3S), 42% for the (2S,3R) and 20% for the (2R,3R).

SNARE-seq2 v2

To study the heterogeneity of complex tissues by joint profiling of gene expression and its regulation, we require an accurate and high-throughput method. Here we described improved high-throughput combinatorial indexing-based single-nucleus chromatin accessibility and mRNA expression sequencing 2 (SNARE-Seq2) co-assay. This protocol involves fixing and permeabilizing the nucleus followed by tagmentation, chromatin barcode ligation, reverse transcription, pooling and splitting for the next rounds of cell barcode ligation into cDNA and accessible chromatin (AC) on the same nucleus. The captured cDNA and AC are co-amplified before splitting and enrichment into single-nucleus RNA and single-nucleus AC sequencing libraries. The protocol can also be applied to both nuclei and whole cells to capture mRNA in the cytoplasm. This improvement allows us to generate hundreds of thousands of data set of each assay and can be scaled up to half a million cells from a single experiment. The entire procedure can be complete in 3.5 d for generating joint single-nucleus RNA and single-nucleus ATAC sequencing libraries.

SNARE-seq2 v2

To study the heterogeneity of complex tissues by joint profiling of gene expression and its regulation, we require an accurate and high-throughput method. Here we described improved high-throughput combinatorial indexing-based single-nucleus chromatin accessibility and mRNA expression sequencing 2 (SNARE-Seq2) co-assay. This protocol involves fixing and permeabilizing the nucleus followed by tagmentation, chromatin barcode ligation, reverse transcription, pooling and splitting for the next rounds of cell barcode ligation into cDNA and accessible chromatin (AC) on the same nucleus. The captured cDNA and AC are co-amplified before splitting and enrichment into single-nucleus RNA and single-nucleus AC sequencing libraries. The protocol can also be applied to both nuclei and whole cells to capture mRNA in the cytoplasm. This improvement allows us to generate hundreds of thousands of data set of each assay and can be scaled up to half a million cells from a single experiment. The entire procedure can be complete in 3.5 d for generating joint single-nucleus RNA and single-nucleus ATAC sequencing libraries.

SNARE-seq2 v2

To study the heterogeneity of complex tissues by joint profiling of gene expression and its regulation, we require an accurate and high-throughput method. Here we described improved high-throughput combinatorial indexing-based single-nucleus chromatin accessibility and mRNA expression sequencing 2 (SNARE-Seq2) co-assay. This protocol involves fixing and permeabilizing the nucleus followed by tagmentation, chromatin barcode ligation, reverse transcription, pooling and splitting for the next rounds of cell barcode ligation into cDNA and accessible chromatin (AC) on the same nucleus. The captured cDNA and AC are co-amplified before splitting and enrichment into single-nucleus RNA and single-nucleus AC sequencing libraries. The protocol can also be applied to both nuclei and whole cells to capture mRNA in the cytoplasm. This improvement allows us to generate hundreds of thousands of data set of each assay and can be scaled up to half a million cells from a single experiment. The entire procedure can be complete in 3.5 d for generating joint single-nucleus RNA and single-nucleus ATAC sequencing libraries.

A clinical study on shodhananga snehapana with special reference to Samyak Snigdha Lakshana

Snehana (internal oleation) is the major preparatory procedure to be performed before Shodhana (Biopurification).The entire procedure of Shodhana depends upon the proper mobilization of humors (Dosha) from peripheral circulation (Shakha) to intestinal circulation (Koshtha),which is achieved with the help of Snehana and Svedana. Oleation leads and decides total outcome of The Bio purification therapy; Hence in this study standard guidelines are applied for performing internal oleation in an effective manner to avoid Ayoga (insufficient use) and Atiyoga (excessive use) of Snehana. For that we start and increased dose of lipids in an appropriate manner considering Agni (power of digestion) and Koshtha (nature of bowels) of patients. The study was carried out on total 30 healthy volunteers undergoing Vasantik Vamana. Shodhananga Snehapana with Shuddha Ghrita was administered according to Agni and Koshtha of patients. Samyak snigdha Lakshanas were assessed using special scoring pattern. Statistical analysis using paired‘t’ test were done. Onset of samyak snigdha lakshana occurs in sequence. Vatanuloman, Agnidipti, Gatra Mruduta, Klama, Snehodvega, Adhastat Sneha Darshana was seen in all patients; whereas, glani, Anga Laghava, Twak Snighdata were noted in less percentage of patients.

Euthanasia in adults with psychiatric conditions: A descriptive study of the experiences of Belgian psychiatrists

To investigate the experience of psychiatrists who completed assessment procedures of euthanasia requests from adults with psychiatric conditions (APC) over the last 12 months. Between November 2018 and April 2019 a cross-sectional survey was sent to a sample of 753 psychiatrists affiliated with Belgian organisations of psychiatrists to gather detailed information on their latest experience with a completed euthanasia assessment procedure, irrespective of its outcome (i.e. euthanasia being performed or not). Information on 46 unique cases revealed that most APC suffered from comorbid psychiatric and/or somatic disorders, and had received different kinds of treatment for many years prior to their euthanasia request. Existential suffering was the main reason for the request. The entire procedure spanned an average of 14 months, and an average of 13.5 months in the 23 cases that culminated in the performance of euthanasia. In all cases, the entire procedure entailed multidisciplinary consultations, including with family and friends. Psychiatrists reported fewer difficulties in assessing due care criteria related to the APC’s self-contemplation – for example, unbearable suffering on top of the due care criteria related to their medical condition; incurability due to lack of reasonable treatment perspectives. In a few cases in which euthanasia was the outcome, not all legal criteria were fulfilled in the reporting physicians’ opinions. Both positive and negative experiences of the assessment procedure were reported: for example, reduced suicide risk for the APC; an emotional burden and a feeling of being pressured for the psychiatrist. This study confirms that euthanasia assessment in APC entails a lengthy process with diverse complexities, and psychiatrists require support in more than one respect if the assessments are to be handled adequately. Thorough evaluation of current guidelines is recommended: that is, to what extent the guidelines sufficiently address the complexities around (e.g.) assessing legal criteria or involving relatives. We formulate various avenues for further research to build on this study’s insights and to fill remaining knowledge gaps.

Clinical Research on Lens Cortex Removal Assisted by Hydropolish

Background: This retrospective study investigated the efficiency and safety of lens cortex removal assisted by a fluid-based capsular polishing technique, hydropolish. Study design: Prospective case series.Methods: Sixty patients were included in this study. All these patients underwent phacoemulsification cataract surgery using different sequences of surgical steps and were divided into two groups; hydropolish before irrigation/aspiration (I/A) (Group 1, 30 eyes) and I/A before hydropolish (Group 2, 30 eyes). Hydropolish and I/A cortex time, and time of the entire procedure were noted. Results: The hydropolish time was longer in group 1 than that in group 2 (P ≤ 0.001). The I/A cortex time and hydropolish and I/A cortex time together were not different between the two groups (P = 0.294 and P = 0.258, respectively). However, the time of the entire procedure was shorter in group 1 (P = 0.002). Conclusions: Lens cortex removal assisted by hydropolish is a safe, time saving, and simple surgery.