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Objective: To characterize the circadian features of the trigeminal ganglion in a mouse model of headache., Background: Several headache disorders, such as migraine and cluster headache, are known to exhibit distinct circadian rhythms of attacks. The circadian basis for these rhythmic pain responses, however, remains poorly understood., Methods: We examined trigeminal ganglion ex vivo and single-cell cultures from Per2::LucSV reporter mice and performed immunohistochemistry. Circadian behavior and transcriptomics were investigated using a novel combination of trigeminovascular and circadian models: a nitroglycerin mouse headache model with mechanical thresholds measured every 6 h, and trigeminal ganglion RNA sequencing measured every 4 h for 24 h. Finally, we performed pharmacogenomic analysis of gene targets for migraine, cluster headache, and trigeminal neuralgia treatments as well as trigeminal ganglion neuropeptides; this information was cross-referenced with our cycling genes from RNA sequencing data to identify potential targets for chronotherapy., Results: The trigeminal ganglion demonstrates strong circadian rhythms in both ex vivo and single-cell cultures, with core circadian proteins found in both neuronal and non-neuronal cells. Using our novel behavioral model, we showed that nitroglycerin-treated mice display circadian rhythms of pain sensitivity which were abolished in arrhythmic Per1/2 double knockout mice. Furthermore, RNA-sequencing analysis of the trigeminal ganglion revealed 466 genes that displayed circadian oscillations in the control group, including core clock genes and clock-regulated pain neurotransmitters. In the nitroglycerin group, we observed a profound circadian reprogramming of gene expression, as 331 of circadian genes in the control group lost rhythm and another 584 genes gained rhythm. Finally, pharmacogenetics analysis identified 10 genes in our trigeminal ganglion circadian transcriptome that encode target proteins of current medications used to treat migraine, cluster headache, or trigeminal neuralgia., Conclusion: Our study unveiled robust circadian rhythms in the trigeminal ganglion at the behavioral, transcriptomic, and pharmacogenetic levels. These results support a fundamental role of the clock in pain pathophysiology., Plain Language Summary: Several headache diseases, such as migraine and cluster headache, have headaches that occur at the same time each day. We learned that the trigeminal ganglion, an important pain structure in several headache diseases, has a 24-hour cycle that might be related to this daily cycle of headaches. Our genetic analysis suggests that some medications may be more effective in treating migraine and cluster headache when taken at specific times of the day., (© 2024 American Headache Society.)

These days, photodetectors are a crucial part of optoelectronic devices, ranging from environmental monitoring to international communication systems. Therefore, fabricating these devices at a low cost but obtaining high sensitivity in a wide range of wavelengths is of great interest. This report introduces a simple solution-processed hybrid 2D structure of CuO and rGO for broadband photodetector applications. Particularly, 2D CuO acts as the active material, absorbing light to generate electron-hole pairs, while 2D rGO plays the role of a transport layer, driving charge carriers between two electrodes. Our device exhibits remarkable sensitivity to a wide wavelength range from 395 nm to 945 nm (vis-NIR region). Interestingly, our devices' responsivity and photoconductive gain were calculated (under 395 nm wavelength excitation) to be up to 8 mA W -1 and 28 fold, respectively, which are comparable values with previous publications. Our hybrid 2D structure between rGO and CuO enables a potential approach for developing low-cost but high-performance optoelectronic devices, especially photodetectors, in the future., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background: Several nations around the world have utilized autologous immune enhancement therapy in the treatment of cancer, with initial positive outcomes. This study describes our experience with autologous gamma delta T cell immunotherapy for the treatment of non-small cell lung cancer patients in Vietnam, a developing nation., Methods: Five patients with non-small cell lung cancer at stages III - IV were enrolled in the study. Each patient received six infusions of autologous γδT cells, separated by two weeks. Before, during, at the end of treatment, and three and six months after treatment, a comprehensive evaluation of clinical, laboratory, quality of life, and adverse events related to the method was conducted., Results: At the time of culture seeding, the total number of cells ranged from 2.9 to 18.2 x 106, with γδT cells ranging in number from 10.7 to 19.6 x 104. On day 14 of the culture, the number of γδT cells ranged from 3.1 to 8.3 x 108. Regarding the safety of therapy in a total of 30 infusions, two (fever), one (myalgia), and one (joint pain) were graded as 1 by CTCAE criteria. After the course, no toxicity was observed in the hematopoietic system, kidney function, or liver function. Evaluation of the patient's response in accordance with the RECIST 1.1 criteria: 20% of patients (one patient) had partial response disease, and 80% of patients (four patients) had stable disease at the end of treatment. During the follow-up period of the study, three patients were still alive, and the disease remained stable. The patient's quality of life improved after treatment in most functional measures (activity, cognitive, and social), but physical and emotional scores decreased slightly. Two patients' fatigue symptoms increased, but after six months of treatment, the average value dropped from 25.3 to 8.3. Dyspnea symptoms decreased gradually from 33.3 at the start of treatment to 8.3 six months later., Conclusions: The initial results we obtained regarding the efficacy and safety of autologous γδT cell immunotherapy for patients with non-small cell lung cancer are extremely encouraging and comparable to those of previous studies.

Optoelectronic devices have various applications in medical equipment, sensors, and communication systems. Photodetectors, which convert light into electrical signals, have gained much attention from many research teams. This study describes a low-cost photodetector based on CuO nanoparticles and ZnO nanorods operating in a wide range of light wavelengths (395, 464, 532, and 640 nm). Particularly, under 395 nm excitation, the heterostructure device exhibits high responsivity, photoconductive gain, detectivity, and sensitivity with maximum values of 1.38 A·W -1 , 4.33, 2.58 × 10 11 Jones, and 1934.5% at a bias of 2 V, respectively. The sensing mechanism of the p-n heterojunction of CuO/ZnO is also explored. Overall, this study indicates that the heterostructure of CuO nanoparticles and ZnO nanorods obtained via a simple and cost-effective synthesis process has great potential for optoelectronic applications., Competing Interests: There are no conflicts to declare., (Copyright © 2023, Giang et al.)

Background: There is limited research investigating sexual-orientation-related differences in older adults and their relationship with alcohol use., Objective: The purpose of this study was to determine if sexual minority status moderates the relationship between psychological distress and alcohol drinking patterns., Methods: This study was a secondary analysis of data from the 2017-2018 National Survey on Drug Use and Health. Health outcomes among lesbian, gay, and bisexual (LGB) older adults (N = 462) aged 50 years or older were compared with heterosexual (N = 16,856) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption., Results: Sexual orientation was a predictor of alcohol use in the past year, past month, and at any time (p < .001) but was not a predictor of alcohol dependence or misuse, binge drinking, or heavy drinking. Heterosexual older adults were less likely to consume alcohol than those who identified as LGB. Respondents not reporting psychological distress were less likely to engage in problematic drinking. However, there was no evidence that sexual minority status moderates the relationship between psychological distress and alcohol use., Conclusion: Limited evidence supports higher rates of alcohol use and alcohol-related problems among sexual minority persons than heterosexuals. Prediction models for alcohol use were not improved by using sexual orientation and psychological distress as interaction terms. Future research should examine the underlying causes of impaired health in the older LGB population. Those findings should be used to research methods of preventing and minimizing alcohol misuse., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2023 International Nurses Society on Addictions.)

Photodetectors are essential elements for various applications like fiber optic communication systems, biomedical imaging, and so on. Thus, improving the performance and reducing the material costs of photodetectors would act as a motivation toward the future advancement of those applications. This study introduces the development of a nanohybrid of zinc oxide nanorods (ZnONRs) and multi-shaped silver nanoparticles MAgNPs through a simple solution process; in which ZnONRs are hybridized with MAgNPs to enable visible absorption through the surface plasmon resonance (SPR) effect. The photodetector based on ZnONRs/MAgNPs is responsive to visible light with representative wavelengths of 395, 464, 532 and 640 nm, and it exhibits high responsivity ( R ), photoconductive gain ( G ) and detectivity ( D ). The maximum R is calculated from the fitting curve of the responsivity-power relation with the value of 5.35 × 10 3 (mA W -1 ) at 395 nm excitation. The highest G and D reach 8.984 and 3.71 × 10 10 Jones at that wavelength. This reveals the promise of our innovative broadband photodetector for practical usage., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Background and Objectives: Cluster headache and migraine have circadian features at multiple levels (cellular, systems, and behavioral). A thorough understanding of their circadian features informs their pathophysiologies., Methods: A librarian created search criteria in MEDLINE Ovid, Embase, PsycINFO, Web of Science, and Cochrane Library. Two physicians independently performed the remainder of the systematic review/meta-analysis using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Separate from the systematic review/meta-analysis, we performed a genetic analysis for genes with a circadian pattern of expression (clock-controlled genes or CCGs) by cross-referencing genome-wide association studies (GWASs) of headache, a nonhuman primate study of CCGs in a variety of tissues, and recent reviews of brain areas relevant in headache disorders. Altogether, this allowed us to catalog circadian features at the behavioral level (circadian timing, time of day, time of year, and chronotype), systems level (relevant brain areas where CCGs are active, melatonin and corticosteroid levels), and cellular level (core circadian genes and CCGs)., Results: For the systematic review and meta-analysis, 1,513 studies were found, and 72 met the inclusion criteria; for the genetic analysis, we found 16 GWASs, 1 nonhuman primate study, and 16 imaging reviews. For cluster headache behavior, meta-analyses showed a circadian pattern of attacks in 70.5% (3,490/4,953) of participants across 16 studies, with a clear circadian peak between 21:00 and 03:00 and circannual peaks in spring and autumn. Chronotype was highly variable across studies. At the systems level, lower melatonin and higher cortisol levels were reported in cluster headache participants. At the cellular level, cluster headache was associated with core circadian genes CLOCK and REV-ERBα , and 5 of the 9 cluster headache susceptibility genes were CCGs. For migraine behavior, meta-analyses showed a circadian pattern of attacks in 50.1% (2,698/5,385) of participants across 8 studies, with a clear circadian trough between 23:00 and 07:00 and a broad circannual peak between April and October. Chronotype was highly variable across studies. At the systems level, urinary melatonin levels were lower in participants with migraine and even lower during an attack. At the cellular level, migraine was associated with core circadian genes CK1δ and RORα , and 110 of the 168 migraine susceptibility genes were CCGs., Discussion: Cluster headache and migraine are highly circadian at multiple levels, reinforcing the importance of the hypothalamus. This review provides a pathophysiologic foundation for circadian-targeted research into these disorders., Trial Registration Information: The study was registered with PROSPERO (registration number CRD42021234238)., (© 2023 American Academy of Neurology.)

Antibacterial materials have been developed for a long time but bacteria adapt very quickly and become resistant to these materials. This study focuses on the synthesis of a hybrid material system from lignin and silver/silica nanoparticles (Lig@Ag/SiO 2 NPs) which were used against bacteria including Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) and inhibited the growth of the fungal Aspergillus flavus (A. flavus). The results showed that the spherical diameter of Lig@Ag/SiO 2 NPs has narrow Gaussian distribution with a range from 15 nm to 40 nm in diameter. Moreover, there was no growth of E. coli in samples containing Lig@Ag/SiO 2 NPs during 72-h incubation while colonies of S. aureus were only observed at high concentrations (10 6  CFU/mL) although both species of bacteria were able to thrive even at low bacterial concentration when they were exposed to Ag/SiO 2 or lignin. For fungal resistance results, Lig@Ag/SiO 2 NPs not only reduced mycelial growth but also inhibited sporulation in A. flavus, leading to decreasing the spreading of spores into the environment. This result represents a highly effective fungal growth inhibition of Lig@Ag/SiO 2 NPs compared to lignin or Ag/SiO 2 , which could not inhibit the growth of sporulation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Natural killer (NK) cells have developed as a potent tool in cancer immunotherapy. Especially, patients who have failed in the first-line or maintenance treatment received a good response with immunotherapy in association with other approaches. We report the case of a 61-year-old male patient with programmed cell death ligand - 1(PD-L1) expression in advanced non-small cell lung cancer (NSCLC) (stage IV). Even though the patient was treated with standard therapy using keytruda, he still appeared with new lesions. Therefore, the patient was treated in combination with autologous NK cells therapy, gemcitabine, bevacizumab. NK cells were expanded from peripheral blood mononuclear cells (PBMCs) of the patient, and after that, they were transferred back to the patient. After 6 infusions of autologous NK cells in combination with gemcitabine, bevacizumab, the patient decreased significantly the size of primary, metastatic lesions and had a marked improvement in the quality of life. Besides, during combination therapy, no side effects have been reported and there was no toxicity observed in the hematopoietic system, liver as well as kidneys. Our case suggests that this treatment regimen is a potential treatment approach for advanced NSCLC with PD-L1 expression., Competing Interests: We have no conflicts to declare., (© 2023 The Authors.)

Numerous molecular and physiological processes in the skeletal muscle undergo circadian time-dependent oscillations in accordance with daily activity/rest cycles. The circadian regulatory mechanisms underlying these cyclic processes, especially at the post-transcriptional level, are not well defined. Previously, we reported that the circadian E3 ligase FBXL21 mediates rhythmic degradation of the sarcomere protein TCAP in conjunction with GSK-3β, and Psttm mice harboring an Fbxl21 hypomorph allele show reduced muscle fiber diameter and impaired muscle function. To further elucidate the regulatory function of FBXL21 in skeletal muscle, we investigated another sarcomere protein, Myozenin1 (MYOZ1), that we identified as an FBXL21-binding protein from yeast 2-hybrid screening. We show that FBXL21 binding to MYOZ1 led to ubiquitination-mediated proteasomal degradation. GSK-3β co-expression and inhibition were found to accelerate and decelerate FBXL21-mediated MYOZ1 degradation, respectively. Previously, MYOZ1 has been shown to inhibit calcineurin/NFAT signaling important for muscle differentiation. In accordance, Fbxl21 KO and MyoZ1 KO in C2C12 cells impaired and enhanced myogenic differentiation respectively compared with control C2C12 cells, concomitant with distinct effects on NFAT nuclear localization and NFAT target gene expression. Importantly, in Psttm mice, both the levels and diurnal rhythm of NFAT2 nuclear localization were significantly diminished relative to wild-type mice, and circadian expression of NFAT target genes associated with muscle differentiation was also markedly dampened. Furthermore, Psttm mice exhibited significant disruption of sarcomere structure with a considerable excess of MYOZ1 accumulation in the Z-line. Taken together, our study illustrates a pivotal role of FBXL21 in sarcomere structure and muscle differentiation by regulating MYOZ1 degradation and NFAT2 signaling., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Lim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Rice husk is one of the most abundant biomass resources in the world, yet it is not effectively used. This study focuses on the sustainably rice-husk-extracted lignin, nano-lignin (n-Lignin), lignin-capped silver nanoparticles (LCSN), n-Lignin-capped silver nanoparticles (n-LCSN), and lignin-capped silica-silver nanoparticles (LCSSN), and using them for antibacterial activities. The final n-Lignin-based products had a sphere-like structure, of which the size varied between 50 and 80 nm. We found that while n-Lignin and lignin were less effective against Escherichia coli than against Staphylococcus aureus , n-Lignin/lignin-based hybrid materials, i.e., n-LCSN, LCSN, and LCSSN, were better against E. coli than against S. aureus . Interestingly, the antimicrobial behaviors of n-LCSNs could be further improved by decreasing the size of n-Lignin. Considering the facile, sustainable, and eco-friendly method that we have developed here, it is promising to use n-Lignin/lignin-based materials as highly efficient antimicrobials without environmental concerns.

Purpose: To explore the opioid prescribing practices after common ambulatory head and neck surgeries in a large academic institution; and to examine the association between opioid prescription and the patient's satisfaction with pain control., Methods: This retrospective cohort study conducted in a tertiary academic medical center. Phone interviews of patients who underwent ambulatory head and neck surgeries one month after their procedures were conducted. The interview included, among several questions, the amount of opioid prescribed and consumed, the use of non-opioid pain medications, and the patient's satisfaction with pain control. Logistic regression models were used to investigate the significant factors affecting the patient's satisfaction with pain control., Results: Most patients were prescribed opioids at discharge (84%). Of those, 17% did not use their prescriptions. The median of leftover opioid was 76.50 morphine milligram equivalents (MMEs) with IQR (45-130.95). Patient satisfaction with pain control is not associated with opioid prescription at discharge (OR 0.195 [95% CL, 0.036-1.036], p = 0.059) or the amount of the prescribed opioid (OR 1.001 [95% CL, 0.997-1.004], p = 0.717) after controlling for other patient and procedural factors., Conclusion: A significant portion of ambulatory head and neck surgery patients were discharged with opioid prescriptions they may not use. Patient satisfaction with pain control is not associated with the presence or the amount of opioid prescribed., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Ag/SiO₂ colloidal nanocomposites (NCs) were prepared through the semi-continuous chemical reduction of silver ions on a silica surface; NaBH4 was used as a primary reducing agent, while carboxymethyl cellulose (CMC) served as a secondary reductant and a stabilizer at low temperature. Silver nanoparticles (AgNPs) of an average diameter of 3.89±0.18 nm were uniformly and densely dispersed on the SiO₂ surface, forming 218.6-nm-sized Ag/SiO₂ NCs. The zeta potential of the Ag/SiO₂ NCs (-92.6 mV) was more negative than that of silica (-24 mV), indicating their high long-term stability. Furthermore, their proposed formation mechanism was confirmed via Fourier transform infrared spectroscopy. Then, the bactericidal effect of the Ag/SiO₂ was evaluated based on their minimal inhibitory concentration (MIC) against Ralstonia solanacearum 15 ( R. solanacearum 15); it was 62.5 ppm, much lower than that of conventional AgNPs (500 ppm). Therefore, these highly stable Ag/SiO₂ colloidal NCs with more effective antibacterial activity than conventional AgNPs are a promising nanopesticide in agriculture.

Background: Equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy (eNAD/EDM) is a neurodegenerative disorder affecting genetically predisposed foals maintained on an α-tocopherol (α-TOH) deficient diet. Currently no antemortem diagnostic test for eNAD/EDM is available., Hypothesis: Because α-TOH deficiency is associated with increased lipid peroxidation, it was hypothesized that F 2 -isoprostanes (F 2 IsoP), F 4 -neuroprostanes (F 4 NP) and oxysterols derived from free radical oxidation would be increased in the cerebrospinal fluid (CSF) and neural tissue of eNAD/EDM affected horses and could serve as potential biomarkers for disease., Animals: Isoprostane Study A: 14 Quarter horse foals (10 healthy foals and 4 eNAD/EDM affected foals) at 1 and 6 months of age. Isoprostane Study B: 17 eNAD/EDM affected and 10 unaffected horses ≥ 1-4 years of age. Oxysterol study: eNAD/EDM affected (n = 14, serum; n = 11, CSF; n = 10, spinal cord [SC]) and unaffected horses 1-4 years of age (n = 12, serum; n = 10, CSF; n = 7, SC)., Procedures: Cerebrospinal fluid [F 2 IsoP] and [F 4 NP] were assessed using gas chromatography-negative ion chemical ionization mass spectrometry. Serum, CSF, and cervical SC [oxysterols] were quantified using high performance liquid chromatography mass spectrometry. Results were compared with respective α-TOH concentrations., Results: Spinal cord [7-ketocholesterol], [7-hydroxycholesterol], and [7-keto-27-hydrocholesterol] were higher in eNAD/EDM horses whereas [24-ketocholesterol] was lower. No significant difference was found in CSF [F 2 IsoP] and [F 4 NP], serum [oxysterols] and CSF [oxysterols] between eNAD/EDM affected and unaffected horses. No correlation was found between [F 2 IsoP], [F 4 NP], or [oxysterols] and respective [α-TOH]., Conclusions and Clinical Importance: In the SC, targeted markers of cholesterol oxidation were significantly increased in horses with eNAD/EDM., (© 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Mice with deficiency in tocopherol (alpha) transfer protein gene develop peripheral tocopherol deficiency and sensory neurodegeneration. Ttpa -/- mice maintained on diets with deficient α-tocopherol (α-TOH) had proprioceptive deficits by six months of age, axonal degeneration and neuronal chromatolysis within the dorsal column of the spinal cord and its projections into the medulla. Transmission electron microscopy revealed degeneration of dorsal column axons. We addressed the potential pathomechanism of α-TOH deficient neurodegeneration by global transcriptome sequencing within the spinal cord and cerebellum. RNA-sequencing of the spinal cord in Ttpa -/- mice revealed upregulation of genes associated with the innate immune response, indicating a molecular signature of microglial activation as a result of tocopherol deficiency. For the first time, low level Ttpa expression was identified in the murine spinal cord. Further, the transcription factor liver X receptor (LXR) was strongly activated by α-TOH deficiency, triggering dysregulation of cholesterol biosynthesis. The aberrant activation of transcription factor LXR suppressed the normal induction of the transcription factor retinoic-related orphan receptor-α (RORA), which is required for neural homeostasis. Thus we find that α-TOH deficiency induces LXR, which may lead to a molecular signature of microglial activation and contribute to sensory neurodegeneration., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The goals are to understand the primary genetic mechanisms that cause Sick Sinus Syndrome and to identify potential modifiers that may result in intrafamilial variability within a multigenerational family. The proband is a 63-year-old male with a family history of individuals (>10) with sinus node dysfunction, ventricular arrhythmia, cardiomyopathy, heart failure, and sudden death. We used exome sequencing of a single individual to identify a novel LMNA mutation and demonstrated the importance of Sanger validation and family studies when evaluating candidates. After initial single-gene studies were negative, we conducted exome sequencing for the proband which produced 9 gigabases of sequencing data. Bioinformatics analysis showed 94% of the reads mapped to the reference and identified 128,563 unique variants with 108,795 (85%) located in 16,319 genes of 19,056 target genes. We discovered multiple variants in known arrhythmia, cardiomyopathy, or ion channel associated genes that may serve as potential modifiers in disease expression. To identify candidate mutations, we focused on ~2,000 variants located in 237 genes of 283 known arrhythmia, cardiomyopathy, or ion channel associated genes. We filtered the candidates to 41 variants in 33 genes using zygosity, protein impact, database searches, and clinical association. Only 21 of 41 (51%) variants were validated by Sanger sequencing. We selected nine confirmed variants with minor allele frequencies <1% for family studies. The results identified LMNA c.357-2A>G, a novel heterozygous splice-site mutation as the primary mutation with rare or novel variants in HCN4, MYBPC3, PKP4, TMPO, TTN, DMPK and KCNJ10 as potential modifiers and a mechanism consistent with haploinsufficiency.

Caring for the Jehovah's Witness parturient is a complex task that presents a number of ethical, medical, and legal concerns because many Jehovah's Witnesses refuse allogeneic blood transfusion. Childbirth and its surrounding events may be associated with significant blood loss. Given their significant role in the intraoperative administration of blood products, anesthesia providers should be familiar with factors that must be considered in the perioperative care of Jehovah's Witness parturients. Several pharmacologic therapies, anesthetic techniques, and operative interventions aimed at blood conservation may be useful in the care of such patients. Aside from their refusal of transfusion, each Witness makes a personal decision on the acceptability of derivatives of plasma or cellular blood components and autologous blood management. Therefore, the patient-physician relationship must ensure that the individual patient's desires are accurately communicated, respected, and documented in the patient's medical record. The Perioperative Surgical Home model is appropriate for use in caring for Jehovah's Witness patients because it allows for the early and continuing coordination of care and communication between the patient and a multidisciplinary team. In this article, we present a focused review of concepts important to the provision of anesthetic care of parturients who are Jehovah's Witnesses and introduce an algorithmic perioperative approach that may be applied to the care of the Jehovah's Witness parturient undergoing an operative procedure.

The pregnane steroid, (E)-aglawone, along with four known triterpenes, and a known sterol mixture were isolated from the bark of Aglaia lawii (Wight) Saldanha ex Ramamoorty (Meliaceae). The structural determination/identification was accomplished by a combination of 1D- and 2D-NMR spectroscopic techniques. The relative stereochemistry of the known triterpene, 20S,24S-epoxydammarane-3alpha,25-diol acetate, was also unequivocally determined for the first time by X-ray crystallography. The isolates were not active against various human cancer cell lines.