Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor...Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.展开更多
AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye Retroscope Randomized Clinical Evaluation...AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye Retroscope Randomized Clinical Evaluation(TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy(SC) and Third Eye colonoscopy(TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects(51.0%),surveillance after previous polypectomy in 87(25.2%) and diagnostic workup in 82(23.8%).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to SC.Relative risk(RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92(P = 0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11(P = 0.815) for screening,3.15(P = 0.014) for surveillance,8.64(P = 0.039) for diagnostic and 3.34(P = 0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically significant.Age,bowel prep quality and withdrawal time did not展开更多
Background and Aims:The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown.This study aimed to determine t...Background and Aims:The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown.This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRAAKI) and expired during that hospitalization.Methods:One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis.These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF.Results:BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens.Patients with BCN had significantly higher levels of serum total bilirubin,total leukocyte count and model for end-stage liver disease score,as compared to those without BCN.BCN was detected in 32/43 (74.4%) of the patients with ACLF,as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis (p < 0.001).On multivariate analysis,direct bilirubin (OR (95% CI):1.27 (1121-1.698);p < 0.001)and presence of ACLF (OR (95% CI):2.603 (1.054-7.111);p =0.041) were found to be significant predictors of BCN on postmortem renal biopsy.Conclusion:BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal biopsy.Direct serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.展开更多
Nicotinamide adenine dinucleotide phosphate oxidase(NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under...Nicotinamide adenine dinucleotide phosphate oxidase(NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however,excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis. Moreover, recent studies have established that glucose, as a NOX substrate, plays a vital role in the pathogenesis of reperfusion injury. Thus, NOX inhibition has the potential to mitigate the deleterious impact of hyperglycemia on stroke. In this paper, we provide an overview of this research,coupled with a discussion of its implications for the development of NOX inhibition as a strategy for the treatment of ischemic stroke. Both inhibition using apocynin, as well as the prospect of developing more specific inhibitors based on what is now understood of the biology of NOX assembly and activation, will be highlighted in the course of our discussion.展开更多
Rheumatic heart disease(RHD)is a major cause of cardiovascular morbidity and mortality in developing nations like India.RHD commonly affects the mitral valve which is lined by a single layer of endothelial cells(ECs)....Rheumatic heart disease(RHD)is a major cause of cardiovascular morbidity and mortality in developing nations like India.RHD commonly affects the mitral valve which is lined by a single layer of endothelial cells(ECs).The role of ECs in mitral valve damage during RHD is not well elucidated.In here,anti-endothelial cell antibody from RHD patients has been used to stimulate the ECs(HUVECs and HMVECs).ECs proinflammatory phenotype with increased expression of TNFa,IL-6,IL-8,IFNg,IL-1b,ICAM1,VCAM1,E-selectin,laminin B,and vimentin was documented in both ECs.The promoter hypomethylation of various key inflammatory cytokines(TNFa,IL-6,and IL-8),integrin(ICAM1)associated with leukocyte transendothelial migration,and extracellular matrix genes(vimentin,and laminin)were also observed.Further,the in-vitro data was in accordance with ex-vivo observations which correlated significantly with the etiological factors such as smoking,socioeconomic status,and housing.Thus,the study sheds light on the role of ECs in RHD which is a step forward in the elucidation of disease pathogenesis.展开更多
Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fra...Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.展开更多
Seawater intrusion caused by groundwater over-exploitation from coastal aquifers poses a severe problem in many regions. Formulation of proper pumping strategy using a simulation model can assure sustainable supply of...Seawater intrusion caused by groundwater over-exploitation from coastal aquifers poses a severe problem in many regions. Formulation of proper pumping strategy using a simulation model can assure sustainable supply of fresh water from the coastal aquifers. The focus of the present study is on the development of a numerical model based on Meshfree (MFree) method to study the seawater intrusion problem. For the simulation of seawater intrusion problem, widely used models are based on Finite Difference (FDM) and Finite Element (FEM) Methods, which demand well defined grids/meshes and considerable pre-processing efforts. Here, MFree Point Collocation Method (PCM) based on the Radial Basis Function (RBF) is proposed for the simulation. Diffusive interface approach with density-dependent dispersion and solution of flow and solute transport is adopted. These equations are solved using PCM with appropriate boundary conditions. The developed model has been verified with Henry’s problem, and found to be satisfactory. Further the model has been applied to another established problem and an attempt is made to examine the influence of important system parameters including pumping and recharge on the seawater intrusion. The PCM based MFree model is found computationally efficient as preprocessing is avoided when compared to other numerical methods.展开更多
Background:There is increased use of early nasal continuous positive airway pressure(NCPAP)to manage respiratory distress in preterm infants but optimal methods and factors associated with successful wean are not well...Background:There is increased use of early nasal continuous positive airway pressure(NCPAP)to manage respiratory distress in preterm infants but optimal methods and factors associated with successful wean are not well defined.A systematic review was performed to define the corected gestational age(CGA),weight to wean NCPAP and the methods associated with successful weaning of the NCPAP among preterm infants,along with factors affecting it.Methods:Searches were made of PubMed using the keywords-NCPAP,CPAP,weaning,withdrawal,preterm,and infants from its inception to January 1st,2014,for studies in all languages but limited to humans.Previous reviews(including cross references)were also searched.We included all randomized and quasi-randomized controlled trials where preterm neonates were randomized to different NCPAP weaning strategies.Details of CGA,weight and methods used for weaning NCPAP were extracted along with factors which affect its withdrawal.Results:Seven studies met the search criteria.The successful wean was at 32 to 33 weeks CGA and at 1600 g.Three different methods were used for weaning were sudden,gradual pressure wean and gradual graded time off wean.Criteria for readiness,success and failure to wean were defined.Factors affecting successful weaning were intubation,anemia,infection and gastro-esophageal reflux.Conclusions:The successful wean was at 32 to 33 weeks CGA and 1600 g.Criteria for readiness,success and failure to wean are well defined.Sudden weaning may be associated with a shorter weaning time.Future trials are needed comparing weaning methods using defined criteria for readiness and success of NCPAP wean and stratify the results by gestational age and birth weight.展开更多
OBJECTIVE： Tephrosia purpurea （Linn.） Pers. is widely used in traditional medicine to treat liver disorders, febrile attacks, enlargement and obstruction of liver, spleen, and kidney. In the present study investiga...OBJECTIVE： Tephrosia purpurea （Linn.） Pers. is widely used in traditional medicine to treat liver disorders, febrile attacks, enlargement and obstruction of liver, spleen, and kidney. In the present study investigations were carried out to determine the seasonal impact on the content of flavonoid glycosides and on antioxidant activities so as to identify the optimal time of harvesting. METHODS： The plant materials were collected in different seasons during 2013-2014. Air-dried, powdered plant materials were extracted with 95% ethanol and ethanol：water （1：1 ） by ultrasound-assisted extraction process. Their chemical composition in terms of total polyphenol and flavonoid contents （TPCs and TFCs） was determined using modified colorimetric Folin-Ciocalteu method and aluminum chloride colorimetric assay respectively. To determine the in vitro antioxidant activity, diphenyl-picryl hydrazyl （DPPH） radical-scavenging assay and total antioxidant capacity by phosphomolybdate antioxidant assay were carried out. High-performance liquid chromatography （HPLC）/photo-diode array （PDA） analysis was used to quantify the flavonoid glycosides in the samples collected in different seasons. Correlation studies were also carried out between antioxidant activities and TPCs. RESULTS： The highest TPC and TFC were found to be in the 95% ethanolic extract of the August sample and the lowest in the 50% hydro-alcoholic extract of the plant sample collected in winter season. It was observed that in both the assays used to determine the antioxidant activity, the 95% ethanolic extracts in all the seasons showed a higher activity than their respective 50% hydro- alcoholic extracts with an increase in activity as we go from cold to hot to rainy seasons. Based on correlation analysis, DPPH radical-scavenging activities as well as the spectrophotometrically measured phosphomolybdenum complex were also strongly correlated with TPC of the extracts, The most abundant flavonoid glycoside was quercetin-3-O-rhamnoglucosid展开更多
In this era of fast-depleting natural resources,the hike in fuel prices is ever-growing.With stringent norms over environmental policies,the automotive manufacturers are on a voyage to produce efficient vehicles with ...In this era of fast-depleting natural resources,the hike in fuel prices is ever-growing.With stringent norms over environmental policies,the automotive manufacturers are on a voyage to produce efficient vehicles with lower emissions.High-speed cars are at a stake to provide uncompromised performance but having strict rules over emissions drives the companies to approach through a different route to keep the demands of performance intact.One of the most sought-after ways is to improve the aerodynamics of the vehicles.Drag force is one of the major setbacks when it comes to achieving high speeds when the vehicle is in motion.This research aims to examine the effects of different add on devices on the vehicle to reduce drag and make the vehicle aerodynamically streamlined.A more streamlined vehicle will be able to achieve high speeds and consequently,the fuel economy is also improved.The three-dimensional car model is developed in SOLIDWORKS v17.Computational Fluid Dynamics(CFD)is performed to understand the effects of these add on devices.CFD is carried out in the ANSYS^(TM) 17.0 Fluent module.Drag Coefficient(CD),Lift Coefficient(CL),Drag Force and Lift Force are calculated and compared in different cases.The result of the simulations was analyzed and it was observed that different devices posed several different functionalities,but maximum drag reduction was found in the case of GT with spoiler and diffuser with a maximum reduction of 16.53%.展开更多
BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No univers...BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No universal clinical guidelines are used and questions remain. This review aimed to address the current status of early extubation after liver transplantation. DATA SOURCES: A literature search of MEDLINE and ISI Web of Knowledge databases was performed using terms such as liver transplantation, early extubation, immediate tracheal extubation fast tracking or fast track anesthesia and postoperative tracheal extubation. Additional papers were identified by a manual search of the references in the key articles. RESULTS: Review of the available literature provided an insight into the definition, evolution, advantages and risks of early extubation, and anesthetic techniques that prompt early extubation in liver transplant patients. Early extubation has proved to be feasible and safe in these patients, but the outcomes are still uncertain. CONCLUSIONS: Early extubation after liver transplantation is feasible, safe and cost-effective in the majority of patients and has been increasingly accepted as an option for conventional postoperative ventilation. Comprehensive and individualized evaluation of the patient’s condition before extubation by an experienced anesthesiologist is the cornerstone of success Understanding of its effect on the outcome remains incomplete In the future, additional trials are required to establish universal early extubation guidelines and to determine its benefits for patients and practitioners.展开更多
Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI s...Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.展开更多
Naturopathy is a traditional health care science having its own concepts of health and healing rooting through nature.It is a non-pharmacological system of health care which derives its disease causing and health keep...Naturopathy is a traditional health care science having its own concepts of health and healing rooting through nature.It is a non-pharmacological system of health care which derives its disease causing and health keeping principles from fundamental natural elements(Panchamahabhutas)viz.Prithvi,Jala,Vayu,Agni,and Akash.The imbalance among these five elements individually or in respect to others creates disease and in turn also forms the basis of healing if such imbalances are corrected.This paper reviews the simple concepts of naturopathy referring to health and disease and contextualises them to the on-going pandemic which has affected the entire world.An extensive manual and digital search of the relevant literature was done related to naturopathy in order to compile the review.This review is important from the perspectives that in the current pandemic the cure is still not evident from any corner of the world and from any system of medicine.Therefore such simple health keeping strategies from naturopathy seem to be of much relevance.展开更多
Chondroblastoma is a rare benign cartilaginous neoplasm of bone. The recurrence rate is high and complications are frequent following open curettage with bone grafting which is the standard treatment forchondroblastom...Chondroblastoma is a rare benign cartilaginous neoplasm of bone. The recurrence rate is high and complications are frequent following open curettage with bone grafting which is the standard treatment forchondroblastomas. We performed radiofrequency ablation in three cases of tibialchondroblastoma using the bipolar system. One patient experienced residual pain for which repeat ablation was performed. No other complications were observed during follow-up. Radiofrequency ablation may offer an effective alternative for the treatment of selected cases of chondroblastoma. The lesion characteristics which are likely to influence treatment outcome and the advantages offered by the bipolar system are discussed.展开更多
An obligatory sunlight requirement for photosynthesis has exposed cyanobacteria to different quantity and quality of light. Cyanobacteria can exhibit efficient photosynthesis over broad region(450 to 650 nm) of solar ...An obligatory sunlight requirement for photosynthesis has exposed cyanobacteria to different quantity and quality of light. Cyanobacteria can exhibit efficient photosynthesis over broad region(450 to 650 nm) of solar spectrum with the help of brilliantly coloured pigment proteins called phycobiliproteins(PBPs). Besides light-harvesting, PBPs are found to involve in several life sustaining phenomena including photoprotection in cyanobacteria. The unique spectral features(like strong absorbance and fluorescence), proteineous nature and, some imperative properties like hepato-protective, antioxidants, anti-inflammatory and anti-aging activity of PBPs enable their use in food, cosmetics, pharmaceutical and biomedical industries. PBPs have been also noted to show beneficial effect in therapeutics of some disease like Alzheimer and cancer. Such large range of applications increases the demand of PBPs in commodity market. Therefore, the large-scale and coast effective production of PBPs is the real need of time. To fulfil this need, many researchers have been working to find the potential producer of PBPs for the production and purification of PBPs. Results of these efforts have caused the inventions of some novel techniques like mixotrophic and heterotrophic strategies for production and aqueous two phase separation for purification purpose. Overall, the present review summarises the recent findings and identifies gaps in the field of production, purification and applications of this biological and economically important proteins.展开更多
Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. Th...Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northem India. Methods： An observational study of 748 patients chosen by random assortment was carried out over a peri- od of 1 year （August 2008 to July 2009）. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results： Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6：1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries （94.92%） were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common （40.3%）. Most spinal cord injuries were caused by falls from height （51.09%）. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than up- per limb fractures. Conclusion： Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and plan- ning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.展开更多
AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted...AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.展开更多
The longitudinal dispersion of solute in open channel flow with short period progressive waves is investigated. The waves induce second order drift velocity in the direction of propagation and enhance the mixing proce...The longitudinal dispersion of solute in open channel flow with short period progressive waves is investigated. The waves induce second order drift velocity in the direction of propagation and enhance the mixing process in concurrent direction. The 1-D wave-period-averaged dispersion equation is derived and an expression for the wave-current induced longitudinal dispersion coefficient （WCLDC） is propased based on Fiscber＇ s expression （1979） for dispersion in unidirectional flow. The result shows that the effect of waves on dispersion is mainly due to the cross-sectional variation of the drift velocity. Furthermore, to obtain a more practical expression of the WCLDC, the longitudinal dispersion coefficient due to Seo and Cheong （1998） is modified to incluee the effect of drift velocity. Laboratory experiments have been conducted to verify the propased expression. The experimental results, together with dimensional analysis, show that tbe wave effect can be reflected by the ratio between the wave amplitude and wave period. A comparative study between the cases with and without waves demonstrates that the magnitude of the longitudinal dispersion coefficient is increased nnder the presence of waves.展开更多
文摘Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.
基金Supported by A grant from Avantis Medical Systems,in part
文摘AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye Retroscope Randomized Clinical Evaluation(TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy(SC) and Third Eye colonoscopy(TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects(51.0%),surveillance after previous polypectomy in 87(25.2%) and diagnostic workup in 82(23.8%).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to SC.Relative risk(RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92(P = 0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11(P = 0.815) for screening,3.15(P = 0.014) for surveillance,8.64(P = 0.039) for diagnostic and 3.34(P = 0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically significant.Age,bowel prep quality and withdrawal time did not
文摘Background and Aims:The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown.This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRAAKI) and expired during that hospitalization.Methods:One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis.These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF.Results:BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens.Patients with BCN had significantly higher levels of serum total bilirubin,total leukocyte count and model for end-stage liver disease score,as compared to those without BCN.BCN was detected in 32/43 (74.4%) of the patients with ACLF,as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis (p < 0.001).On multivariate analysis,direct bilirubin (OR (95% CI):1.27 (1121-1.698);p < 0.001)and presence of ACLF (OR (95% CI):2.603 (1.054-7.111);p =0.041) were found to be significant predictors of BCN on postmortem renal biopsy.Conclusion:BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal biopsy.Direct serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.
基金partially supported by Merit Review Award(I01RX-001964-01)from the US Department of Veterans Affairs Rehabilitation Research and Development Service(to YD)the National Natural Science Foundation of China(81501141)+1 种基金Beijing New Star of Science and Technology Program of China(xx2016061)Beijing Tongzhou District Financial Fund,and Scientific Research Common Program of Beijing Municipal Commission of Education,China(KM201610025028)(to XG)
文摘Nicotinamide adenine dinucleotide phosphate oxidase(NOX) is a multisubunit enzyme complex that utilizes nicotinamide adenine dinucleotide phosphate to produce superoxide anions and other reactive oxygen species. Under normal circumstances, reactive oxygen species mediate a number of important cellular functions, including the facilitation of adaptive immunity. In pathogenic circumstances, however,excess reactive oxygen species generated by NOX promotes apoptotic cell death. In ischemic stroke, in particular, it has been shown that both NOX activation and derangements in glucose metabolism result in increased apoptosis. Moreover, recent studies have established that glucose, as a NOX substrate, plays a vital role in the pathogenesis of reperfusion injury. Thus, NOX inhibition has the potential to mitigate the deleterious impact of hyperglycemia on stroke. In this paper, we provide an overview of this research,coupled with a discussion of its implications for the development of NOX inhibition as a strategy for the treatment of ischemic stroke. Both inhibition using apocynin, as well as the prospect of developing more specific inhibitors based on what is now understood of the biology of NOX assembly and activation, will be highlighted in the course of our discussion.
基金We immensely thank Indian Council of Medical Research,New Delhi for the award of Junior Research Fellowship to Mukul Rastogi[(3/1/3/JRF-2012/HRD-107(11172)].
文摘Rheumatic heart disease(RHD)is a major cause of cardiovascular morbidity and mortality in developing nations like India.RHD commonly affects the mitral valve which is lined by a single layer of endothelial cells(ECs).The role of ECs in mitral valve damage during RHD is not well elucidated.In here,anti-endothelial cell antibody from RHD patients has been used to stimulate the ECs(HUVECs and HMVECs).ECs proinflammatory phenotype with increased expression of TNFa,IL-6,IL-8,IFNg,IL-1b,ICAM1,VCAM1,E-selectin,laminin B,and vimentin was documented in both ECs.The promoter hypomethylation of various key inflammatory cytokines(TNFa,IL-6,and IL-8),integrin(ICAM1)associated with leukocyte transendothelial migration,and extracellular matrix genes(vimentin,and laminin)were also observed.Further,the in-vitro data was in accordance with ex-vivo observations which correlated significantly with the etiological factors such as smoking,socioeconomic status,and housing.Thus,the study sheds light on the role of ECs in RHD which is a step forward in the elucidation of disease pathogenesis.
文摘Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.
文摘Seawater intrusion caused by groundwater over-exploitation from coastal aquifers poses a severe problem in many regions. Formulation of proper pumping strategy using a simulation model can assure sustainable supply of fresh water from the coastal aquifers. The focus of the present study is on the development of a numerical model based on Meshfree (MFree) method to study the seawater intrusion problem. For the simulation of seawater intrusion problem, widely used models are based on Finite Difference (FDM) and Finite Element (FEM) Methods, which demand well defined grids/meshes and considerable pre-processing efforts. Here, MFree Point Collocation Method (PCM) based on the Radial Basis Function (RBF) is proposed for the simulation. Diffusive interface approach with density-dependent dispersion and solution of flow and solute transport is adopted. These equations are solved using PCM with appropriate boundary conditions. The developed model has been verified with Henry’s problem, and found to be satisfactory. Further the model has been applied to another established problem and an attempt is made to examine the influence of important system parameters including pumping and recharge on the seawater intrusion. The PCM based MFree model is found computationally efficient as preprocessing is avoided when compared to other numerical methods.
文摘Background:There is increased use of early nasal continuous positive airway pressure(NCPAP)to manage respiratory distress in preterm infants but optimal methods and factors associated with successful wean are not well defined.A systematic review was performed to define the corected gestational age(CGA),weight to wean NCPAP and the methods associated with successful weaning of the NCPAP among preterm infants,along with factors affecting it.Methods:Searches were made of PubMed using the keywords-NCPAP,CPAP,weaning,withdrawal,preterm,and infants from its inception to January 1st,2014,for studies in all languages but limited to humans.Previous reviews(including cross references)were also searched.We included all randomized and quasi-randomized controlled trials where preterm neonates were randomized to different NCPAP weaning strategies.Details of CGA,weight and methods used for weaning NCPAP were extracted along with factors which affect its withdrawal.Results:Seven studies met the search criteria.The successful wean was at 32 to 33 weeks CGA and at 1600 g.Three different methods were used for weaning were sudden,gradual pressure wean and gradual graded time off wean.Criteria for readiness,success and failure to wean were defined.Factors affecting successful weaning were intubation,anemia,infection and gastro-esophageal reflux.Conclusions:The successful wean was at 32 to 33 weeks CGA and 1600 g.Criteria for readiness,success and failure to wean are well defined.Sudden weaning may be associated with a shorter weaning time.Future trials are needed comparing weaning methods using defined criteria for readiness and success of NCPAP wean and stratify the results by gestational age and birth weight.
文摘OBJECTIVE： Tephrosia purpurea （Linn.） Pers. is widely used in traditional medicine to treat liver disorders, febrile attacks, enlargement and obstruction of liver, spleen, and kidney. In the present study investigations were carried out to determine the seasonal impact on the content of flavonoid glycosides and on antioxidant activities so as to identify the optimal time of harvesting. METHODS： The plant materials were collected in different seasons during 2013-2014. Air-dried, powdered plant materials were extracted with 95% ethanol and ethanol：water （1：1 ） by ultrasound-assisted extraction process. Their chemical composition in terms of total polyphenol and flavonoid contents （TPCs and TFCs） was determined using modified colorimetric Folin-Ciocalteu method and aluminum chloride colorimetric assay respectively. To determine the in vitro antioxidant activity, diphenyl-picryl hydrazyl （DPPH） radical-scavenging assay and total antioxidant capacity by phosphomolybdate antioxidant assay were carried out. High-performance liquid chromatography （HPLC）/photo-diode array （PDA） analysis was used to quantify the flavonoid glycosides in the samples collected in different seasons. Correlation studies were also carried out between antioxidant activities and TPCs. RESULTS： The highest TPC and TFC were found to be in the 95% ethanolic extract of the August sample and the lowest in the 50% hydro-alcoholic extract of the plant sample collected in winter season. It was observed that in both the assays used to determine the antioxidant activity, the 95% ethanolic extracts in all the seasons showed a higher activity than their respective 50% hydro- alcoholic extracts with an increase in activity as we go from cold to hot to rainy seasons. Based on correlation analysis, DPPH radical-scavenging activities as well as the spectrophotometrically measured phosphomolybdenum complex were also strongly correlated with TPC of the extracts, The most abundant flavonoid glycoside was quercetin-3-O-rhamnoglucosid
文摘In this era of fast-depleting natural resources,the hike in fuel prices is ever-growing.With stringent norms over environmental policies,the automotive manufacturers are on a voyage to produce efficient vehicles with lower emissions.High-speed cars are at a stake to provide uncompromised performance but having strict rules over emissions drives the companies to approach through a different route to keep the demands of performance intact.One of the most sought-after ways is to improve the aerodynamics of the vehicles.Drag force is one of the major setbacks when it comes to achieving high speeds when the vehicle is in motion.This research aims to examine the effects of different add on devices on the vehicle to reduce drag and make the vehicle aerodynamically streamlined.A more streamlined vehicle will be able to achieve high speeds and consequently,the fuel economy is also improved.The three-dimensional car model is developed in SOLIDWORKS v17.Computational Fluid Dynamics(CFD)is performed to understand the effects of these add on devices.CFD is carried out in the ANSYS^(TM) 17.0 Fluent module.Drag Coefficient(CD),Lift Coefficient(CL),Drag Force and Lift Force are calculated and compared in different cases.The result of the simulations was analyzed and it was observed that different devices posed several different functionalities,but maximum drag reduction was found in the case of GT with spoiler and diffuser with a maximum reduction of 16.53%.
基金supported by a grant from the National S&T Major Project of China (2012ZX10002-017)
文摘BACKGROUND: Anesthetic practices such as early tracheal extubation facilitate postoperative recovery. Early extubation after liver transplantation has been adopted by some centers in the recent two decades. No universal clinical guidelines are used and questions remain. This review aimed to address the current status of early extubation after liver transplantation. DATA SOURCES: A literature search of MEDLINE and ISI Web of Knowledge databases was performed using terms such as liver transplantation, early extubation, immediate tracheal extubation fast tracking or fast track anesthesia and postoperative tracheal extubation. Additional papers were identified by a manual search of the references in the key articles. RESULTS: Review of the available literature provided an insight into the definition, evolution, advantages and risks of early extubation, and anesthetic techniques that prompt early extubation in liver transplant patients. Early extubation has proved to be feasible and safe in these patients, but the outcomes are still uncertain. CONCLUSIONS: Early extubation after liver transplantation is feasible, safe and cost-effective in the majority of patients and has been increasingly accepted as an option for conventional postoperative ventilation. Comprehensive and individualized evaluation of the patient’s condition before extubation by an experienced anesthesiologist is the cornerstone of success Understanding of its effect on the outcome remains incomplete In the future, additional trials are required to establish universal early extubation guidelines and to determine its benefits for patients and practitioners.
文摘Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual.We report a case of a 35 year old woman presenting with an insidious onset of myelopathy,where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.
文摘Naturopathy is a traditional health care science having its own concepts of health and healing rooting through nature.It is a non-pharmacological system of health care which derives its disease causing and health keeping principles from fundamental natural elements(Panchamahabhutas)viz.Prithvi,Jala,Vayu,Agni,and Akash.The imbalance among these five elements individually or in respect to others creates disease and in turn also forms the basis of healing if such imbalances are corrected.This paper reviews the simple concepts of naturopathy referring to health and disease and contextualises them to the on-going pandemic which has affected the entire world.An extensive manual and digital search of the relevant literature was done related to naturopathy in order to compile the review.This review is important from the perspectives that in the current pandemic the cure is still not evident from any corner of the world and from any system of medicine.Therefore such simple health keeping strategies from naturopathy seem to be of much relevance.
文摘Chondroblastoma is a rare benign cartilaginous neoplasm of bone. The recurrence rate is high and complications are frequent following open curettage with bone grafting which is the standard treatment forchondroblastomas. We performed radiofrequency ablation in three cases of tibialchondroblastoma using the bipolar system. One patient experienced residual pain for which repeat ablation was performed. No other complications were observed during follow-up. Radiofrequency ablation may offer an effective alternative for the treatment of selected cases of chondroblastoma. The lesion characteristics which are likely to influence treatment outcome and the advantages offered by the bipolar system are discussed.
基金Department of Science and Technology,New Delhi,India for financial help in the form of the INSPIRE (IF120712) fellowshipUniversity Grant Commission,New Delhi,India for Dr.Kothari DS Post- doctoral Research Grant
文摘An obligatory sunlight requirement for photosynthesis has exposed cyanobacteria to different quantity and quality of light. Cyanobacteria can exhibit efficient photosynthesis over broad region(450 to 650 nm) of solar spectrum with the help of brilliantly coloured pigment proteins called phycobiliproteins(PBPs). Besides light-harvesting, PBPs are found to involve in several life sustaining phenomena including photoprotection in cyanobacteria. The unique spectral features(like strong absorbance and fluorescence), proteineous nature and, some imperative properties like hepato-protective, antioxidants, anti-inflammatory and anti-aging activity of PBPs enable their use in food, cosmetics, pharmaceutical and biomedical industries. PBPs have been also noted to show beneficial effect in therapeutics of some disease like Alzheimer and cancer. Such large range of applications increases the demand of PBPs in commodity market. Therefore, the large-scale and coast effective production of PBPs is the real need of time. To fulfil this need, many researchers have been working to find the potential producer of PBPs for the production and purification of PBPs. Results of these efforts have caused the inventions of some novel techniques like mixotrophic and heterotrophic strategies for production and aqueous two phase separation for purification purpose. Overall, the present review summarises the recent findings and identifies gaps in the field of production, purification and applications of this biological and economically important proteins.
文摘Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northem India. Methods： An observational study of 748 patients chosen by random assortment was carried out over a peri- od of 1 year （August 2008 to July 2009）. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results： Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6：1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries （94.92%） were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common （40.3%）. Most spinal cord injuries were caused by falls from height （51.09%）. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than up- per limb fractures. Conclusion： Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and plan- ning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.
文摘AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.
文摘The longitudinal dispersion of solute in open channel flow with short period progressive waves is investigated. The waves induce second order drift velocity in the direction of propagation and enhance the mixing process in concurrent direction. The 1-D wave-period-averaged dispersion equation is derived and an expression for the wave-current induced longitudinal dispersion coefficient （WCLDC） is propased based on Fiscber＇ s expression （1979） for dispersion in unidirectional flow. The result shows that the effect of waves on dispersion is mainly due to the cross-sectional variation of the drift velocity. Furthermore, to obtain a more practical expression of the WCLDC, the longitudinal dispersion coefficient due to Seo and Cheong （1998） is modified to incluee the effect of drift velocity. Laboratory experiments have been conducted to verify the propased expression. The experimental results, together with dimensional analysis, show that tbe wave effect can be reflected by the ratio between the wave amplitude and wave period. A comparative study between the cases with and without waves demonstrates that the magnitude of the longitudinal dispersion coefficient is increased nnder the presence of waves.
