This issue of the Biomedical Journal includes two reviews discussing how studying the gut of the humble fruit fly can reveal important insight about our own microbial communities. In addition, we focus on work showing that acupuncture may not be the best treatment for idiopathic chronic pelvic pain. Finally, we report on several studies that will hopefully help to optimize surgical techniques, from laser treatment for birthmarks to the design of prostheses for radial head fractures.

In the wild, the fruit fly Drosophila melanogaster thrives on rotten fruit. The digestive tract maintains a powerful gut immune barrier to regulate the ingested microbiota, including entomopathogenic bacteria. This gut immune barrier includes a chitinous peritrophic matrix that isolates the gut contents from the epithelial cells. In addition, the epithelial cells are tightly sealed by septate junctions and can mount an inducible immune response. This local response can be activated by invasive bacteria, or triggered by commensal bacteria in the gut lumen. As with chronic inflammation in mammals, constitutive activation of the gut innate immune response is detrimental to the health of flies. Accordingly, the Drosophila gut innate immune response is tightly regulated to maintain the endogenous microbiota, while preventing infections by pathogenic microorganisms.

The complex interaction between the metazoan host and its commensal gut microbiota is one of the essential features of symbiosis in the animal kingdom. As there is a burgeoning interest to decipher the molecular dialog that shapes host-microbiota mutualism, the use of gnotobiotic model organism becomes an imperative approach to unambiguously parse the specific contributions to such interaction from the microbiome. In this review, we focus on several remarkable gnotobiotic studies in Drosophila that functionally depicted how the gut microbes can alter host physiology and behavior through transcriptomic regulation, hormonal control, and diet modification. These results in concert illustrate that the gnotobiotic flies mono- or poly-associated with members of its gut microbiota deliver a versatile and powerful model that is amenable to different types of studies ranging from classic genetics to large-scale systems approaches.

Mitochondrial function has long been recognized as central to normal physiology and a contributor to a broad range of pathologies. Much of the early research in mitochondrial biology focused on the mechanisms to generate ATP and characterization of mitochondria from highly energetic tissues such as the heart or liver. More recent studies emphasize the role of mitochondria in redox signaling and in less energetic cells such as those in the innate immune system and the vasculature. In this short overview, we discuss some of these recent developments in translational and basic research in mitochondrial pathophysiology. Advanced high throughput analytical techniques are now allowing the assessment of bioenergetic health in human populations and the emergence of the exciting new field of metabolotherapeutics. These have led to the emergence of the new field of redox bioenergetics which encompasses both the canonical aspects of mitochondrial energy production and the organelles' role in cell signaling and disease.

Background: Euphorbia hirta has been reported to possess anti-inflammatory activity. This study was carried out to determine the prostaglandin E ₂ (PGE ₂ ) inhibition activity of the fractions of the E. hirta aqueous extract on rabbit synovial fibroblast cells (HIG-82). Methods: E. hirta aqueous extract was fractionated into five fractions (fractions A, B, C, D, and E) by reversed phase flash chromatography. Rabbit synovial fibroblast cells (HIG-82) were activated with phorbol myristate acetate and treated with the fractions. The amount of PGE ₂ released into the medium was measured by enzyme-linked immunosorbent assay. Results: Fraction A (0.1, 1, and 10 μg/ml) had the greatest PGE ₂ inhibitory effect among the five fractions, and showed a greater extent of PGE ₂ inhibition compared to the aqueous extract. In contrast, Fraction E had the greatest stimulatory effect on PGE ₂ release. Conclusions: Fraction A of the aqueous extract inhibited the production of PGE ₂ from activated HIG-82 cells to a greater extent than the crude aqueous extract. Bioactive compounds with anti-inflammatory activity are likely to be concentrated in Fraction A of E. hirta aqueous extract.

Background: Little is known about the prevalence of thyroid disorders and their associated anemia in the Kingdom of Saudi Arabia. The aim of the current study was to measure the prevalence and types of thyroid disorders and their relationship with anemia frequency and types in non-pregnant Saudi females during the childbearing age. Methods: Blood samples were collected from 600 non-pregnant females (between ≥18 and ≤45 years) with no history of thyroid dysfunction, chronic diseases, and/or anemia to measure serum thyroid stimulating hormone (TSH), free T4, erythrocyte indices, and iron parameters. Results: Thyroid disorders were detected in 118 participants (19.6%), and occult hypothyroidism was the most prevalent type (70/118) followed by overt hypothyroidism (38/118) and hyperthyroidism (10/118). Anemia was detected in 52 females with abnormal thyroid (44%) and the prevalence was significantly higher (p < 0.05) compared to euthyroid (14.3%). The red blood cell (RBC) count, hemoglobin, hematocrit value, serum iron, and serum ferritin were significantly lower in thyroid disorder compared to euthyroid group (p < 0.05). Erythrocyte indices correlated significantly with serum free T4, while iron parameters correlated with serum TSH (p < 0.05). Conclusion: Thyroid disorders are common in non-pregnant females in the Western province of Saudi Arabia, and they are associated with an increase in the prevalence of both anemia and iron deficiency. Further studies are needed to determine the underlying mechanism (s) contributing to the development of thyroiditis-induced anemia in the kingdom and the role of thyroid hormones in iron metabolism.

Background: To compare the clinical efficacies of inferior hypogastric plexus blockade and acupuncture in the management of idiopathic chronic pelvic pain (CPP). Methods: The study included 117 patients with CPP. Group 1 included 62 patients who underwent inferior hypogastric plexus blockade and group 2 included 55 patients who underwent acupuncture. Pain level was assessed using a visual analogue scale (VAS) immediately and at 2, 6, and 12 weeks after treatment. Results: The preprocedure VAS score was 7.6 ± 0.15 in group 1 and 7.7 ± 0.24 in group 2 (p > 0.05). Pelvic pain decreased significantly in both groups after treatment, with pretreatment and posttreatment scores of 7.6 ± 0.15 and 2.2 ± 0.88, respectively, in group 1 (p < 0.0001) and 7.7 ± 0.24 and 4.7 ± 0.11, respectively, in group 2 (p < 0.0001). However, the decrease in pain scores throughout the clinical follow-up was significantly more in group 1 than in group 2 (p< 0.0001). Complete disappearance of symptoms was achieved in 72.6% of patients in group 1 compared to 54.5% of patients in group 2 (p = 0.3737). Patients who did not benefit from the treatment were significantly more in group 2 than in group 1 (25.5% vs. 6.5%, p = 0.0294). No complications were reported in both groups. Conclusion: The study results showed that inferior hypogastric blockade had a 72.6% success rate and showed a significantly higher effect on reducing pain intensity in a short period of time in the management of CPP, compared to acupuncture.

Background: Knowledge of the size and shape of radial head is essential for construction of radial head prosthesis. Further, the measurements of bicipital tuberosity and its angular relationship to radial head are significant in surgical techniques, like in the reconstruction of biceps tendon. Even the morphometry of the distal radius is significant in numerous clinical orthopedic situations such as reduction of distal radius fractures and in the design of distal radius prosthesis. So, the aim of the study was to determine the morphometric parameters of proximal and distal radius in dry adult Indian radius. Methods: Fifty intact adult Indian radius (right = 23, left = 27) were chosen, and the various parameters of proximal and distal ends of radius were studied. Student's t-test was done to correlate all these parameters on the right and left sides. Results: The mean length of radius, height of head at medial and lateral ends, head anteroposterior and transverse diameter, head thickness at ventral, dorsal, and lateral ends were 23.5, 0.90, 0.75, 1.91, 1.85, 0.42, 0.32, and 0.30 cm, respectively. The mean depth of articular facet, length of neck, proximal and distal neck diameter, width and length of bicipital tuberosity, and radial circumference at bicipital tuberosity were 0.19, 1.19, 1.36, 1.31, 1.23, 1.97, and 4.54 cm, respectively. The mean length of styloid process, oblique and transverse width of lower end, anteroposterior diameter of lower end, and angle of radial inclination were 0.98cm, 2. 81cm, 2.59cm, 1.86cm, and 25.05°, respectively. Conclusion: This study will be useful for orthopedic surgeons in making prosthesis for the proximal and distal ends of radius.

Background: N2-positive non-small cell lung cancer (NSCLC) exhibits extremely low survival rates. The role of surgery in operable locally advanced N2 NSCLC remains controversial. In this study, we tried to analyze the role of surgery in resectable N2 NSCLC and the relationship between survival and clinico-pathologic factors from a pathologic point of view. Methods: 108 resectable pathologic N2-positive NSCLC patients, diagnosed from January 2005 to July 2012, were enrolled in this study. We retrospectively reviewed the medical records, image studies, and pathology reports to collect the clinico-pathologic factors in these patients. Results: Those who received lobectomy (p = 0.002) and had a metastatic lymph node ratio less than 0.4 (p = 0.01) had a better overall survival rate. In addition, our study also showed that perineural invasion may play a significant role in disease-free survival (p = 0.01) Conclusions: Metastatic lymph node ratio greater than 0.4 and non-anatomic resection were poor prognostic factors for disease-free survival. Anatomic resection for selected N2 patients may play a crucial role in the overall survival rate. Perineural invasion showed an adverse impact on disease-free survival, but further investigation is warranted.

Background: The resistance form is a key factor for a successful crown fabrication. This in vitro study evaluates the effects of proximal grooves and abutment height on the resistance of single cast crowns in molars with inadequate resistance. Methods: Sixty extracted human molars were prepared to possess 20° of total occlusal convergence for single crown fabrication. All of the prepared teeth were divided into six groups and prepared according to three axial heights (2, 3, and 4 mm) with or without preparing a pair of proximal grooves. Alloy metal copings of 5% titanium were casted and cemented. A self-adhesive modified-resin cement was used for cementation. A lateral dislodgement test was performed with an increasing external force applied at a 45° angulation on a universal testing machine. The force required to dislodge the crown from the tooth or to break the core was recorded. Results: Proximal grooves increased the dislodgement resistance in groups with an abutment height of 4 mm, whereas adding grooves made no significant differences in resistance in groups with abutment heights of 2 and 3 mm. The 2 mm groups exhibited worse performance than the other groups, whether they had proximal grooves or not. Conclusion: An abutment height of 3 mm provided adequate resistance for single cast crowns when self-adhesive modified-resin cement was used. Preparing a pair of proximal grooves on abutments shorter than 4 mm had no significant influence on the resistance.

Background: This study was performed to assess the photothermal response of highly focused laser energy using infrared thermal imaging instrument to detect and assess the actual temperature distribution during flash lamp pumped pulsed dye laser (FLPPDL) treatment for port wine stain (PWS) patients and avoiding its complications. Methods: A retrospective review of 40 patients with PWS birthmark treated with FLPPDL (l = 585 nm, tp = 1500 ms, 7 mm spot) was conducted over a 2-year period. Subjects' ages ranged between 28 and 46 years (mean 29 years); there were 24 females and 16 males. Twenty patients received non-cooling laser treatment (NC-LT) using light dosages of 5-12 J/cm ² . Another 20 patients received cryogen spray cooling laser treatment (CSC-LT) using light dosages of 5-12 J/cm ² . A real-time infrared thermal imaging and the thermal wave equation were used for assessment. The results of temperature distributions related to the energy change were analyzed. Results: Proper temperature measurement using infrared thermal imaging instrument and thermal wave equation in non-cooled PWS patients showed that the energy density of pulsed dye laser (PDL) higher than 7 J/cm ² can reach >44°C and result in burn injury. However, when energy densities beyond 10 J/cm ² were administered, along with using CSC, thermal damage was could still be minimized without the risk of damage to the treated area. Conclusion: Using infrared thermal imaging instrument and thermal wave equation, we can predict the skin temperature distribution in FLPPDL for PWS patients during the treatment. In conjunction with CSC, the complications can be minimized.

Background: When performing a total knee arthroplasty, most surgeons use the intramedullary alignment guide with a fixed distal femoral valgus resection angle. In this study, we assessed the variability of the distal femoral valgus resection angle in ethnic Asian patients by reviewing our arthroplasty database. Methods: Between January 2004 and December 2012, the patients with end-stage osteoarthritis with genu varum deformity who underwent total knee arthroplasty were enrolled in this retrospective review. Clinical and radiographic data were collected and analyzed. Results: Nine hundred and fifty-two knees met the inclusion criteria. Three hundred and four (31.9%) knees had a distal femoral valgus resection angle value outside the range of 5° ±2° (range, 4°-14°). There were significant differences in the mean distal femoral valgus resection angle between males and females (p < 0.001) and between non-bowed femur and bowed femur (p < 0.001) cohorts. With regard to the correlation coefficients between the distal femoral valgus resection angle and the usual radiographic measurements, only the coronal femoral bowing angle demonstrated a good correlation (r = 0.72). Conclusions: 32% of Asian patients present with a distal femoral valgus resection angle that is outside the range of 5° ±2°. Taking a long-leg weight-bearing split scanogram may provide information that allows the surgeon to determine the true distal femoral valgus resection angle and adjust the cut accordingly. Level of Evidence: Therapeutic level III.

A questionnaire-based cross-sectional survey was undertaken to assess the awareness and practice patterns of family planning among the antenatal women in North India. The study included 400 respondents. Three-fourths of the respondents (74.2%, n = 297) were aware of family planning methods. Condoms were the most commonly used family planning method (78.2%), while intrauterine devices and oral contraceptive pills were used by 25.5% and 16.7% respondents, respectively. The main reasons cited for not using contraception were inadequate knowledge and fear of side-effects. Post counseling, 90.5% (n = 362) of the respondents clearly conveyed their desire to use one of the family planning methods in the postpartum period. Awareness and acceptance of family planning methods in the Indian community needs strengthening. Family planning counseling during antenatal check-up is likely to increase the acceptance of family planning methods in the postpartum period.

Globally the increasing prevalence of diabetes mellitus (DM) is major public health concern. The Indian Diabetes Risk Score (IDRS) was developed by Madras Diabetes Research Foundation (MDRF) as a simple tool to help detect undiagnosed type 2 DM (T2DM) in the community. We conducted a study among 911 adults of Jabalpur District to validate the IDRS score against increased fasting blood sugar levels in diagnosing T2DM. T2DM was confirmed either by history of previously known disease or fasting plasma glucose ≥126 mg/dl on two occasions. Sensitivity, specificity, positive predictive value, negative predictive value, Youden index (sensitivity + specificity −1), likelihood ratio for positive test, and likelihood ratio for negative test were calculated for IDRS cut-offs of ≥20, ≥40, ≥60, and ≥80 against the presence of T2DM (either known diabetic or fasting plasma glucose >126 mg/dl on two occasions). The overall prevalence of T2DM was 9.99% (95% confidence interval, 8.04-11.94%). In the Receiver operating characteristic analysis, IDRS had an area under the curve of 0.736 (P < 0.001). The best cut-off was IDRS 40 with a sensitivity, specificity, and Youden index of 60.4%, 70.7%, and 0.31, respectively. The findings of our study indicate that IDRS has excellent predictive value for detecting undiagnosed diabetes in the community and IDRS is also a much stronger risk indicator than examining individual risk factors like age, family history, obesity, or physical activity.