Methods: In this randomized placebo-controlled study, T2DM patients (aged 35 – 65 years) were recruited from the Government Yoga and Naturopathy Medical College and Hospital, Chennai, India, between January 5, 2022 and March 15, 2023. Participants were randomly assigned to either acupuncture group or sham acupuncture group. The acupuncture group received bilateral needling at Sanyinjiao (SP6) while sham acupuncture group received needling at a non-acupuncture point [1.5 cun lateral to Sanyinjiao (SP6)] for 30 min. Primary outcome was RBG, and secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), pulse pressure (PP), mean arterial pressure (MAP), rate pressure product (RPP), and double product (Do-P). All parameters were assessed immediately before and after intervention. Results: A total of 100 patients with T2DM were enrolled in the study, and blinded to acupuncture group (n = 50) and sham acupuncture group (n = 50). Intergroup analysis showed that significant reductions in RBG (P < 0.001), SBP (P = 0.035), DBP (P = 0.008), and MAP (P = 0.009) were found in acupuncture group compared with sham acupuncture group. Within-group analysis showed significant reductions in RBG (P < 0.001), SBP (P < 0.001), DBP (P = 0.008), PP (P = 0.023), MAP (P < 0.001), RPP (P < 0.001), and Do-P (P = 0.002) in acupuncture group, whereas sham acupuncture group showed a significant decrease in PR (P = 0.023) only in the post-test assessment compared with pre-test assessment. Conclusion A period of 30 min of needling at the Sanyinjiao (SP6) acupuncture point reduces RBG and promotes cardiovascular function in patients with T2DM as compared with needling at non-acupuncture points. Sanyinjiao (SP6) acupuncture may offer an immediate, non-pharmacological intervention to strengthen glycemic control management and cardiovascular health in T2DM patients.

BACKGROUND: Adipose-derived stem cells (ASCs) have applications in regenerative medicine based on their therapeutic potential to repair and regenerate diseased and damaged tissue. They are commonly subject to oxidative stress during harvest and transplantation, which has detrimental effects on their subsequent viability. By functioning as an antioxidant against free radicals, melatonin may exert cytoprotective effects on ASCs. METHODS: We cultured human ASCs in the presence of varying dosages of hydrogen peroxide and/or melatonin for a period of 3 hours. Cell viability and apoptosis were determined with propidium iodide and Hoechst 33342 staining under fluorescence microscopy. RESULTS: Hydrogen peroxide (1-2.5 mM) treatment resulted in an incremental increase in cell death. 2 mM hydrogen peroxide was thereafter selected as the dose for co-treatment with melatonin. Melatonin alone had no adverse effects on ASCs. Co-treatment of ASCs with melatonin in the presence of hydrogen peroxide protected ASCs from cell death in a dose-dependent manner, and afforded maximal protection at 100 µM (n=4, one-way analysis of variance P<0.001). Melatonin co-treated ASCs displayed significantly fewer apoptotic cells, as demonstrated by condensed and fragmented nuclei under fluorescence microscopy. CONCLUSIONS: Melatonin possesses cytoprotective properties against oxidative stress in human ASCs and might be a useful adjunct in fat grafting and cell-assisted lipotransfer.
Apoptosis ; Cell Death* ; Cell Survival ; Cytoprotection ; Free Radicals ; Humans* ; Hydrogen Peroxide ; Melatonin* ; Mesenchymal Stromal Cells ; Microscopy, Fluorescence ; Oxidative Stress* ; Propidium ; Regenerative Medicine ; Stem Cells* ; Transplants

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.
Humans ; Child, Preschool ; Surgical Flaps/surgery* ; Upper Extremity ; Plastic Surgery Procedures ; Skin Transplantation ; Contracture/surgery*