Dihadron azimuthal correlations containing a high transverse momentum(pr)trigger particle are sensit-ive to the properties of the nuclear medium created at RHIC through the strong interactions occurring between the tr...Dihadron azimuthal correlations containing a high transverse momentum(pr)trigger particle are sensit-ive to the properties of the nuclear medium created at RHIC through the strong interactions occurring between the traversing parton and the medium,ie.jet-quenching.Previous measurements revealed a strong modification to di-hadron azimuthal correlations in Au+Au collisions with respect to ptp and d+Au collisions.The modification in-creases with the collision centrality,suggesting a path-length or energy density dependence to the je-quenching ef-fect.This paper reports STAR measurements of dihadron azimuthal correlations in mid-central(20%-60%)Au+Au collisions at√^(S)NN=200 GeV as a function of the trigger particle's azimuthal angle relative to the event plane,Ф_(s)=|Ф_(t)-ψ_(Ep)|.The azimuthal correlation is studied as a function of both the trigger and associated particle pr.The subtractions of the combinatorial background and anisotropic flow,assuming Zero Yield At Minimum(ZYAM),are described.The correlation results are first discussed with subtraction of the even harmonic(elliptic and quadrangu-lar)flow backgrounds.The away-side correlation is strongly modifed,and the modification varies withФ_(s),with a double-peak structure for out-of-plane trigger particles.The near-side ridge(long range pseudo-rapidity△_(η)correla-tion)appears to drop with increasingФ_(s)while the jet-like component remains approximately constant.The correla-tion functions are further studied with the subtraction of odd harmonic triangular flow background arising from fluc-tuations.It is found that the triangular flow,while responsible for the majority of the amplitudes,is not sufficient to explain theφs-dependence of the ridge or the away-side double-peak structure.The dropping ridge withФ_(s)could be attributed to aФ_(s)-dependent lliptie anisotropy;however,the physics mechanism of the ridge remains an open ques-tion.Even with aФ_(s)-dependent elliptic flow,the away-side correlation structure is robust.These results,with exte展开更多
Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provid...Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.展开更多
Objective： To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior （AP） view and also assess if the addition of lateral view change...Objective： To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior （AP） view and also assess if the addition of lateral view changes the classification and management plan. Methods： Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan. Then the same films were reshown in conjunction with their lateral view after 10 days. Results were compared with respect to the classification and management plan between two groups. Interobserver agreement was calculated using Fleiss＇ kappa. Results： There was only a fair interobserver agreement （kappa value 0.39） on Garden classification on AP view only which improved to moderate agreement （kappa value 0.52） after adding a lateral view. While there was only a slight improvement in the interobserver agreement on the management plan on AP view only （kappa value 0.50） and AP combined with lateral views （kappa value 0.52）. Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases. Conclusion： We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.展开更多
Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more v...Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%.Conventional risk factors such as smoking,diabetes,hypertension,obesity and family history seems to be as important as in older CAD subjects.But the prevalence of these risk factors seems to vary in younger subjects.By far the most commonly associated risk factor is smoking in young CAD.Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein(CETP) gene,hepatic lipase gene,lipoprotein lipase gene,apo A1 gene,apo E gene and apo B.Biomarkers such as lipoprotein(a),fibrinogen,D-dimer,serum Wnt,gamma glutamyl transferase,vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies.In general CAD in young has better prognosis than older subjects.In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes.Angiographic studies shows predominance of single vessel disease in young CAD patients.Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.展开更多
AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospe...AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.展开更多
Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic comp...Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic complications.Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research,it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors.Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis[deep vein thrombosis(DVT)and pulmonary embolism(PE)];it has also been associated with progression of liver fibrosis.The use of anticoagulants in cirrhosis patients is a challenging,and often a scary situation.This review summarizes the current literature on the prevalence of venous thrombosis(DVT and PE),risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.展开更多
Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recom...Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence.展开更多
Background:In China, the prevalence of allergic rhinitis (AR) and asthma has increased in the past decade. As these two diseases frequently coexist, the Asia-Pacific Survey of Physicians on Asthma and Allergic Rhiniti...Background:In China, the prevalence of allergic rhinitis (AR) and asthma has increased in the past decade. As these two diseases frequently coexist, the Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR) study aimed to assess physicians5 beliefs and treatment patterns of coexistent asthma-AR across six Asian countries. This analysis presents the results from China. Methods: The 200 hospital-based general physicians and pediatricians were interviewed from five cities in China. Physicians were questioned in-person about their knowledge, beliefs and management practices for patients with coexistent asthma-AR. Results: Approximately 70% of the physicians interviewed routinely evaluated their patients with asthma or AR for signs of coexistent disease. While the majority of physicians (>90% of physicians) recognized the increased burden of coexistent asthma-AR vs. one condition alone and that coexistent disease requires additional treatment, most physicians (96%) also believed that patients with coexistent asthma-AR were well managed if either condition alone improved. Similarly, although 71% of physicians selected a combination of intranasal and inhaled corticosteroids as their preferred treatment for coexistent asthma-AR, in line with treatment guidelines, two fifths of physicians indicated that treatment for coexistent disease requires too much medication and that their patients prefer oral medications and a third of physicians believed that corticosteroids should be delayed in children. Conclusions: This survey demonstrates that physicians interviewed in China have a broad understanding of coexistent asthma-AR and its impact on patients. A holistic approach to patient management with informed decisions regarding patients' overall treatment will benefit patients who suffer from coexistent disease.展开更多
Cervical cancer prevention requires a multipronged approach involving primary, secondary and tertiary prevention. The key element under primary prevention is human papilloma virus(HPV) vaccination. So far, only prophy...Cervical cancer prevention requires a multipronged approach involving primary, secondary and tertiary prevention. The key element under primary prevention is human papilloma virus(HPV) vaccination. So far, only prophylactic HPV vaccines which prevent HPV infection by one or more subtypes are commercially available. Therapeutic HPV vaccines which aid in clearing established infection are still under trial. Secondary prevention entails early detection of precancerous lesions and its success is determined by the population coverage and the efficacy of the screening technique. A number of techniques are in use, including cytology, visual inspection(using the naked eye, magnivisualizer, acetic acid and Lugol's iodine), HPV testing and a combination of these methods. Updated screening guidelines have been advocated by the American Cancer Society in light of the role of HPV on cervical carcinogenesis. Recent research has also focussed on novel biomarkers that can predict progression to cancer in screen positive women and help to differentiate those who need treatment from those who can be left for follow-up. Last but not the least, effective treatment of precancerous lesions can help to reduce the incidence of invasive cervical cancer and this constitutes tertiary prevention.A combination of these approaches can help to prevent the burden of cervical cancer and its antecedent morbidity and mortality, but all of these are not feasible in all settings due to resource and allocation constraints. Thus, all countries, especially low and middle income ones, have to determine their own cocktail of approaches that work before we can say with certainty that yes, cervical cancer can be prevented.展开更多
Atorvastatin has low aqueous solubility resulting in low oral bioavailability(12%)and thus presents a challenge in formulating a suitable dosage form.To improve the aqueous solubility,a solid dispersion formulation of...Atorvastatin has low aqueous solubility resulting in low oral bioavailability(12%)and thus presents a challenge in formulating a suitable dosage form.To improve the aqueous solubility,a solid dispersion formulation of atorvasta tin was prepared by lyophilization utilising skimmed milk as a carrier.Six different formulations were prepared with varying ratios of drug and carrier and the corresponding physical mixtures were also prepared.The formation of a solid dispersion formulation was confirmed by differential scanning ca lorimetry and X-ray diffraction studies.The optimum drug-to-carrier ratio of 1:9 en hanced solubility nearly 33-fold as compared to pure drug.In vitro drug release studies exhibited a cumulative release of 83.69% as compared to 22.7% for the pure drug.Additionally,scanning electron microscopy studies suggested the conversion of crystalline atorvastatin to an amorphous form.In a Triton-induced hyperlipidemia model,a 3-fold increase in the lipid lowering potential was obtained with the reformulated drug as compared to pure drug.These results suggest that solid dispersion of atorvastatin using skimmed milk as carrier is a promising approach for oral delivery of atorvastatin.展开更多
Gastric cancer(GC) is a highly heterogenic disease,and it is the second leading cause of cancer death in the world.Common chemotherapies are not very effective for GC,which often presents as an advanced or metastatic ...Gastric cancer(GC) is a highly heterogenic disease,and it is the second leading cause of cancer death in the world.Common chemotherapies are not very effective for GC,which often presents as an advanced or metastatic disease at diagnosis.Treatment options are limited,and the prognosis for advanced GCs is poor.The landscape of genomic alterations in GCs has recently been characterized by several international cancer genome programs,including studies that focused exclusively on GCs in Asians.These studies identified major recurrent driver mutations and provided new insights into the mutational heterogeneity and genetic profiles of GCs.An analysis of gene expression data by the Asian Cancer Research Group(ACRG) further uncovered four distinct molecular subtypes with well-defined clinical features and their intersections with actionable genetic alterations to which targeted therapeutic agents are either already available or under clinical development.In this article,we review the ACRG GC project.We also discuss the implications of the genetic and molecular findings from various GC genomic studies with respect to developing more precise diagnoses and treatment approaches for GCs.展开更多
Purpose: Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads ...Purpose: Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads and traffics but related literature regarding the overall epidemiology of these injuries is scarce and scanty. Our aim was to study the epidemiology of patients admitted with pelvic fractures at a level 1 trauma centre in India. Methods: A 16-month (between September 2015 and December 2016) prospective observational study was carried out on trauma patients with pelvic fractures at a level 1 trauma centre of a tertiary care hospital. Demography of patients, mechanism of injuries and complications were recorded prospectively. Results: We observed 75 patients who presented with pelvic fractures, where 56 were males and 19 were females. Mean age of the study populationwas 37.57 years. Road traffic accidents were the most common mode of injuries. Lateral compression injuries were the most common pattern. Associated injuries frequently encountered were lower extremities and acetabulum fractures, blunt abdominal trauma, urogenital injuries and head injuries. Out of the 75 patients, 52 were treated surgically and 23 were managed by conservative methods. Associated injuries of the extremities, head, abdomen and urogenital system indicated a longer hospital stay. Conclusion: Pelvic fractures, although belong to a relatively rare trauma subset, cause a high morbidity and mortality with considerable burden on the economy. Proper road safety training and driving etiquettes along with its strict implementation in true sense and spirit are the need of the hour.展开更多
There has been a considerable development in microfluidic based immunodiagnostics over the past few years which has greatly favored the growth of novel point-of-care-testing(POCT).However,the realization of an inexpen...There has been a considerable development in microfluidic based immunodiagnostics over the past few years which has greatly favored the growth of novel point-of-care-testing(POCT).However,the realization of an inexpensive,low-power POCT needs cheap and disposable microfluidic devices that can perform autonomously with minimum user intervention.This work,for the first time,reports the development of a new microchannel capillary flow assay(MCFA)platform that can perform chemiluminescence based ELISA with lyophilized chemiluminescent reagents.This new MCFA platform exploits the ultra-high sensitivity of chemiluminescent detection while eliminating the shortcomings associated with liquid reagent handling,control of assay sequence and user intervention.The functionally designed microchannels along with adequate hydrophilicity produce a sequential flow of assay reagents and autonomously performs the ultra-high sensitive chemiluminescence based ELISA for the detection of malaria biomarker such as PfHRP2.The MCFA platform with no external flow control and simple chemiluminescence detection can easily communicate with smartphone via USB-OTG port using a custom-designed optical detector.The use of the smartphone for display,data transfer,storage and analysis,as well as the source of power allows the development of a smartphone based POCT analyzer for disease diagnostics.This paper reports a limit of detection(LOD)of 8 ng/mL by the smartphone analyzer which is sensitive enough to detect active malarial infection.The MCFA platform developed with the smartphone analyzer can be easily customized for different biomarkers,so a hand-held POCT for various infectious diseases can be envisaged with full networking capability at low cost.展开更多
Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- t...Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single- implant cephalomedullary fix展开更多
Helicobacter pylori(H. pylori) is a known pathogen implicated in genesis of gastritis, peptic ulcer disease, gastric carcinoma and gastric lymphoma. Beyond the stomach, the organism has also been implicated in the cau...Helicobacter pylori(H. pylori) is a known pathogen implicated in genesis of gastritis, peptic ulcer disease, gastric carcinoma and gastric lymphoma. Beyond the stomach, the organism has also been implicated in the causation of immune thrombocytopenia and iron deficiency anemia. Although an area of active clinical research, the role of this gram negative organism in causation of atherosclerosis and coronary artery disease(CAD) remains enigmatic. CAD is a multifactorial disease which results from the atherosclerosis involving coronaryarteries. The major risk factors include age, diabetes mellitus, smoking, hypertension and dyslipidemia. The risk of coronary artery disease is believed to increase with chronic inflammation. Various organisms like Chlamydia and Helicobacter have been suspected to have a role in genesis of atherosclerosis via causation of chronic inflammation. This paper focuses on available evidence to ascertain if the role of H. pylori in CAD causation has been proven beyond doubt and if eradication may reduce the risk of CAD or improve outcomes in these patients.展开更多
BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer(GBC)patients but only 10%of patients have a resectable disease at presentation.Even after surgical resection,overall survival(OS)has been p...BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer(GBC)patients but only 10%of patients have a resectable disease at presentation.Even after surgical resection,overall survival(OS)has been poor due to high rates of recurrence.Combination of surgery and systemic therapy can improve outcomes in this aggressive disease.AIM To summarize our single-center experience with multimodality management of resectable GBC patients.METHODS Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database.Information extracted included demographics,operative and perioperative details,histopathology,neoadjuvant/adjuvant therapy,follow-up,and recurrence.To know the factors associated with recurrence and OS,univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables,respectively.Multivariate analysis was done using multiple regression analysis.RESULTS Of 274 patients with GBC taken up for surgical resection,172(62.7%)were female and the median age was 56 years.On exploration,102 patients were found to have a metastatic or unresectable disease(distant metastasis in 66 and locally unresectable in 34).Of 172 patients who finally underwent surgery,93(54%)underwent wedge resection followed by anatomical segment IVb/V resection in 66(38.4%)and modified extended right hepatectomy in 12(7%)patients.The postoperative mortality at 90 d was 4.6%.During a median follow-up period of 20 mo,71(41.2%)patients developed recurrence.Estimated 1-,3-,and 5-years OS rates were 86.5%,56%,and 43.5%,respectively.Estimated 1-and 3-year disease free survival(DFS)rates were 75%and 49.2%,respectively.On multivariate analysis,inferior OS was seen with pT3/T4 tumor(P=0.0001),perineural invasion(P=0.0096),and R+resection(P=0.0125).However,only pT3/T4 tumors were associated with a poor DFS(P<0.0001).CONCLUSION Multimodality treatment significantly improves the 5-y展开更多
Hepatic tuberculosis particularly in the absence of military tuberculosis is rare.It can occur as a primary case or due to reactivation of an old tubercular focus.We report case of a 24 year old married female who die...Hepatic tuberculosis particularly in the absence of military tuberculosis is rare.It can occur as a primary case or due to reactivation of an old tubercular focus.We report case of a 24 year old married female who died of primary hepatic tuberculosis.She had no evidence of tuberculosis elsewhere.Appropriale treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.展开更多
To compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design. ...To compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design. METHODSForty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus (T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2DM, hypertension (HTN), obstructive sleep apnea syndrome (OSAS), hypothyroidism and gastroesophageal reflux disease (GERD). RESULTSPercentage excess weight loss (EWL%) was similar in LRYGB and LSG groups at one year follow-up (70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group (76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar (10% vs 7.5%, P = 0.99). The median duration of T2DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group (7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG. CONCLUSIONLRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.展开更多
基金Supported in part by the Offices of NP and HEP within the U.S.DOE Office of Sciencethe U.S.NSF+18 种基金the Sloan Foundationthe DFG cluster of excellence‘Origin and Structure of the Universe’of Germany,CNRS/IN2P3STFC and EPSRC of the United KingdomFAPESP CNPq of Brazil,Ministry of Ed.Sci.of the Russian FederationNNSFCCASMoSTMoE of ChinaGA and MSMT of the Czech RepublicFOM and NWO of the NetherlandsDAEDSTCSIR of IndiaPolish Ministry of Sci.Higher Ed.,Korea Research Foundation,Ministry of Sci.,Ed.Sports of the Rep.Of CroatiaRussian Ministry of Sci.and TechRos-Atom of Russia。
文摘Dihadron azimuthal correlations containing a high transverse momentum(pr)trigger particle are sensit-ive to the properties of the nuclear medium created at RHIC through the strong interactions occurring between the traversing parton and the medium,ie.jet-quenching.Previous measurements revealed a strong modification to di-hadron azimuthal correlations in Au+Au collisions with respect to ptp and d+Au collisions.The modification in-creases with the collision centrality,suggesting a path-length or energy density dependence to the je-quenching ef-fect.This paper reports STAR measurements of dihadron azimuthal correlations in mid-central(20%-60%)Au+Au collisions at√^(S)NN=200 GeV as a function of the trigger particle's azimuthal angle relative to the event plane,Ф_(s)=|Ф_(t)-ψ_(Ep)|.The azimuthal correlation is studied as a function of both the trigger and associated particle pr.The subtractions of the combinatorial background and anisotropic flow,assuming Zero Yield At Minimum(ZYAM),are described.The correlation results are first discussed with subtraction of the even harmonic(elliptic and quadrangu-lar)flow backgrounds.The away-side correlation is strongly modifed,and the modification varies withФ_(s),with a double-peak structure for out-of-plane trigger particles.The near-side ridge(long range pseudo-rapidity△_(η)correla-tion)appears to drop with increasingФ_(s)while the jet-like component remains approximately constant.The correla-tion functions are further studied with the subtraction of odd harmonic triangular flow background arising from fluc-tuations.It is found that the triangular flow,while responsible for the majority of the amplitudes,is not sufficient to explain theφs-dependence of the ridge or the away-side double-peak structure.The dropping ridge withФ_(s)could be attributed to aФ_(s)-dependent lliptie anisotropy;however,the physics mechanism of the ridge remains an open ques-tion.Even with aФ_(s)-dependent elliptic flow,the away-side correlation structure is robust.These results,with exte
文摘Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.
文摘Objective： To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior （AP） view and also assess if the addition of lateral view changes the classification and management plan. Methods： Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan. Then the same films were reshown in conjunction with their lateral view after 10 days. Results were compared with respect to the classification and management plan between two groups. Interobserver agreement was calculated using Fleiss＇ kappa. Results： There was only a fair interobserver agreement （kappa value 0.39） on Garden classification on AP view only which improved to moderate agreement （kappa value 0.52） after adding a lateral view. While there was only a slight improvement in the interobserver agreement on the management plan on AP view only （kappa value 0.50） and AP combined with lateral views （kappa value 0.52）. Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases. Conclusion： We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.
文摘Coronary artery disease(CAD) occurring in less than 45 years of age is termed as young CAD.Recent studies show a prevalence of 1.2% of CAD cases in this age group.Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%.Conventional risk factors such as smoking,diabetes,hypertension,obesity and family history seems to be as important as in older CAD subjects.But the prevalence of these risk factors seems to vary in younger subjects.By far the most commonly associated risk factor is smoking in young CAD.Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein(CETP) gene,hepatic lipase gene,lipoprotein lipase gene,apo A1 gene,apo E gene and apo B.Biomarkers such as lipoprotein(a),fibrinogen,D-dimer,serum Wnt,gamma glutamyl transferase,vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies.In general CAD in young has better prognosis than older subjects.In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes.Angiographic studies shows predominance of single vessel disease in young CAD patients.Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.
文摘AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.
文摘Patients with liver cirrhosis were traditionally believed to be protected against development of blood clots.Lately,studies have shown that these patients may probably be at an increased risk of venous thrombotic complications.Although the hemostatic changes in the chronic liver disease patients and the factors that may predict bleeding vs thrombotic complications remains an area of active research,it is believed that the coagulation cascade is delicately balanced in these patients because of parallel reduced hepatic synthesis of pro and anticoagulant factors.Thrombotic state in cirrhotic patients is responsible for not only portal or non-portal thrombosis[deep vein thrombosis(DVT)and pulmonary embolism(PE)];it has also been associated with progression of liver fibrosis.The use of anticoagulants in cirrhosis patients is a challenging,and often a scary situation.This review summarizes the current literature on the prevalence of venous thrombosis(DVT and PE),risk factors and safety of prophylactic and therapeutic anticoagulation in patients with chronic liver disease.
文摘Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence.
文摘Background:In China, the prevalence of allergic rhinitis (AR) and asthma has increased in the past decade. As these two diseases frequently coexist, the Asia-Pacific Survey of Physicians on Asthma and Allergic Rhinitis (ASPAIR) study aimed to assess physicians5 beliefs and treatment patterns of coexistent asthma-AR across six Asian countries. This analysis presents the results from China. Methods: The 200 hospital-based general physicians and pediatricians were interviewed from five cities in China. Physicians were questioned in-person about their knowledge, beliefs and management practices for patients with coexistent asthma-AR. Results: Approximately 70% of the physicians interviewed routinely evaluated their patients with asthma or AR for signs of coexistent disease. While the majority of physicians (>90% of physicians) recognized the increased burden of coexistent asthma-AR vs. one condition alone and that coexistent disease requires additional treatment, most physicians (96%) also believed that patients with coexistent asthma-AR were well managed if either condition alone improved. Similarly, although 71% of physicians selected a combination of intranasal and inhaled corticosteroids as their preferred treatment for coexistent asthma-AR, in line with treatment guidelines, two fifths of physicians indicated that treatment for coexistent disease requires too much medication and that their patients prefer oral medications and a third of physicians believed that corticosteroids should be delayed in children. Conclusions: This survey demonstrates that physicians interviewed in China have a broad understanding of coexistent asthma-AR and its impact on patients. A holistic approach to patient management with informed decisions regarding patients' overall treatment will benefit patients who suffer from coexistent disease.
文摘Cervical cancer prevention requires a multipronged approach involving primary, secondary and tertiary prevention. The key element under primary prevention is human papilloma virus(HPV) vaccination. So far, only prophylactic HPV vaccines which prevent HPV infection by one or more subtypes are commercially available. Therapeutic HPV vaccines which aid in clearing established infection are still under trial. Secondary prevention entails early detection of precancerous lesions and its success is determined by the population coverage and the efficacy of the screening technique. A number of techniques are in use, including cytology, visual inspection(using the naked eye, magnivisualizer, acetic acid and Lugol's iodine), HPV testing and a combination of these methods. Updated screening guidelines have been advocated by the American Cancer Society in light of the role of HPV on cervical carcinogenesis. Recent research has also focussed on novel biomarkers that can predict progression to cancer in screen positive women and help to differentiate those who need treatment from those who can be left for follow-up. Last but not the least, effective treatment of precancerous lesions can help to reduce the incidence of invasive cervical cancer and this constitutes tertiary prevention.A combination of these approaches can help to prevent the burden of cervical cancer and its antecedent morbidity and mortality, but all of these are not feasible in all settings due to resource and allocation constraints. Thus, all countries, especially low and middle income ones, have to determine their own cocktail of approaches that work before we can say with certainty that yes, cervical cancer can be prevented.
文摘Atorvastatin has low aqueous solubility resulting in low oral bioavailability(12%)and thus presents a challenge in formulating a suitable dosage form.To improve the aqueous solubility,a solid dispersion formulation of atorvasta tin was prepared by lyophilization utilising skimmed milk as a carrier.Six different formulations were prepared with varying ratios of drug and carrier and the corresponding physical mixtures were also prepared.The formation of a solid dispersion formulation was confirmed by differential scanning ca lorimetry and X-ray diffraction studies.The optimum drug-to-carrier ratio of 1:9 en hanced solubility nearly 33-fold as compared to pure drug.In vitro drug release studies exhibited a cumulative release of 83.69% as compared to 22.7% for the pure drug.Additionally,scanning electron microscopy studies suggested the conversion of crystalline atorvastatin to an amorphous form.In a Triton-induced hyperlipidemia model,a 3-fold increase in the lipid lowering potential was obtained with the reformulated drug as compared to pure drug.These results suggest that solid dispersion of atorvastatin using skimmed milk as carrier is a promising approach for oral delivery of atorvastatin.
文摘Gastric cancer(GC) is a highly heterogenic disease,and it is the second leading cause of cancer death in the world.Common chemotherapies are not very effective for GC,which often presents as an advanced or metastatic disease at diagnosis.Treatment options are limited,and the prognosis for advanced GCs is poor.The landscape of genomic alterations in GCs has recently been characterized by several international cancer genome programs,including studies that focused exclusively on GCs in Asians.These studies identified major recurrent driver mutations and provided new insights into the mutational heterogeneity and genetic profiles of GCs.An analysis of gene expression data by the Asian Cancer Research Group(ACRG) further uncovered four distinct molecular subtypes with well-defined clinical features and their intersections with actionable genetic alterations to which targeted therapeutic agents are either already available or under clinical development.In this article,we review the ACRG GC project.We also discuss the implications of the genetic and molecular findings from various GC genomic studies with respect to developing more precise diagnoses and treatment approaches for GCs.
文摘Purpose: Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads and traffics but related literature regarding the overall epidemiology of these injuries is scarce and scanty. Our aim was to study the epidemiology of patients admitted with pelvic fractures at a level 1 trauma centre in India. Methods: A 16-month (between September 2015 and December 2016) prospective observational study was carried out on trauma patients with pelvic fractures at a level 1 trauma centre of a tertiary care hospital. Demography of patients, mechanism of injuries and complications were recorded prospectively. Results: We observed 75 patients who presented with pelvic fractures, where 56 were males and 19 were females. Mean age of the study populationwas 37.57 years. Road traffic accidents were the most common mode of injuries. Lateral compression injuries were the most common pattern. Associated injuries frequently encountered were lower extremities and acetabulum fractures, blunt abdominal trauma, urogenital injuries and head injuries. Out of the 75 patients, 52 were treated surgically and 23 were managed by conservative methods. Associated injuries of the extremities, head, abdomen and urogenital system indicated a longer hospital stay. Conclusion: Pelvic fractures, although belong to a relatively rare trauma subset, cause a high morbidity and mortality with considerable burden on the economy. Proper road safety training and driving etiquettes along with its strict implementation in true sense and spirit are the need of the hour.
文摘There has been a considerable development in microfluidic based immunodiagnostics over the past few years which has greatly favored the growth of novel point-of-care-testing(POCT).However,the realization of an inexpensive,low-power POCT needs cheap and disposable microfluidic devices that can perform autonomously with minimum user intervention.This work,for the first time,reports the development of a new microchannel capillary flow assay(MCFA)platform that can perform chemiluminescence based ELISA with lyophilized chemiluminescent reagents.This new MCFA platform exploits the ultra-high sensitivity of chemiluminescent detection while eliminating the shortcomings associated with liquid reagent handling,control of assay sequence and user intervention.The functionally designed microchannels along with adequate hydrophilicity produce a sequential flow of assay reagents and autonomously performs the ultra-high sensitive chemiluminescence based ELISA for the detection of malaria biomarker such as PfHRP2.The MCFA platform with no external flow control and simple chemiluminescence detection can easily communicate with smartphone via USB-OTG port using a custom-designed optical detector.The use of the smartphone for display,data transfer,storage and analysis,as well as the source of power allows the development of a smartphone based POCT analyzer for disease diagnostics.This paper reports a limit of detection(LOD)of 8 ng/mL by the smartphone analyzer which is sensitive enough to detect active malarial infection.The MCFA platform developed with the smartphone analyzer can be easily customized for different biomarkers,so a hand-held POCT for various infectious diseases can be envisaged with full networking capability at low cost.
文摘Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single- implant cephalomedullary fix
文摘Helicobacter pylori(H. pylori) is a known pathogen implicated in genesis of gastritis, peptic ulcer disease, gastric carcinoma and gastric lymphoma. Beyond the stomach, the organism has also been implicated in the causation of immune thrombocytopenia and iron deficiency anemia. Although an area of active clinical research, the role of this gram negative organism in causation of atherosclerosis and coronary artery disease(CAD) remains enigmatic. CAD is a multifactorial disease which results from the atherosclerosis involving coronaryarteries. The major risk factors include age, diabetes mellitus, smoking, hypertension and dyslipidemia. The risk of coronary artery disease is believed to increase with chronic inflammation. Various organisms like Chlamydia and Helicobacter have been suspected to have a role in genesis of atherosclerosis via causation of chronic inflammation. This paper focuses on available evidence to ascertain if the role of H. pylori in CAD causation has been proven beyond doubt and if eradication may reduce the risk of CAD or improve outcomes in these patients.
文摘BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer(GBC)patients but only 10%of patients have a resectable disease at presentation.Even after surgical resection,overall survival(OS)has been poor due to high rates of recurrence.Combination of surgery and systemic therapy can improve outcomes in this aggressive disease.AIM To summarize our single-center experience with multimodality management of resectable GBC patients.METHODS Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database.Information extracted included demographics,operative and perioperative details,histopathology,neoadjuvant/adjuvant therapy,follow-up,and recurrence.To know the factors associated with recurrence and OS,univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables,respectively.Multivariate analysis was done using multiple regression analysis.RESULTS Of 274 patients with GBC taken up for surgical resection,172(62.7%)were female and the median age was 56 years.On exploration,102 patients were found to have a metastatic or unresectable disease(distant metastasis in 66 and locally unresectable in 34).Of 172 patients who finally underwent surgery,93(54%)underwent wedge resection followed by anatomical segment IVb/V resection in 66(38.4%)and modified extended right hepatectomy in 12(7%)patients.The postoperative mortality at 90 d was 4.6%.During a median follow-up period of 20 mo,71(41.2%)patients developed recurrence.Estimated 1-,3-,and 5-years OS rates were 86.5%,56%,and 43.5%,respectively.Estimated 1-and 3-year disease free survival(DFS)rates were 75%and 49.2%,respectively.On multivariate analysis,inferior OS was seen with pT3/T4 tumor(P=0.0001),perineural invasion(P=0.0096),and R+resection(P=0.0125).However,only pT3/T4 tumors were associated with a poor DFS(P<0.0001).CONCLUSION Multimodality treatment significantly improves the 5-y
文摘Hepatic tuberculosis particularly in the absence of military tuberculosis is rare.It can occur as a primary case or due to reactivation of an old tubercular focus.We report case of a 24 year old married female who died of primary hepatic tuberculosis.She had no evidence of tuberculosis elsewhere.Appropriale treatment initiated early can result in marked recovery whereas failure to recognize this entity can prove to be fatal.
文摘To compare the impact of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design. METHODSForty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus (T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2DM, hypertension (HTN), obstructive sleep apnea syndrome (OSAS), hypothyroidism and gastroesophageal reflux disease (GERD). RESULTSPercentage excess weight loss (EWL%) was similar in LRYGB and LSG groups at one year follow-up (70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group (76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar (10% vs 7.5%, P = 0.99). The median duration of T2DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group (7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG. CONCLUSIONLRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.
