Search results for: percent depth dose
4396 Expression of Ki-67 in Multiple Myeloma: A Clinicopathological Study
Authors: Kangana Sengar, Sanjay Deb, Ramesh Dawar
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Introduction: Ki-67 can be a useful marker in determining proliferative activity in patients with multiple myeloma (MM). However, using Ki-67 alone results in the erroneous inclusion of non-myeloma cells leading to false high counts. We have used Dual IHC (immunohistochemistry) staining with Ki-67 and CD138 to enhance specificity in assessing proliferative activity of bone marrow plasma cells. Aims and objectives: To estimate the proportion of proliferating (Ki-67 expressing) plasma cells in patients with MM and correlation of Ki-67 with other known prognostic parameters. Materials and Methods: Fifty FFPE (formalin fixed paraffin embedded) blocks of trephine biopsies of cases diagnosed as MM from 2010 to 2015 are subjected to H & E staining and Dual IHC staining for CD 138 and Ki-67. H & E staining is done to evaluate various histological parameters like percentage of plasma cells, pattern of infiltration (nodular, interstitial, mixed and diffuse), routine parameters of marrow cellularity and hematopoiesis. Clinical data is collected from patient records from Medical Record Department. Each of CD138 expressing cells (cytoplasmic, red) are scored as proliferating plasma cells (containing a brown Ki¬67 nucleus) or non¬proliferating plasma cells (containing a blue, counter-stained, Ki-¬67 negative nucleus). Ki-67 is measured as percentage positivity with a maximum score of hundred percent and lowest of zero percent. The intensity of staining is not relevant. Results: Statistically significant correlation of Ki-67 in D-S Stage (Durie & Salmon Stage) I vs. III (p=0.026) and ISS (International Staging System) Stage I vs. III (p=0.019), β2m (p=0.029) and percentage of plasma cells (p < 0.001) is seen. No statistically significant correlation is seen between Ki-67 and hemoglobin, platelet count, total leukocyte count, total protein, albumin, S. calcium, S. creatinine, S. LDH, blood urea and pattern of infiltration. Conclusion: Ki-67 index correlated with other known prognostic parameters. However, it is not determined routinely in patients with MM due to little information available regarding its relevance and paucity of studies done to correlate with other known prognostic factors in MM patients. To the best of our knowledge, this is the first study in India using Dual IHC staining for Ki-67 and CD138 in MM patients. Routine determination of Ki-67 will help to identify patients who may benefit with more aggressive therapy. Recommendation: In this study follow up of patients is not included, and the sample size is small. Studying with larger sample size and long follow up is advocated to prognosticate Ki-67 as a marker of survival in patients with multiple myeloma.Keywords: bone marrow, dual IHC, Ki-67, multiple myeloma
Procedia PDF Downloads 1554395 Hepatoprotective Action of Emblica officinalis Linn. against Radiation and Lead Induced Changes in Swiss Albino Mice
Authors: R. K. Purohit
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Ionizing radiation induces cellular damage through direct ionization of DNA and other cellular targets and indirectly via reactive oxygen species which may include effects from epigenetic changes. So there is a need of hour is to search for an ideal radioprotector which could minimize the deleterious and damaging effects caused by ionizing radiation. Radioprotectors are agents which reduce the radiation effects on cell when applied prior to exposure of radiation. The aim of this study was to access the efficacy of Emblica officinalis in reducing radiation and lead induced changes in mice liver. For the present experiment, healthy male Swiss albino mice (6-8 weeks) were selected and maintained under standard conditions of temperature and light. Fruit extract of Emblica was fed orally at the dose of 0.01 ml/animal/day. The animal were divided into seven groups according to the treatment i.e. lead acetate solution as drinking water (group-II) or exposed to 3.5 or 7.0 Gy gamma radiation (group-III) or combined treatment of radiation and lead acetate (group-IV). The animals of experimental groups were administered Emblica extract seven days prior to radiation or lead acetate treatment (group V, VI and VII) respectively. The animals from all the groups were sacrificed by cervical dislocation at each post-treatment intervals of 1, 2, 4, 7, 14 and 28 days. After sacrificing the animals pieces of liver were taken out and some of them were kept at -20°C for different biochemical parameters. The histopathological changes included cytoplasmic degranulation, vacuolation, hyperaemia, pycnotic and crenated nuclei. The changes observed in the control groups were compared with the respective experimental groups. An increase in the value of total proteins, glycogen, acid phosphtase, alkaline phosphatase activity and RNA was observed up to day-14 in the non drug treated group and day 7 in the Emblica treated groups, thereafter value declined up to day-28 without reaching to normal. The value of cholesterol and DNA showed a decreasing trend up to day -14 in non drug treated groups and day-7 in drug treated groups, thereafter value elevated up to day-28. The biochemical parameters were observed in the form of increase or decrease in the values. The changes were found dose dependent. After combined treatment of radiation and lead acetate synergistic effect were observed. The liver of Emblica treated animals exhibited less severe damage as compared to non-drug treated animals at all the corresponding intervals. An early and fast recovery was also noticed in Emblica pretreated animals. Thus, it appears that Emblica is potent enough to check lead and radiation induced heptic lesion in Swiss albino mice.Keywords: radiation, lead , emblica, mice, liver
Procedia PDF Downloads 3224394 Managing Shallow Gas for Offshore Platforms via Fit-For-Purpose Solutions: Case Study for Offshore Malaysia
Authors: Noorizal Huang, Christian Girsang, Mohamad Razi Mansoor
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Shallow gas seepage was first spotted at a central processing platform offshore Malaysia in 2010, acknowledged as Platform T in this paper. Frequent monitoring of the gas seepage was performed through remotely operated vehicle (ROV) baseline survey and a comprehensive geophysical survey was conducted to understand the characteristics of the gas seepage and to ensure that the integrity of the foundation at Platform T was not compromised. The origin of the gas back then was unknown. A soil investigation campaign was performed in 2016 to study the origin of the gas seepage. Two boreholes were drilled; a composite borehole to 150m below seabed for the purpose of soil sampling and in-situ testing and a pilot hole to 155m below the seabed, which was later converted to a fit-for-purpose relief well as an alternate migration path for the gas. During the soil investigation campaign, dissipation tests were performed at several layers which were potentially the source or migration path for the gas. Five (5) soil samples were segregated for headspace test, to identify the gas type which subsequently can be used to identify the origin of the gas. Dissipation tests performed at four depth intervals indicates pore water pressure less than 20 % of the effective vertical stress and appear to continue decreasing if the test had not been stopped. It was concluded that a low to a negligible amount of excess pore pressure exist in clayey silt layers. Results from headspace test show presence of methane corresponding to the clayey silt layers as reported in the boring logs. The gas most likely comes from biogenic sources, feeding on organic matter in situ over a large depth range. It is unlikely that there are large pockets of gas in the soil due to its homogeneous clayey nature and the lack of excess pore pressure in other permeable clayey silt layers encountered. Instead, it is more likely that when pore water at certain depth encounters a more permeable path, such as a borehole, it rises up through this path due to the temperature gradient in the soil. As the water rises the pressure decreases, which could cause gases dissolved in the water to come out of solution and form bubbles. As a result, the gas will have no impact on the integrity of the foundation at Platform T. The fit-for-purpose relief well design as well as adopting headspace testing can be used to address the shallow gas issue at Platform T in a cost effective and efficient manners.Keywords: dissipation test, headspace test, excess pore pressure, relief well, shallow gas
Procedia PDF Downloads 2734393 Establishment of Landslide Warning System Using Surface or Sub-Surface Sensors Data
Authors: Neetu Tyagi, Sumit Sharma
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The study illustrates the results of an integrated study done on Tangni landslide located on NH-58 at Chamoli, Uttarakhand. Geological, geo-morphological and geotechnical investigations were carried out to understand the mechanism of landslide and to plan further investigation and monitoring. At any rate, the movements were favored by continuous rainfall water infiltration from the zones where the phyllites/slates and Dolomites outcrop. The site investigations were carried out including the monitoring of landslide movements and of the water level fluctuations due to rainfall give us a better understanding of landslide dynamics that have been causing in time soil instability at Tangni landslide site. The Early Warning System (EWS) installed different types of sensors and all sensors were directly connected to data logger and raw data transfer to the Defence Terrain Research Laboratory (DTRL) server room with the help of File Transfer Protocol (FTP). The slip surfaces were found at depths ranging from 8 to 10 m from Geophysical survey and hence sensors were installed to the depth of 15m at various locations of landslide. Rainfall is the main triggering factor of landslide. In this study, the developed model of unsaturated soil slope stability is carried out. The analysis of sensors data available for one year, indicated the sliding surface of landslide at depth between 6 to 12m with total displacement up to 6cm per year recorded at the body of landslide. The aim of this study is to set the threshold and generate early warning. Local peoples already alert towards landslide, if they have any types of warning system.Keywords: early warning system, file transfer protocol, geo-morphological, geotechnical, landslide
Procedia PDF Downloads 1584392 Alloying Effect on Hot Workability of M42 High Speed Steel
Authors: Jung-Ho Moon, Tae Kwon Ha
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In the present study, the effect of Si, Al, Ti, Zr, and Nb addition on the microstructure and hot workability of cast M42 tool steels, basically consisting of 1.0C, 0.2Mn, 3.8Cr, 1.5W, 8.5Co, 9.2Mo, and 1.0V in weight percent has been investigated. Tool steels containing Si of 0.25 and 0.5 wt.%, Al of 0.06 and 0.12 wt.%, Ti of 0.3 wt.%, Zr of 0.3 wt.%, and Nb of 0.3 wt.% were cast into ingots of 140 mm´ 140 mm´ 330 mm by vacuum induction melting. After solution treatment at 1150°C for 1.5 hrs. followed by furnace cooling, hot rolling at 1180 °C was conducted on the ingots. Addition of titanium, zirconium and niobium was found to retard the decomposition of the eutectic carbides and result in the deterioration of hot workability of the tool steels, while addition of aluminium and silicon showed relatively well decomposed carbide structure and resulted in sound hot rolled plates.Keywords: high speed steels, alloying elements, eutectic carbides, microstructure, hot workability
Procedia PDF Downloads 3524391 Teaching Material, Books, Publications versus the Practice: Myths and Truths about Installation and Use of Downhole Safety Valve
Authors: Robson da Cunha Santos, Caio Cezar R. Bonifacio, Diego Mureb Quesada, Gerson Gomes Cunha
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The paper is related to the safety of oil wells and environmental preservation on the planet, because they require great attention and commitment from oil companies and people who work with these equipments. This must occur from drilling the well until it is abandoned in order to safeguard the environment and prevent possible damage. The project had as main objective the constitution resulting from comparatives made among books, articles and publications with information gathered in technical visits to operational bases of Petrobras. After the visits, the information from methods of utilization and present managements, which were not available before, became available to the general audience. As a result, it is observed a huge flux of incorrect and out-of-date information that comprehends not only bibliographic archives, but also academic resources and materials. During the gathering of more in-depth information on the manufacturing, assembling, and use aspects of DHSVs, several issues that were previously known as correct, customary issues were discovered to be uncertain and outdated. Information of great importance resulted in affirmations about subjects as the depth of the valve installation that was before installed to 30 meters from the seabed (mud line). Despite this, the installation should vary in conformity to the ideal depth to escape from area with the biggest tendency to hydrates formation according to the temperature and pressure. Regarding to valves with nitrogen chamber, in accordance with books, they have their utilization linked to water line ≥ 700 meters, but in Brazilian exploratory fields, their use occurs from 600 meters of water line. The valves used in Brazilian fields are able to be inserted to the production column and self-equalizing, but the use of screwed valve in the column of production and equalizing is predominant. Although these valves are more expensive to acquire, they are more reliable, efficient, with a bigger shelf life and they do not cause restriction to the fluid flux. It follows that based on researches and theoretical information confronted to usual forms used in fields, the present project is important and relevant. This project will be used as source of actualization and information equalization that connects academic environment and real situations in exploratory situations and also taking into consideration the enrichment of precise and easy to understand information to future researches and academic upgrading.Keywords: down hole safety valve, security devices, installation, oil-wells
Procedia PDF Downloads 2714390 Delineation of Fracture Zones for Investigation of Groundwater Potentials Using Vertical Electrical Sounding in a Sedimentary Complex Terrain
Authors: M. N. Yahaya, K. A. Salako, U. Z. Magawata
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Vertical electrical sounding (VES) method was used to investigate the groundwater potential at the southern part of Gulumbe district, Kebbi State, north-western part of Nigeria. The study was carried out with the aim of determining the subsurface layer’s parameters (resistivity and thickness) and uses the same to characterize the groundwater potential of the study area. The Schlumberger configuration was used for data acquisition. A total number of thirty-three (33) sounding points (VES) were surveyed over six profiles. The software IPI2WIN was used to obtain n-layered geo-electric sections. The geo-electric section drawn from the results of the interpretation revealed that three subsurface layers could be delineated, which comprise of top soil, sand, sandstone, coarse sand, limestone, and gravelly sand. The results of the resistivity sounding were correlated with the lithological logs of nearby boreholes that expose cross-section geologic units around the study area. We found out that the area is dominated by three subsurface layers. The coarse sand layers constituted the aquifer zones in the majority of sounding stations. Thus, this present study concluded that the depth of any borehole in the study area should be located between the depth of 18.5 to 39 m. The study further classified the VES points penetrated based on their conductivity content as highly suitable, suitable, moderately suitably, and poor zones for groundwater exploration. Hence, from this research, we recommended that boreholes can be sited in high conductivity zones across VES 2, 11, 13, 16, 20, 21, 27, and 33, respectively.Keywords: vertical electrical sounding, resistivity, geo-electric, resistivity, aquifer and groundwater
Procedia PDF Downloads 1664389 Relation between Properties of Internally Cured Concrete and Water Cement Ratio
Authors: T. Manzur, S. Iffat, M. A. Noor
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In this paper, relationship between different properties of IC concrete and water cement ratio, obtained from a comprehensive experiment conducted on IC using local materials (Burnt clay chips- BC) is presented. In addition, saturated SAP was used as an IC material in some cases. Relationships have been developed through regression analysis. The focus of this analysis is on developing relationship between a dependent variable and an independent variable. Different percent replacements of BC and water cement ratios were used. Compressive strength, modulus of elasticity, water permeability and chloride permeability were tested and variations of these parameters were analyzed with respect to water cement ratio.Keywords: compressive strength, concrete, curing, lightweight, aggregate, superabsorbent polymer, internal curing
Procedia PDF Downloads 4644388 Enhanced Thai Character Recognition with Histogram Projection Feature Extraction
Authors: Benjawan Rangsikamol, Chutimet Srinilta
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This research paper deals with extraction of Thai character features using the proposed histogram projection so as to improve the recognition performance. The process starts with transformation of image files into binary files before thinning. After character thinning, the skeletons are entered into the proposed extraction using histogram projection (horizontal and vertical) to extract unique features which are inputs of the subsequent recognition step. The recognition rate with the proposed extraction technique is as high as 97 percent since the technique works very well with the idiosyncrasies of Thai characters.Keywords: character recognition, histogram projection, multilayer perceptron, Thai character features extraction
Procedia PDF Downloads 4644387 Vertical Uplift Capacity of a Group of Equally Spaced Helical Screw Anchors in Sand
Authors: Sanjeev Mukherjee, Satyendra Mittal
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This paper presents the experimental investigations on the behaviour of a group of single, double and triple helical screw anchors embedded vertically at the same level in sand. The tests were carried out on one, two, three and four numbers of anchors in sand for different depths of embedment keeping shallow and deep mode of behaviour in mind. The testing program included 48 tests conducted on three model anchors installed in sand whose density kept constant throughout the tests. It was observed that the ultimate pullout load varied significantly with the installation depth of the anchor and the number of anchors. The apparent coefficient of friction (f*) between anchor and soil was also calculated based on the test results. It was found that the apparent coefficient of friction varies between 1.02 and 4.76 for 1, 2, 3, and 4 numbers of single, double and triple helical screw anchors. Plate load tests conducted on model soil showed that the value of ф increases from 35o for virgin soil to 48o for soil with four double screw helical anchors. The graphs of ultimate pullout capacity of a group of two, three and four no. of anchors with respect to one anchor were plotted and design equations have been proposed correlating them. Based on these findings, it has been concluded that the load-displacement relationships for all groups can be reduced to a common curve. A 3-D finite element model, PLAXIS, was used to confirm the results obtained from laboratory tests and the agreement is excellent.Keywords: apparent coefficient of friction, helical screw anchor, installation depth, plate load test
Procedia PDF Downloads 5554386 Slope Stabilisation of Highly Fractured Geological Strata Consisting of Mica Schist Layers While Construction of Tunnel Shaft
Authors: Saurabh Sharma
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Introduction: The case study deals with the ground stabilisation of Nabi Karim Metro Station in Delhi, India, wherein an extremely complex geology was encountered while excavating the tunnelling shaft for launching Tunnel Boring Machine. The borelog investigation and the Seismic Refraction Technique (SRT) indicated towards the presence of an extremely hard rocky mass from a depth of 3-4 m itself, and accordingly, the Geotechnical Interpretation Report (GIR) concluded the presence of Grade-IV rock from 3m onwards and presence of Grade-III and better rock from 5-6m onwards. Accordingly, it was planned to retain the ground by providing secant piles all around the launching shaft and then excavating the shaft vertically after leaving a berm of 1.5m to prevent secant piles from getting exposed. To retain the side slopes, rock bolting with shotcreting and wire meshing were proposed, which is a normal practice in such strata. However, with the increase in depth of excavation, the rock quality kept on decreasing at an unexpected and surprising pace, with the Grade-III rock mass at 5-6 m converting to conglomerate formation at the depth of 15m. This worsening of geology from high grade rock to slushy conglomerate formation can never be predicted and came as a surprise to even the best geotechnical engineers. Since the excavation had already been cut down vertically to manage the shaft size, the execution was continued with enhanced cautions to stabilise the side slopes. But, when the shaft work was about to finish, a collapse was encountered on one side of the excavation shaft. This collapse was unexpected and surprising since all measures to stabilise the side slopes had been taken after face mapping, and the grid size, diameter, and depth of the rockbolts had already been readjusted to accommodate rock fractures. The above scenario was baffling even to the best geologists and geotechnical engineers, and it was decided that any further slope stabilisation scheme shall have to be designed in such a way to ensure safe completion of works. Accordingly, following revisions to excavation scheme were made: The excavation would be carried while maintaining a slope based on type of soil/rock. The rock bolt type was changed from SN rockbolts to Self Drilling type anchor. The grid size of the bolts changed on real time assessment. the excavation carried out by implementing a ‘Bench Release Approach’. Aggressive Real Time Instrumentation Scheme. Discussion: The above case Study again asserts vitality of correct interpretation of the geological strata and the need of real time revisions of the construction schemes based on the actual site data. The excavation is successfully being done with the above revised scheme, and further details of the Revised Slope Stabilisation Scheme, Instrumentation Schemes, Monitoring results, along with the actual site photographs, shall form the part of the final Paper.Keywords: unconfined compressive strength (ucs), rock mass rating (rmr), rock bolts, self drilling anchors, face mapping of rock, secant pile, shotcrete
Procedia PDF Downloads 664385 Power Production Performance of Different Wave Energy Converters in the Southwestern Black Sea
Authors: Ajab G. Majidi, Bilal Bingölbali, Adem Akpınar
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This study aims to investigate the amount of energy (economic wave energy potential) that can be obtained from the existing wave energy converters in the high wave energy potential region of the Black Sea in terms of wave energy potential and their performance at different depths in the region. The data needed for this purpose were obtained using the calibrated nested layered SWAN wave modeling program version 41.01AB, which was forced with Climate Forecast System Reanalysis (CFSR) winds from 1979 to 2009. The wave dataset at a time interval of 2 hours was accumulated for a sub-grid domain for around Karaburun beach in Arnavutkoy, a district of Istanbul city. The annual sea state characteristic matrices for the five different depths along with a vertical line to the coastline were calculated for 31 years. According to the power matrices of different wave energy converter systems and characteristic matrices for each possible installation depth, the probability distribution tables of the specified mean wave period or wave energy period and significant wave height were calculated. Then, by using the relationship between these distribution tables, according to the present wave climate, the energy that the wave energy converter systems at each depth can produce was determined. Thus, the economically feasible potential of the relevant coastal zone was revealed, and the effect of different depths on energy converter systems is presented. The Oceantic at 50, 75 and 100 m depths and Oyster at 5 and 25 m depths presents the best performance. In the 31-year long period 1998 the most and 1989 is the least dynamic year.Keywords: annual power production, Black Sea, efficiency, power production performance, wave energy converter
Procedia PDF Downloads 1334384 Growth Stimulating Effects of Aspilia africana Fed to Female Pseudo-Ruminant Herbivores (Rabbits) at Different Physiological States
Authors: Nseabasi Nsikakabasi Etim
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In recent times, there has been a significant shortfall in between the production and supply of animal protein to meet the ever increasing population. To meet the increasing demand for animal protein, there is a need to focus attention on the production of livestock whose nutritional requirement does not put much strain on the limited sources of feed ingredients to which men subscribe. An example of such livestock is the rabbit. Rabbit is a pseudo-ruminant herbivore which utilizes much undigested and unabsorbed feed materials as sources of nutrient for maintenance and production. Thus, this study was conducted to investigate the effects of feeding Aspilia africana as forage on the growth rates of female pseudo-ruminant herbivores (rabbits) at different physiological states. Thirty (30) Dutch breed rabbit does of 5–6 months of age were used for the experiment which was conducted in a completely randomized design for four months. The rabbits were divided into three treatment groups, ten does per treatment group; which consisted of mixed forages (Centrosema pubescent (200g), Panicum maximum (200g) and Ipomea batatas leaves (100g) without Aspilia africana (T1; control), fresh Aspilia africana (500g/dose/day) (T2) and wilted Aspilia africana (500g/dose/day) (T3). Rabbits in all treatment groups received the same concentrate (300g/animal/day) throughout the period of the study and mixed forages from the commencement of the experiment till the does kindled. After parturition, fresh and wilted Aspilia africana were introduced in treatments 2 and three respectively, whereas the control group continued on mixed forages throughout the study. The result of the study revealed that the initial average body weight of the rabbit does was 1.74kg. At mating and gestation periods, the body weights of the does in T2 was significantly higher (P<0.05) than the rest. There were no significant differences (P<0.05) in the body weights of does at kindling between the various treatment groups. During the physiological states of lactation, weaning and re-mating, the control group (T1) had significantly lower body weight than those of the treated groups (T2 and T3). Furthermore, T2 had significantly higher body weight than T3. The study revealed that Aspilia africana; mainly the fresh leaves have greater growth stimulating effects when fed to pseudo-ruminants (rabbits), thereby enhancing body weights of does during lactation and weaning.Keywords: Aspilia africana, herbivores, pseudo-ruminants, physiological states
Procedia PDF Downloads 6894383 Aging Effect on Mechanical Behavior of Duplex Stainless Steel
Authors: Jeonho Moon, Tae Kwon Ha
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In the present study, the effect of Si, Al, Ti, Zr, and Nb addition on the microstructure and hot workability of cast M42 tool steels, basically consisting of 1.0 C, 0.2 Mn, 3.8 Cr, 1.5 W, 8.5 Co, 9.2 Mo, and 1.0 V in weight percent has been investigated. Tool steels containing Si of 0.25 and 0.5 wt.%, Al of 0.06 and 0.12 wt.%, Ti of 0.3 wt.%, Zr of 0.3 wt.%, and Nb of 0.3wt.% were cast into ingots of 140 mm x 140 mm x 330 mm by vacuum induction melting. After solution treatment at 1150 °C for 1.5 hr followed by furnace cooling, hot rolling at 1180 °C was conducted on the ingots. Addition of titanium, zirconium and niobium was found to retard the decomposition of the eutectic carbides and result in the deterioration of hot workability of the tool steels, while addition of aluminum and silicon showed relatively well decomposed carbide structure and resulted in sound hot rolled plates.Keywords: duplex stainless steel, alloying elements, eutectic carbides, microstructure, hot workability
Procedia PDF Downloads 4174382 The Role of ICT in Engaging Youth in Agricultural Transformation of Africa
Authors: Adebola Adedugbe
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Agriculture is the mainstay of most countries in Africa. It employs up to 90 percent of the rural workforce, who are mostly youth and women. Engaging youths in Information and Communications Technology (ICT) in agriculture is critical to economic and agricultural development of the African continent. The objective of this paper is to identify and mobilize the potentials of young Africans in agriculture through ICT and recognize their role as the dominant driver for sustainable agricultural development in Africa. This paper identifies the role of ICT as a tool for attracting youths to agriculture. The development of ICT is important in stimulating youths in SME’s to compete favorably and effectively as a way to fight poverty through job and wealth creation. It is one of the strategies for promoting entrepreneurship by increasing the availability and diversity of online information.Keywords: Africa, agriculture, ICT, tool, youth
Procedia PDF Downloads 4504381 Intensity Modulated Radiotherapy of Nasopharyngeal Carcinomas: Patterns of Loco Regional Relapse
Authors: Omar Nouri, Wafa Mnejja, Nejla Fourati, Fatma Dhouib, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Jamel Daoud
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Background and objective: Induction chemotherapy (IC) followed by concomitant chemo radiotherapy with intensity modulated radiation (IMRT) technique is actually the recommended treatment modality for locally advanced nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the prognostic factors predicting loco regional relapse with this new treatment protocol. Patients and methods: A retrospective study of 52 patients with NPC treated between June 2016 and July 2019. All patients received IC according to the protocol of the Head and Neck Radiotherapy Oncology Group (Gortec) NPC 2006 (3 TPF courses) followed by concomitant chemo radiotherapy with weekly cisplatin (40 mg / m2). Patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. Median age was 49 years (19-69) with a sex ratio of 3.3. Forty five tumors (86.5%) were classified as stages III - IV according to the 2017 UICC TNM classification. Loco regional relapse (LRR) was defined as a local and/or regional progression that occurs at least 6 months after the end of treatment. Survival analysis was performed according to Kaplan-Meier method and Log-rank test was used to compare anatomy clinical and therapeutic factors that may influence loco regional free survival (LRFS). Results: After a median follow up of 42 months, 6 patients (11.5%) experienced LRR. A metastatic relapse was also noted for 3 of these patients (50%). Target volumes coverage was optimal for all patient with LRR. Four relapses (66.6%) were in high-risk target volume and two (33.3%) were borderline. Three years LRFS was 85,9%. Four factors predicted loco regional relapses: histologic type other than undifferentiated (UCNT) (p=0.027), a macroscopic pre chemotherapy tumor volume exceeding 100 cm³ (p=0.005), a reduction in IC doses exceeding 20% (p=0.016) and a total cumulative cisplatin dose less than 380 mg/m² (p=0.0.34). TNM classification and response to IC did not impact loco regional relapses. Conclusion: For nasopharyngeal carcinoma, tumors with initial high volume and/or histologic type other than UCNT, have a higher risk of loco regional relapse. Therefore, they require a more aggressive therapeutic approaches and a suitable monitoring protocol.Keywords: loco regional relapse, modulation intensity radiotherapy, nasopharyngeal carcinoma, prognostic factors
Procedia PDF Downloads 1284380 Geophysical Exploration of Aquifer Zones by (Ves) Method at Ayma-Kharagpur, District Paschim Midnapore, West Bengal
Authors: Mayank Sharma
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Groundwater has been a matter of great concern in the past years due to the depletion in the water table. This has resulted from the over-exploitation of groundwater resources. Sub-surface exploration of groundwater is a great way to identify the groundwater potential of an area. Thus, in order to meet the water needs for irrigation in the study area, there was a need for a tube well to be installed. Therefore, a Geophysical investigation was carried out to find the most suitable point of drilling and sinking of tube well that encounters an aquifer. Hence, an electrical resistivity survey of geophysical exploration was used to know the aquifer zones of the area. The Vertical Electrical Sounding (VES) method was employed to know the subsurface geology of the area. Seven vertical electrical soundings using Schlumberger electrode array were carried out, having the maximum AB electrode separation of 700m at selected points in Ayma, Kharagpur-1 block of Paschim Midnapore district, West Bengal. The VES was done using an IGIS DDR3 Resistivity meter up to an approximate depth of 160-180m. The data was interpreted, processed and analyzed. Based on all the interpretations using the direct method, the geology of the area at the points of sounding was interpreted. It was established that two deeper clay-sand sections exist in the area at a depth of 50-70m (having resistivity range of 40-60ohm-m) and 70-160m (having resistivity range of 25-35ohm-m). These aquifers will provide a high yield of water which would be sufficient for the desired irrigation in the study area.Keywords: VES method, Schlumberger method, electrical resistivity survey, geophysical exploration
Procedia PDF Downloads 1964379 Impact of Agriculture on the Groundwater Quality: Case of the Alluvial Plain of Nil River (North-Eastern Algerian)
Authors: S. Benessam, T. H. Debieche, A. Drouiche, F. Zahi, S. Mahdid
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The intensive use of the chemical fertilizers and the pesticides in agriculture often produces a contamination of the groundwater by organic pollutants. The irrigation and/or rainwater transport the pollutants towards groundwater or water surface. Among these pollutants, one finds the nitrogen, often observed in the agricultural zones in the nitrate form. In order to understand the form and chemical mobility of nitrogen in groundwater, this study was conducted. A two-monthly monitoring of the parameters physicochemical and chemistry of water of the alluvial plain of Nil river (North-eastern Algerian) were carried out during the period from November 2013 to January 2015 as well as an in-situ investigation of the various chemical products used by the farmers. The results show a raise concentration of nitrates in the wells (depth < 20 m) of the plain, which the concentrations arrive at 50 mg/L (standard of potable water). On the other hand in drillings (depth > 20 m), one observes two behaviors. The first in the upstream part, where the aquifer is unconfined and the medium is oxidizing, one observes the weak nitrate concentrations, indicating its absorption by the ground during the infiltration of water towards the groundwater. The second in the central and downstream parts, where the groundwater is locally confined and the reducing medium, one observes an absence of nitrates and the appearance of nitrites and ammonium, indicating the reduction of nitrates. The projection of the analyses on diagrams Eh-pH of nitrogen has enabled to us to determine the intervals of variation of the nitrogen forms. This study also highlighted the effect of the rains, the pumping and the nature of the geological formations in the form and the mobility of nitrogen in the plain.Keywords: groundwater, nitrogen, mobility, speciation
Procedia PDF Downloads 2484378 Deep Foundations: Analysis of the Lateral Response of Closed Ended Steel Tubular Piles Embedded in Sandy Soil Using P-Y Curves
Authors: Ameer A. Jebur, William Atherton, Rafid M. Alkhaddar, Edward Loffill
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Understanding the behaviour of the piles under the action of the independent lateral loads and the precise prediction of the capacity of piles subjected to different lateral loads are vital topics in foundation design and analysis. Moreover, the laterally loaded behaviour of deep foundations penetrated in cohesive and non-cohesive soils is basically analysed by the Winkler Model (beam on elastic foundation), in which the interaction between the pile embedded depth and contacted soil is simulated by nonlinear p–y curves. The presence of many approaches to interpret the behaviour of soil-pile interaction has resulted in numerous outputs and indicates that no general approach has yet been adopted. The current study presents the result of numerical modelling of the behaviour of steel tubular piles (25.4mm) outside diameter with various embedment depth-to-diameter ratios (L/d) embedded in a sand calibrated chamber of known relative density. The study revealed that the shear strength parameters of the sand specimens and the (L/d) ratios are the most significant factor influencing the response of the pile and its capacity while taking into consideration the complex interaction between the pile and soil. Good agreement has been achieved when comparing the application of this modelling approach with experimental physical modelling carried out by another researcher.Keywords: deep foundations, slenderness ratio, soil-pile interaction, winkler model (beam on elastic foundation), non-cohesive soil
Procedia PDF Downloads 2994377 Using Vertical Electrical Soundings Data to Investigate and Assess Groundwater Resources for Irrigation in the Canal Command Area
Authors: Vijaya Pradhan, S. M. Deshpande, D. G. Regulwar
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Intense hydrogeological research has been prompted by the rising groundwater demand in typical hard rock terrain. In the current study, groundwater resources for irrigation in the canal command of the Jayakwadi Reservoir in the Indian state of Maharashtra are located using Vertical Electrical Soundings (VES). A Computer Resistivity Monitor is used to monitor the geoelectric field (CRM). Using Schlumberger setups, the investigation was carried out at seven different places in the region. Plotting of the sounding curves is the outcome of the data processing. The underlying layers and groundwater potential in the research region have been examined by analyzing these curves using curve-matching techniques, also known as partial curve matching. IPIWin2 is used to examine the relationship between resistivity and electrode spacing. The resistivity value in a geological formation is significantly reduced when groundwater is present. Up to a depth of 35 meters, the resistivity readings are minimal; beyond that, they continuously increase, suggesting a lack of water in deeper strata. As a result, the wells may only receive water up to a depth of 35 meters. In addition, the trap may occasionally fracture at deeper depths, retaining a limited amount of water in the cracks and producing a low yield. According to the findings, weathered basalt or soil make up the top layer (5–10 m), which is followed by a layer of amygdaloidal basalt (10–35 m) that is somewhat cracked and either hard basalt or compact basalt underneath.Keywords: vertical electrical soundings (VES), resistivity, electrode spacing, Schlumberger configurations, partial curve matching.
Procedia PDF Downloads 244376 Modeling Sediment Transports under Extreme Storm Situation along Persian Gulf North Coast
Authors: Majid Samiee Zenoozian
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The Persian Gulf is a bordering sea with an normal depth of 35 m and a supreme depth of 100 m near its narrow appearance. Its lengthen bathymetric axis divorces two main geological shires — the steady Arabian Foreland and the unbalanced Iranian Fold Belt — which are imitated in the conflicting shore and bathymetric morphologies of Arabia and Iran. The sediments were experimented with from 72 offshore positions through an oceanographic cruise in the winter of 2018. Throughout the observation era, several storms and river discharge actions happened, as well as the major flood on record since 1982. Suspended-sediment focus at all three sites varied in reaction to both wave resuspension and advection of river-derived sediments. We used hydrological models to evaluation and associate the wave height and inundation distance required to carriage the rocks inland. Our results establish that no known or possible storm happening on the Makran coast is accomplished of detaching and transporting the boulders. The fluid mud consequently is conveyed seaward due to gravitational forcing. The measured sediment focus and velocity profiles on the shelf provide a strong indication to provision this assumption. The sediment model is joined with a 3D hydrodynamic module in the Environmental Fluid Dynamics Code (EFDC) model that offers data on estuarine rotation and salinity transport under normal temperature conditions. 3-D sediment transport from model simulations specify dynamic sediment resuspension and transport near zones of highly industrious oyster beds.Keywords: sediment transport, storm, coast, fluid dynamics
Procedia PDF Downloads 1154375 Valuing Non-Market Environmental Benefits of the Biodiversity Conservation Project
Authors: Huynh Viet Khai, Mitsuyasu Yabe
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The study investigated the economic value of biodiversity attributes that could provide policy-makers reliable information to estimate welfare losses due to biodiversity reductions and analyse the trade-off between biodiversity and economics. In order to obtain the non-market benefits of biodiversity conservation, an indirect utility function and willingness to pay for biodiversity attributes were applied using the approach of choice modelling with the analysis of conditional logit model. The study found that Mekong Delta residents accepted their willingness to pay for VND 913 monthly for a one percent increase in healthy vegetation, VND 360 for an additional mammal species and VND 2,440 to avoid the welfare losses of 100 local farmers.Keywords: choice modelling, genetic resources, wetland conservation, marginal willingness to pay
Procedia PDF Downloads 3274374 Assessment of Rural Youth Adoption of Cassava Production Technologies in Southwestern Nigeria
Authors: J. O. Ayinde, S. O. Olatunji
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This study assessed rural youth adoption of cassava production technologies in Southwestern, Nigeria. Specifically, it examine the level of awareness and adoption of cassava production technologies by rural youth, determined the extent of usage of cassava production technologies available to the rural youth, examined constrains to the adoption of cassava production technologies by youth and suggested possible solutions. Multistage sampling procedure was adopted for the study. In the first stage, two states were purposively selected in southwest, Nigeria which are Osun and Oyo states due to high level of cassava production and access to cassava production technology in the areas. In the second stage, purposive sampling technique was used to select two local governments each from the states selected which are Ibarapa central (Igbo-Ora) and Ibarapa East (Eruwa) Local Government Areas (LGAs) in Oyo state; and Ife North (Ipetumodu) and Ede South (Oke Ireesi) LGAs in Osun State. In the third stage, proportionate sampling technique was used to randomly select five, four, six and four communities from the selected LGAs respectively representing 20 percent of the rural communities in them, in all 19 communities were selected. In the fourth stage, Snow ball sampling technique was used to select about 7 rural youths in each community selected to make a total of 133 respondents. Validated structured interview schedule was used to elicit information from the respondents. The data collected were analyzed using both descriptive and inferential statistics to summarize and test the hypotheses of the study. The results show that the average age of rural youths participating in cassava production in the study area is 29 ± 2.6 years and 60 percent aged between 30 and 35 years. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). The result also reveals that the average size of farm land of the respondents is 2.5 ± 0.3 hectares. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). Also, extent of usage of the technologies (r = 0.363, p ≤ 0.01) shows significant relationship with level of adoption of the technologies. Household size (b = 0.183; P ≤ 0.01) and membership of social organizations were significant at 0.01 (b = 0.331; P ≤ 0.01) while age was significant at 0.10 (b = 0.097; P ≤ 0.05). On the other hand 0.01, years of residence (b = - 0.063; P ≤ 0.01) and income (b = - 0.204; P ≤ 0.01) had negative values and implies that a unit increase in each of these variables would decrease extent of usage of the Cassava production technologies. It was concluded that the extent of usage of the technologies in the communities will affect the rate of adoption positively and this will change the negative perception of youths on cassava production thereby ensure food security in the study area.Keywords: assessment, rural youths’, Cassava production technologies, agricultural production, food security
Procedia PDF Downloads 2074373 Analysis of Users’ Behavior on Book Loan Log Based on Association Rule Mining
Authors: Kanyarat Bussaban, Kunyanuth Kularbphettong
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This research aims to create a model for analysis of student behavior using Library resources based on data mining technique in case of Suan Sunandha Rajabhat University. The model was created under association rules, apriori algorithm. The results were found 14 rules and the rules were tested with testing data set and it showed that the ability of classify data was 79.24 percent and the MSE was 22.91. The results showed that the user’s behavior model by using association rule technique can use to manage the library resources.Keywords: behavior, data mining technique, a priori algorithm, knowledge discovery
Procedia PDF Downloads 4044372 Shallow Water Lidar System in Measuring Erosion Rate of Coarse-Grained Materials
Authors: Ghada S. Ellithy, John. W. Murphy, Maureen K. Corcoran
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Erosion rate of soils during a levee or dam overtopping event is a major component in risk assessment evaluation of breach time and downstream consequences. The mechanism and evolution of dam or levee breach caused by overtopping erosion is a complicated process and difficult to measure during overflow due to accessibility and quickly changing conditions. In this paper, the results of a flume erosion tests are presented and discussed. The tests are conducted on a coarse-grained material with a median grain size D50 of 5 mm in a 1-m (3-ft) wide flume under varying flow rates. Each test is performed by compacting the soil mix r to its near optimum moisture and dry density as determined from standard Proctor test in a box embedded in the flume floor. The box measures 0.45 m wide x 1.2 m long x 0.25 m deep. The material is tested several times at varying hydraulic loading to determine the erosion rate after equal time intervals. The water depth, velocity are measured at each hydraulic loading, and the acting bed shear is calculated. A shallow water lidar (SWL) system was utilized to record the progress of soil erodibility and water depth along the scanned profiles of the tested box. SWL is a non-contact system that transmits laser pulses from above the water and records the time-delay between top and bottom reflections. Results from the SWL scans are compared with before and after manual measurements to determine the erosion rate of the soil mix and other erosion parameters.Keywords: coarse-grained materials, erosion rate, LIDAR system, soil erosion
Procedia PDF Downloads 1134371 Effect of Sodium Arsenite Exposure on Pharmacodynamic of Meloxicam in Male Wistar Rats
Authors: Prashantkumar Waghe, N. Prakash, N. D. Prasada, L. V. Lokesh, M. Vijay Kumar, Vinay Tikare
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Arsenic is a naturally occurring metalloid with potent toxic effects. It is ubiquitous in the environment and released from both natural and anthropogenic sources. It has the potential to cause various health hazards in exposed populations. Arsenic exposure through drinking water is considered as one of the most serious global environmental threats including Southeast Asia. The aim of present study was to evaluate the modulatory role of subacute exposure to sodium (meta) arsenite on the antinociceptive, anti-inflammatory and antipyretic responses mediated by meloxicam in rats. Rats were exposed to arsenic as sodium arsenite through drinking water for 28 days. A single dose of meloxicam (2 mg/kg b. wt.) was administered by oral gavage on the 29th day. The exact time of meloxicam administration depended on the type of test. Rats were divided randomly into 5 groups (n=6). Group I served as normal control and received arsenic free drinking water, while rats in group II were maintained similar to Group I but received meloxicam on 29th day. Groups III, IV and V were pre-exposed to arsenic through drinking water at 0.5, 5.0 and 50 ppm, respectively, for 28 days and was administered meloxicam next day and; pain and inflammation carried out by using formalin-induced nociception and carrageenan-induced inflammatory model(s), respectively by using standard protocol. For assessment of antipyretic effects, one more additional group (Group VI) was taken and given LPS @ 1.8 mg/kg b. wt. for induction of pyrexia (LPS control). Higher dose of arsenic inhibited the meloxicam mediated antinociceptive, anti-inflammatory and antipyretic responses. Further, meloxicam inhibited the arsenic induced level of tumor necrosis factor-α, inetrleukin-1β, interleukin -6 and COX2 mediated prostaglandin E2 in hind paw muscle. These results suggest a functional antagonism of meloxicam by arsenic. This may relate to arsenic mediated local release of tumor necrosis factor-α, inetrleukin-1β, interleukin -6 releases COX2 mediated prostaglandin E2. Based on the experimental study, it is concluded that sub-acute exposure to arsenic through drinking water aggravate pyrexia, inflammation and pain at environment relevant concentration and decrease the therapeutic efficacy of meloxicam at higher level of arsenite exposure. Thus, the observation made has clinical relevance in situations where animals are exposed to arsenite epidemic geographical locations.Keywords: arsenic, analgesic activity, meloxicam, Wistar rats
Procedia PDF Downloads 1864370 “MaxSALIVA”: A Nano-Sized Dual-Drug Delivery System for Salivary Gland Radioprotection and Repair in Head and Neck Cancer
Authors: Ziyad S. Haidar
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Background: Saliva plays a major role in maintaining oral and dental health (consequently, general health and well-being). Where it normally bathes the oral cavity and acts as a clearing agent. This becomes more apparent when the amount and quality of salivare significantly reduced due to medications, salivary gland neoplasms, disorders such as Sjögren’s syndrome, and especially ionizing radiation therapy for tumors of the head and neck, the fifth most common malignancy worldwide, during which the salivary glands are included within the radiation field or zone. Clinically, patients affected by salivary gland dysfunction often opt to terminate their radiotherapy course prematurely because they become malnourished and experience a significant decrease in their quality of life. Accordingly, the development of an alternative treatment to restore or regenerate damaged salivary gland tissue is eagerly awaited. Likewise, the formulation of a radioprotection modality and early damage prevention strategy is also highly desirable. Objectives: To assess the pre-clinical radio-protective effect as well as the reparative/regenerative potential of layer-by-layer self-assembled lipid-polymer-based core-shell nanocapsules designed and fine-tuned in this experimental work for the sequential (ordered) release of dual cytokines, following a single local administration (direct injection) into a murine sub-mandibular salivary gland model of irradiation. Methods: The formulated core-shell nanocapsules were characterized by physical-chemical-mechanically pre-/post-loading with the drugs (in solution and powder formats), followed by optimizing the pharmaco-kinetic profile. Then, nanosuspensions were administered directly into the salivary glands, 24hrs pre-irradiation (PBS, un-loaded nanocapsules, and individual and combined vehicle-free cytokines were injected into the control glands for an in-depth comparative analysis). External irradiation at an elevated dose of 18Gy (revised from our previous 15Gy model) was exposed to the head-and-neck region of C57BL/6 mice. Salivary flow rate (un-stimulated) and salivary protein content/excretion were regularly assessed using an enzyme-linked immunosorbent assay (3-month period). Histological and histomorphometric evaluation and apoptosis/proliferation analysis followed by local versus systemic bio-distribution and immuno-histochemical assays were then performed on all harvested major organs (at the distinct experimental end-points). Results: Monodisperse, stable, and cytocompatible nanocapsules capable of maintaining the bioactivity of the encapsulant within the different compartments with the core and shell and with controlled/customizable pharmaco-kinetics, resulted, as is illustrated in the graphical abstract (Figure) below. The experimental animals demonstrated a significant increase in salivary flow rates when compared to the controls. Herein, salivary protein content was comparable to the pre-irradiation (baseline) level. Histomorphometry further confirmed the biocompatibility and localization of the nanocapsules, in vivo, into the site of injection. Acinar cells showed fewer vacuoles and nuclear aberration in the experimental group, while the amount of mucin was higher in controls. Overall, fewer apoptotic activities were detected by a Terminal deoxynucleotidyl Transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay and proliferative rates were similar to the controls, suggesting an interesting reparative and regenerative potential of irradiation-damaged/-dysfunctional salivary glands. The Figure below exemplifies some of these findings. Conclusions: Biocompatible, reproducible, and customizable self-assembling layer-by-layer core-shell delivery system is formulated and presented. Our findings suggest that localized sequential bioactive delivery of dual cytokines (in specific dose and order) can prevent irradiation-induced damage via reducing apoptosis and also has the potential to promote in situ proliferation of salivary gland cells; maxSALIVA is scalable (Good Manufacturing Practice or GMP production for human clinical trials) and patent-pending.Keywords: saliva, head and neck cancer, nanotechnology, controlled drug delivery, xerostomia, mucositis, biopolymers, innovation
Procedia PDF Downloads 884369 Meaning and Cultivating Factors of Mindfulness as Experienced by Thai Females Who Practice Dhamma
Authors: Sukjai Charoensuk, Penphan Pitaksongkram, Michael Christopher
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Preliminary evidences supported the effectiveness of mindfulness-based interventions in reducing symptoms associated with a variety of medical and psychological conditions. However, the measurements of mindfulness are questionable since they have not been developed based-on Buddhist experiences. The purpose of this qualitative study was to describe meaning and cultivating factors of mindfulness as experienced by Thai females who practice Dhamma. Participants were purposively selected to include 2 groups of Thai females who practice Dhamma. The first group consisted of 6 female Buddhist monks, and the second group consisted of 7 female who practice Dhamma without ordaining. Data were collected using in-depth interview. The instruments used were demographic data questionnaire and guideline for in-depth interview developed by researchers. Content analysis was employed to analyze the data. The results revealed that Thai women who practice Dhamma described their experience in 2 themes, which were meaning and cultivating factors of mindfulness. The meaning composed of 4 categories; 1) Being Present, 2) Self-awareness, 3) Contemplation, and 4) Neutral. The cultivating factors of mindfulness composed of 2 categories; In-personal factors and Ex-personal factors. The In-personal cultivating factors included 4 sub-categories; Faith and Love, the Five Precepts, Sound body, and Practice. The Ex-personal cultivating factors included 2 sub-categories; Serenity, and Learning. These findings increase understanding about meaning of mindfulness and its cultivating factors. These could be used as a guideline to promote mental health and develop nursing interventions using mindfulness based, as well as, develop the instrument for assessing mindfulness in Thai context.Keywords: cultivating factor, meaning of mindfulness, practice Dhamma, Thai women
Procedia PDF Downloads 3514368 Ultrasonic Degradation of Acephate: Effects of Operating Parameters
Authors: Naina Deshmukh
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With the wide production, consumption, and disposal of pesticides in the world, the concerns over their human and environmental health impacts are rapidly growing. Among developing treatment technologies, Ultrasonication, as an emerging and promising technology for the removal of pesticides in the aqueous environment, has attracted the attention of many researchers in recent years. The degradation of acephate in aqueous solutions was investigated under the influence of ultrasound irradiation (20 kHz) in the presence of heterogeneous catalysts titanium dioxide (TiO2) and Zinc oxide (ZnO). The influence of various factors such as amount of catalyst (0.25, 0.5, 0.75, 1.0, 1.25 g/l), initial acephate concentration (100, 200, 300, 400 mg/l), and pH (3, 5, 7, 9, 11) were studied. The optimum catalyst dose was found to be 1 g/l of TiO2 and 1.25 g/l of ZnO for acephate at 100 mg/l, respectively. The maximum percentage degradation of acephate was observed at pH 11 for catalysts TiO2 and ZnO, respectively.Keywords: ultrasonic degradation, acephate, TiO2, ZnO, heterogeneous catalyst
Procedia PDF Downloads 624367 To Compare Norepinephrine and Norepinephrine with Methylene Blue for the Management of Septic Shock
Authors: K. Rajarajeswaran, Krishna Prasad
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Introduction: Refractory shock is a typical consequence of sepsis that does not improve with standard vasopressor therapy. A possible adjuvant therapeutic option for treating refractory shock in sepsis is methylene blue. This study looked at the effects of intravenous methylene blue plus norepinephrine given as a single bolus infusion on mortality and hemodynamic improvement in patients suffering from refractory shock. Methodology: This six-month observational prospective study was carried out at an intensive care unit, teaching hospital, and medical college. It involved 112 patients who had been diagnosed with refractory septic shock and needed vasopressor medication. Group B received injection norepinephrine 0.01 µg/kg/min infusion alone, while Group A received injection methylene blue 2 mg/kg iv single bolus (fixed dose) in addition to injection norepinephrine 0.01 µg/kg/min infusion. Both groups' noradrenaline doses were titrated to reach the desired MAP of 60–75 mm Hg. The amount of norepinephrine needed to sustain a MAP of more than 60 mm Hg was the data gathered. Serum lactate, procalcitonin level, C-reactive protein, length of stay in the intensive care unit (ICU), sequential organ failure assessment (SOFA) score, and duration of mechanical ventilation, incidence of acute kidney injury (AKI), and mortality were compared. Results: A total of 112 patients with refractory shock were included in the study. With the use of IV methylene blue, 36 (59.3%) patients showed significant improvement in MAP within 2 hours (77.12 ± 8.90 vs 74.28 ± 21.84, p = 0.005). Responders were 4.009 times more likely to have vasopressor-free time within 24 hours (19.5% vs 6.1%, p = 0.022, odds ratio 5.017, 95% confidence interval, 1.110–14.283). The serum lactate was lower, and urine output was higher in group I than in group II (p <0.05). Group I had a significantly greater reduction in SOFA score in 12 hours than group II. However, there was no significant difference in terms of mortality, length of ICU stay, ventilator free days, and incidence of AKI. In the responder group, there was a significant increase in the MAP and decrease in vasopressor requirement pre- and post-infusion of methylene blue (p < 0.05). Responder had shorter vasopressor-free days as compared with non-responder (5.44 vs 6.99, p = 0.007). Conclusion: When administered as adjuvant therapy, a single-dose bolus infusion of Methylene Blue plus Norepinephrine may aid in meeting early resuscitation goals for the management of patients with septic shock. But the patients' death rate, ICU stay duration, ventilator-free days, or incidence of AKI were unchanged.Keywords: norepinephrine, methylene blue, shock, vasopressor
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