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   Table of Contents - Current issue
Coverpage
January-February 2021
Volume 41 | Issue 1
Page Nos. 1-52

Online since Friday, January 22, 2021

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ORIGINAL ARTICLES  

Identification of autophagy-related protein 3 in the ancient protist Trichomonas vaginalis p. 1
Chang-Huei Tsao, Hsin-An Lin, Hsin-Chung Lin, Ruei-Min Chen, Chien-Fu F Chen, Yu-Chun Lin, Kuo-Yang Huang
DOI:10.4103/jmedsci.jmedsci_23_20  
Background: Autophagy has been suggested to be involved in the pathogenesis of protists. While the molecular mechanisms of autophagy are mainly studied in model organisms, functional characterization of autophagy-related (Atg) proteins is poorly understood in deep-branching protists. Trichomoniasis is the most common nonviral sexually transmitted infection caused by Trichomonas vaginalis. Bioinformatics analysis of the T. vaginalis genome reveals that the parasite possesses the genes encoding proteins of the Atg8 conjugation system. Herein, we sought to characterize whether the T. vaginalis Atg3 ortholog (TVAG_447140), a putative component of the TvAtg8 conjugation system, regulates autophagy in this parasite. Methods: The recombinant protein of T. vaginalis Atg3 ortholog (TvAtg3) (rTvAtg3) and the polyclonal antibody against rTvAtg3 were generated. The expression and localization was monitored upon autophagy induction by glucose restriction (GR) compared with glucose-rich cultivation. The role of TvAtg3 in autophagy was clarified using small interfering RNA targeting TvAtg3 gene. Results: Phylogenic analysis of Atg3 proteins from different organisms showed that T. vaginalis was not in a close evolutionary relationship with any other protozoan. The expression of TvAtg3 was upregulated in the late-stationary phase of GR culture, implying its involvement in autophagy. Immunofluorescence analysis revealed a much higher TvAtg3 fluorescent intensity located on the round and/or linear structures close to the nucleus. Silencing Tvatg3 expression suppressed GR-induced TvAtg8 expression and autophagic vacuoles formation. Conclusions: These findings suggest the potential role of TvAtg3 in T. vaginalis autophagy and enhance our understanding of the autophagy regulatory network in the deep-branching eukaryotes.
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Association of gastroesophageal reflux disease with anxiety, depression, and sleep disorders p. 9
S Shanmugapriya, A Saravanan, S Shuruthi, J Suriya Dharsini, T Saravanan
DOI:10.4103/jmedsci.jmedsci_51_20  
Background: Gastroesophageal reflux disease (GERD) is commonly associated with impaired quality of life. Chronic symptoms in this highly prevalent disorder could potentially lead to psychological manifestations such as anxiety, depression, and sleep disorders. Aim: The purpose of the study was to evaluate the magnitude of association of GERD symptoms based on health-related quality of life (GERD-HRQL) with anxiety, depression, and sleep quality using Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI). Methods: This was a cross-sectional study done at a tertiary care hospital in 241 participants. Cases were patients diagnosed with GERD, and the control group was participants who did not have GERD, devoid of all gastrointestinal symptoms according to GERD-HRQL. Data on age, gender, body weight, smoking/alcohol intake, and medication history were obtained from 98 cases and 143 matched control subjects. The three questionnaires, namely, GERD-HRQL, HADS, and PSQI questionnaires were administered by a trained blinded interviewer. Results: There was a statistically significant difference (P < 0.001) in the mean score of cases in the HADS depression scale (7.35 ± 3.65); the HADS anxiety scale (9.33 ± 4.51) and the mean global PSQI sleep score (4.62 ± 1.96) compared to the controls. Using Pearson's correlation, heart burn (P = 0.036), and regurgitation scores (P = 0.026), including the global quality of life score (P = 0.003), correlated significantly with the anxiety score. We found a statistically significant correlation between heart burn and poor sleep (P = 0.012) but not for regurgitation (P = 0.772). Conclusions: This study highlights the increased risk of anxiety, depression, sleep disorder in GERD, and the significant correlation between HRQL, especially heartburn with anxiety and poor sleep quality. This enlightens that specific screening and treatment strategies targeting such psychological manifestations are imperative for overall improved quality of life in GERD patients.
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Electrolyte status and plasma glucose levels in birth asphyxia: A case–control study p. 17
Kaustubh Bahatkar, CD Aundhakar
DOI:10.4103/jmedsci.jmedsci_93_20  
Background: Birth asphyxia is characterized by hypoxia, hypercarbia, and acidosis during perinatal period and tends to cause hypoxic-ischemic tissue damage and electrolyte imbalance which may lead to perinatal morbidity and mortality. The aim of this study was to assess the electrolyte status and plasma glucose levels in asphyxiated neonates and determine the correlation with different stages of birth asphyxia. Methods: A total of 100 neonates were allocated into two groups (cases and controls; 50 neonates in each) based on the severity of fetal distress by assessing the Apgar score, fetal heart rates, and meconium-stained liquor after baby delivery. The serum levels of sodium, potassium, calcium, and glucose in cord blood were estimated and compared in both the groups by independent t-test and Mann–Whitney U test using R software version 3.6.0. The estimated electrolyte levels were correlated with different stages of asphyxia using Spearman correlation. Results: Among 100 neonates, meconium-stained liquor was observed in 10% of cases and 4% of controls. A statistically significant difference was found between the groups with respect to serum sodium, calcium, and glucose levels (P < 0.05) in contrast to potassium levels (P = 0.162). A significant negative linear correlation was found between serum sodium, calcium, and glucose levels and different stages of hypoxic-ischemic encephalopathy (−0.591r, −0.484r, and −0.221r, respectively). Conclusions: Hyponatremia, hypocalcemia, and hypoglycemia were observed in asphyxiated neonates and were proportionate to the severity level of asphyxia. Hence, immediate cord blood sampling for serum electrolytes and glucose evaluation at high-risk neonates would be the best measure for early diagnosis and severity assessment of perinatal asphyxia.
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Analysis of in-flight spatial disorientation among military pilots in Taiwan p. 22
Min-Yu Tu, Chao-Chien Cheng, Yi-Hsiang Hsin, Wun-Wei Huang, Fang-Ling Li, Je-Ming Hu, Kwo-Tsao Chiang, Chung-Yu Lai
DOI:10.4103/jmedsci.jmedsci_94_20  
Background: In-flight spatial disorientation (SD) is a predominant threat to flight safety in aviation. This study was conducted to understand the prevalence, severity, and frequency of in-flight SD among military pilots in Taiwan. Methods: A survey was conducted to collect tri-service pilots' experiences of SD during flight. Participants completed anonymous SD questionnaires during refresher physiology training. There were 486 questionnaires delivered to trainees and the completion rate was 97.1% (n = 472). All data were processed using SPSS version 24 software (IBM, Armonk, NY, USA). Results: Of the 472 participants, the average age of the pilots was 36.7 so 7.3 years and 97.7% were male. About 80% of participants experienced in-flight SD events. There was a significant difference between prevalence of SD in fighter (87.0%), trainer (89.8%), transporter (70.6%), and helicopter (66.7%) pilots (P < 0.001). Less than 10% of the events were severe, and there was no obvious variation between aircraft types (P = 0.126). Pilots were sensitive to SD in clouds and under low visibility. Over 70% of pilots experienced visual illusions, especially loss of horizon during bad weather (45.1%), followed by leans (44.5%), false horizon (44.1%), false sense in clouds (39.6%), Coriolis illusion (25.0%), and confusion on entry to instrument meteorological conditions (25.0%). Conclusions: Our survey showed that SD is a common physiological problem among military pilots, who were easily disoriented by in-flight SD without visual cues. Visual illusion was relatively more frequent, especially for trainer and fighter pilots.
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The bHLH transcription factor E protein negatively regulates endoreplication in the salivary gland cells p. 29
Ching-Wei Ho, Yun-Chen Chung, Yi-Lin Chiu, Lan-Hsin Wang
DOI:10.4103/jmedsci.jmedsci_128_20  
Background: Endoreplication is a variant cell cycle which generates massive DNA replication with no features of mitosis. In addition to abnormal occurrence of endoreplication in cancer cells, it is often found in plants and many different animal organs, such as liver, placenta, and Drosophila larval tissues. In treatment with anti-mitotic drugs, it has been shown that cancer cells may undergo endoreplication to escape apoptosis. However, the underlying mechanisms of endoreplication in normal and pathological circumstances remain obscure. Methods: The regulation and function of most physiological processes are highly conserved between the fruit fly Drosophila melanogaster and mammals. In addition, using Drosophila as a research model can largely reduce genetic redundancy issues and provide a suitable way to observe cell autonomy. To address the aforementioned questions, we use the Drosophila as an animal model to study the function of fundamental regulators in endoreplication. Results: In the present study, we demonstrated that high levels of bHLH transcription factor E protein are capable of inhibiting endoreplication in larval salivary glands. The negative regulation of E protein in endoreplication depends on the dysregulation of cell cycle regulators, including E2f1 and its target genes Cyclin E and PCNA. However, the endoreplication defects caused by E protein overexpression are independent of the Hippo tumor suppressor pathway. Conclusions: Our results reveal that endoreplication can be prevented by high levels of E protein through disrupting the oscillations of cell cycle regulators.
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CASE REPORTS Top

Combination of risperidone and fluoxetine in the treatment of schizophrenia-like disorder in a patient with frontal lobe meningioma and oral cancer p. 38
Cian-Cian Lin, Tzu-Yun Wang, Chuan-Chia Chang, Nian-Sheng Tzeng
DOI:10.4103/jmedsci.jmedsci_27_19  
We report a case of a patient with schizophrenia-like disorder related to the right-side frontal lobe meningioma and oral cancer. This 55-year-old female began to show symptoms of talking to herself, insomnia, psychomotor agitation, persecutory delusions, violent behavior, and auditory and visual hallucinations, after the surgery for her oral cancer. The brain imaging studies revealed one right frontal lobe meningioma. The combination of risperidone and fluoxetine has successfully resolved the schizophrenia-like psychotic disorder related to both frontal lobe meningioma and mood disorder related to the body disfigurement due to the oral cancer surgery. This report aims to serve as a reminder for clinicians who are responsible for the treatment of the psychotic disorders in patients with concurrent brain and extracerebral tumors.
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A case report of hemangioblastoma mimicking a meningioma with unusual clinical presentation p. 41
Nien-Tzu Liu, Hong-Wei Gao, Chun-Jung Juan, Da-Tong Ju, Yu-Chun Lin
DOI:10.4103/jmedsci.jmedsci_171_19  
Hemangioblastomas (HBs) are uncommon tumors that occur as sporadic lesions or multiple lesions associated with von Hippel–Lindau (VHL) disease. We report a case of a 77-year-old male with an unusual clinical presentation of HB mimicking meningioma, involving the left anterior temporal fossa, skull, infratemporal fossa, and orbit, and compressing the lateral rectus muscle and optic nerve causing exophthalmos, without a diagnosis of VHL-related HB.
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Unusual case of huge rectal ameboma mimicking a rectal carcinoma in a taiwanese traveler p. 45
Gang-Hua Lin, Yu-Chun Lin, Chun-Wei Yu, Tzu-Chiao Lin, Ta-Wei Pu, Shu-Wen Jao, Je-Ming Hu
DOI:10.4103/jmedsci.jmedsci_111_20  
Invasive protozoan infection with ameboma formation is relatively rare in advanced-modern countries and can be mistakenly diagnosed as a neoplasm, which constitutes the majority of conditions in medical centers. The treatment between rectal ameboma and carcinoma is different, in which the former can be treated by effective medication, and the latter may sustain invasively inconvertible surgical intervention. Herein, we present a case of a 66-year-old man with a travel history to Japan who presented with anal pain and diarrhea secondary to ulcerative rectal mass detected by colonoscopy, which resembled colorectal carcinoma. The mass lesion was later determined histopathologically to be amebic infection caused by invasive Entamoeba histolytica, which had remarkable regression after metronidazole therapy. This case highlights the necessity of complete recognition of ulcerative rectal mass before definitive treatment and inadvertent clues from travel history to achieve a good outcome.
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LETTERS TO EDITOR Top

Pulmonary edema after robot-assisted radical prostatectomy p. 49
Lei-Ying Huang, Zhi-Fu Wu, Guang-Huan Sun, Hou-Chuan Lai
DOI:10.4103/jmedsci.jmedsci_22_20  
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Surgically placed sub-costal transverse abdominis plane catheter as an alternative to ultrasound-guided technique in a converted cholecystectomy p. 51
Mridul Dhar, Ajit Kumar, Naveen Selvaraj
DOI:10.4103/jmedsci.jmedsci_70_20  
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