Search results for: distal EA

Authors: Neerja Gupta

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Objective-Reconstruction of large cavities of the breast without contralateral symmetrisation Background- Reconstruction of breast includes a wide spectrum of procedures from displacement to regional and distant flaps. The pedicled Perforator flaps cover a wide spectrum of reconstruction surgery for all quadrants of the breast, especially in patients with comorbidities. These axial flaps singly or adjunct are based on a near constant perforator vessel, a ratio of 2:1 at its entry in a flap is good to maintain vascularity. The perforators of lateral chest wall viz LICAP, LTAP have overlapping perfurosomes without clear demarcation. LTAP is localized in the narrow zone between the lateral breast fold and anterior axillary line,2.5-3.8cm from the fold. MICAP are localized at 1-2 cm from sternum. Being 1-2mm in diameter, a Single perforator is good to maintain the flap. LICAP has a dominant perforator in 6th-11th spaces, while LTAP has higher placed dominant perforators in 4th and 5th spaces. Methodology-Six consecutive patients who underwent reconstruction of the breast with pedicled perforator flaps were retrospectively analysed. Selections of the flap was done based on the size and locations of the tumour, anticipated volume loss, willingness to undergo contralateral symmetrisation, cosmetic expectations, and finances available.3 patients underwent vertical LTAP, the distal limit of the flap being the inframammary crease. 3 patients underwent MICAP, oriented along the axis of rib, the distal limit being the anterior axillary line. Preoperative identification was done using a unidirectional hand held doppler. The flap was raised caudal to cranial, the pivot point of rotation being the vessel entry into the skin. The donor area is determined by the skin pinch. Flap harvest time was 20-25 minutes. Intra operative vascularity was assessed with dermal bleed. The patient immediate pre, post-operative and follow up pics were compared independently by two breast surgeons. Patients were given a breast Q questionnaire (licensed) for scoring. Results-The median age of six patients was 46. Each patient had a hospital stay of 24 hours. None of the patients was willing for contralateral symmetrisation. The specimen dimensions were from 8x6.8x4 cm to 19x16x9 cm. The breast volume reconstructed range was 30 percent to 45 percent. All wide excision had free margins on frozen. The mean flap dimensions were 12x5x4.5 cm. One LTAP underwent marginal necrosis and delayed wound healing due to seroma. Three patients were phyllodes, of which one was borderline, and 2 were benign on final histopathology. All other 3 patients were invasive ductal cancer and have completed their radiation. The median follow up is 7 months the satisfaction scores at median follow of 7 months are 90 for physical wellbeing and 85 for surgical results. Surgeons scored fair to good in Harvard score. Conclusion- Pedicled perforator flaps are a valuable option for 3/8th volume of breast defects. LTAP is preferred for tumours at the Central, upper, and outer quadrants of the breast and MICAP for the inner and lower quadrant. The vascularity of the flap is dependent on the angiosomalterritories; adequate venous and cavity drainage.

Keywords: breast, oncoplasty, pedicled, perforator

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Authors: Tan G. K. Y., Chew M. S. J., Sajeev S., Vellasamy A.

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Injuries of the extensor hallucis longus (EHL) tendon are a rare phenomenon, with most occurring due to lacerations or penetrating injuries. Closed traumatic ruptures of the EHL are described as “Mallet injuries of the toe”. These can be classified as bony or soft mallet injuries depending on the presence or absence of a fracture at the insertion site of the EHL tendon in the distal phalanx. We present a case of a 33-year-old woman who presented with a hyperflexion injury to the left big toe with an inability to extend the big toe. Ultrasound showed a complete rupture of the EHL tendon with retraction proximal to the hallucal interphalangeal joint of the big toe. The patient was treated through transarticular pinning and repair using the Arthrex Mini Bio-Suture Tak with a 2-0 fibre wire. Six months postoperatively, the patient had symmetrical EHL power and full range of motion of the toe. The lessons to be drawn from this case report are that isolated hallux mallet injuries are rare and can be easily missed in the absence of penetrating wounds. Patients who have such injuries should be investigated early with the appropriate imaging techniques, such as ultrasound or MRI, and treated surgically.

Keywords: hallux mallet, extensor hallucis longus tendon, extensor hallucis longus

Procedia PDF Downloads 36

Authors: Sarah A. Goodchild, Rachel Gao, Philip N. Bartlett

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A novel detection approach using immobilized DNA probes labeled with Anthraquinone (AQ) as an electrochemically active reporter moiety has been successfully developed as a new, simple, reliable method for the detection of DNA. This method represents a step forward in DNA detection as it can discriminate between multiple nucleotide polymorphisms within target DNA strands without the need for any additional reagents, reporters or processes such as melting of DNA strands. The detection approach utilizes single-stranded DNA probes immobilized on gold surfaces labeled at the distal terminus with AQ. The effective immobilization has been monitored using techniques such as AC impedance and Raman spectroscopy. Simple voltammetry techniques (Differential Pulse Voltammetry, Cyclic Voltammetry) are then used to monitor the reduction potential of the AQ before and after the addition of complementary strand of target DNA. A reliable relationship between the shift in reduction potential and the number of base pair mismatch has been established and can be used to discriminate between DNA from highly related pathogenic organisms of clinical importance. This indicates that this approach may have great potential to be exploited within biosensor kits for detection and diagnosis of pathogenic organisms in Point of Care devices.

Keywords: Anthraquinone, discrimination, DNA detection, electrochemical biosensor

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Authors: ELdessouky Sheta, Sayed Elzomor, Haithem Farghali, Kawkab A. Ahmed, Naglaa A. Abd Elkader

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The present investigation has been dealt with Spirocerca (S.) lupi infested mongrel dogs. This parasitic disease is highly infective to human beings and carnivores. The diagnosis march has been comprised the lateral contrast thoracic radiographs, fecal examination, blood profile, endoscopic examination and histopathological sections of deep seated pinch biopsies. These infested dogs have been put under an adopted treatment with Ivermectin injection combined with oral prednisolone. The obtained results reveal an absence of the pessimistic recognitions particularly after 3 weeks from the onset of treatment. Endoscopically the presented esophageal nodules are marked out in the distal third of infested dogs' esophagus as masses assigned into the esophageal lumen and fundus of stomach. The endoscopic outlook of Spirocerca lupi lesions has been considered an integral procedure of the diagnostic march and for evaluation of treatment follow up. The diagnostic procedures and the recommended treatment are the vet's guidance to care for Spirocerca lupi in dogs, hoping in future to prevent this disease from being spread among human beings and other carnivores.

Keywords: endoscopy, esophagus, stomach spirocercosis, dogs

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Authors: Radhe Tado, Ashish B. Deoghare, K. M. Pandey

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The aim of this study is to estimate the effect of blood flow through the coronary artery in human heart so as to assess the coronary artery disease.Velocity, wall shear stress (WSS), strain rate and wall pressure distribution are some of the important hemodynamic parameters that are non-invasively assessed with computational fluid dynamics (CFD). These parameters are used to identify the mechanical factors responsible for the plaque progression and/or rupture in left coronary arteries (LCA) in coronary arteries.The initial step for CFD simulations was the construction of a geometrical model of the LCA. Patient specific artery model is constructed using computed tomography (CT) scan data with the help of MIMICS Research 19.0. For CFD analysis ANSYS FLUENT-14.5 is used.Hemodynamic parameters were quantified and flow patterns were visualized both in the absence and presence of coronary plaques. The wall pressure continuously decreased towards distal segments and showed pressure drops in stenotic segments. Areas of high WSS and high flow velocities were found adjacent to plaques deposition.

Keywords: angiography, computational fluid dynamics (CFD), time-average wall shear stress (TAWSS), wall pressure, wall shear stress (WSS)

Procedia PDF Downloads 158

Authors: A. Beatti, L. Chipchase, A. Rayner, T. Souvlis

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The aims of this study were to investigate the depth of interferential current (IFC) penetration through soft tissue and to investigate the area over which IFC spreads during clinical application. Premodulated IFC and ‘true’ IFC at beat frequencies of 4, 40 and 90Hz were applied via four electrodes to the distal medial thigh of 15 healthy subjects. The current was measured via three Teflon coated fine needle electrodes that were inserted into the superficial layer of skin, then into the subcutaneous tissue (≈1 cm deep) and then into muscle tissue (≈2 cm deep). The needle electrodes were placed in the middle of the four IFC electrodes, between two channels and outside the four electrodes. Readings were taken at each tissue depth from each electrode during each treatment frequency then digitized and stored for analysis. All voltages were greater at all depths and locations than baseline (p < 0.01) and voltages decreased with depth (P=0.039). Lower voltages of all currents were recorded in the middle of the four electrodes with the highest voltage being recorded outside the four electrodes in all depths (P=0.000).For each frequency of ‘true’ IFC, the voltage was higher in the superficial layer outside the electrodes (P ≤ 0.01).Premodulated had higher voltages along the line of one circuit (P ≤ 0.01). Clinically, IFC appears to pass through skin layers to depth and is more efficient than premodulated IFC when targeting muscle tissue.

Keywords: electrotherapy, interferential current, interferential therapy, medium frequency current

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Authors: Y. Ruchi, A. Prerna, S. Deepshikha

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Amyotrophic lateral sclerosis (ALS), also known as “Lou Gehrig’s disease”. It is a neurodegenerative disease associated with degeneration of motor neurons in the cerebral cortex, brain stem, and spinal cord characterized by distal muscle weakness, atrophy, normal sensation, pyramidal signs and progressive muscular paralysis reflecting. ALS2 is a juvenile autosomal recessive disorder, slowly progressive, that maps to chromosome 2q33 and is associated with mutations in the alsin gene, a putative GTPase regulator. In this paper we have done homology modeling of alsin2 protein using multiple templates (3KCI_A, 4LIM_A, 402W_A, 4D9S_A, and 4DNV_A) designed using the Prime program in Schrödinger software. Further modeled structure is used to identify effective binding sites on the basis of structural and physical properties using sitemap program in Schrödinger software, structural and function analysis is done by using Prosite and ExPASy server that gives insight into conserved domains and motifs that can be used for protein classification. This paper summarizes the structural, functional and binding site property of alsin2 protein. These binding sites can be potential drug target sites and can be used for docking studies.

Keywords: ALS, binding site, homology modeling, neuronal degeneration

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Authors: Naraporn Taemaitree, Pruet Areesawangvong, Satchachon Changthom, Tanin Titipungul

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Adult intussusception, unlike childhood intussusception, is rare. Approximately 5-15% of cases are idiopathic without a lead point lesion. Secondary intussusception is caused by pathological conditions such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms, or even iatrogenically due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can help distinguish between intussusceptions with and without a lead point and lesion localization. This report presents the case of a 49-year-old man presented with increasing abdominal pain over the past three days, loss of appetite, constipation, and frequent vomiting. Computed tomography revealed distal small bowel obstruction at the right lower quadrant with thickened outer wall and internal non-dilated small bowel loop. Emergency exploratory laparotomy was performed to clear the obstruction, which upon inspection was caused by extremely long Taenia solium parasites.

Keywords: intussusception, tape worm, Taenia solium, abdominal pain

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Authors: Lydia Andrade, Kumar M. R. Bhat

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Heavy metals, especially lead, is considered to be a multi-organ toxicant. However, such heavy metals, are used in the preparation of traditional medicines. Nagabhasma is one of the traditional medicines. Lead is the metal used in its preparation. Lead is converted into a health beneficial, organometallic compound, when subjected to various traditional methods of purification. Therefore, this study is designed to evaluate the effect of such processed lead in various stages of traditionally prepared Nagabhasma on the histological structure of kidneys. Using the human equivalent doses of Nagabhasma, various stages of its preparation were fed orally for 30 days and 60 days (short term and long term). The treated and untreated rats were then sacrificed for the collection of kidneys. The kidneys were processed for histopathological study. The results show severe changes in the histological structure of kidneys. The animals treated with lead acetate showed changes in the epithelial cells lining the bowman’s capsule. The proximal and distal convoluted tubules were dilated leading to atrophy of their epithelial cells. The amount of inflammatory infiltrates was more in this group. A few groups also showed pockets of inter-tubular hemorrhage. These changes, however, were minimized as the stages progressed form stages 1 to 4 of Nagabhasma preparation. Therefore, it is necessary to stringently monitor the processing of lead acetate during the preparation of Nagabhasma.

Keywords: heavy metals, kidneys, lead acetate, Nagabhasma

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Authors: Keven A. Prusak, William F. Christensen, Zack Beddoes

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Background: For more than a decade, the Sport Motivation Scale (SMS) has been used to measure contextual motivation across a variety of sporting and physical education (PE) settings but not without criticism as to its tenability. Consequently, a new version of the sport motivation scale (SMS-II) was created to address certain weakness of the original SMS. Purpose: The purpose of this study is to assess the suitability of the SMS-II in the secondary PE setting. Methods: Three hundred and twenty (204 females, and 116 males; grades 7-9) completed the 18-item, six-subscale SMS-II at the end of a required PE class. Factor means, standard deviations, and correlations were calculated and further examined via confirmatory factor analysis (CFA). Model parameters were estimated maximum likelihood function. Results: Results indicate that participants held generally positive perceptions toward PE as a context (more so for males than females). Reliability analysis yielded adequate alphas (rα = 0.71 to 0.87, Mα = 0.78) with the exception of the AM subscale (αAM = .64). Correlation analysis indicated some support for the SIMPLEX pattern, but distal ends of the motivation continuum displayed no relationship. CFA yielded robust fit indices to the proposed structure of the SMS-II for PE. A small but significant variance across genders was noted and discussed. Conclusions: In all, the SMS-II suitably accesses PE context-specific motivational indices within Jr. High PE.

Keywords: motivation, self-determination theory, physical education, confirmatory factor analysis

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Authors: Churamani Pokhrel, C. B. Jha, S. R. Niraula, P. R. Pokharel

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Human identification is one of the most challenging subjects that man has confronted. The determination of adult sex and stature are two of the four key factors (sex, stature, age, and race) in identification of an individual. Craniofacial and odontometric parameters are important tools for forensic anthropologists when it is not possible to apply advanced techniques for identification purposes. The present study provides anthropometric correlation of the parameters with stature and gender and also devises regression formulae for reconstruction of stature. A total of 312 Nepalese students with equal distribution of sex i.e., 156 male and 156 female students of age 18-35 years were taken for the study. Total of 10 parameters were measured (age, sex, stature, head circumference, head length, head breadth, facial height, bi-zygomatic width, mesio-distal canine width and inter-canine distance of both maxilla and mandible). Co-relation and regression analysis was done to find the association between the parameters. All parameters were found to be greater in males than females and each was found to be statistically significant. Out of total 312 samples, the best regressor for the determination of stature was head circumference and mandibular inter-canine width and that for gender was head circumference and right mandibular teeth. The accuracy of prediction was 83%. Regression equations and analysis generated from craniofacial and odontometric parameters can be a supplementary approach for the estimation of stature and gender when extremities are not available.

Keywords: craniofacial, gender, odontometric, stature

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Authors: Veera J. Allu, Shreya Pal, Anang Pangeni

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Introduction: Adhesive small bowel obstruction (ASBO) is usually managed conservatively. Failed conservative management leads to operative intervention by an open approach. However, laparoscopic management of ASBO is increasingly being reported in the literature. We report an unusual case of ASBO secondary to a band from the appendicular tip which was managed laparoscopically. Case Description: This patient was a 61-year-old female, otherwise fit and healthy, presenting with abdominal pain and mild distension with vomiting of 3 days duration. She had undergone ultrasound-guided drainage of an appendicular abscess three months ago and laparoscopic right inguinal hernia repair (TEP) in the past. CTAP showed small bowel obstruction with a transition point in the pelvis and the possible cause being adhesions. She was initially managed conservatively; however, as she was not improving for two days, she was consented to diagnostic laparoscopy. Intraoperatively, an adhesive band was found between the appendicular tip and distal ileum around 100cm proximal to the ileocolic junction, resulting in mechanical bowel obstruction. Laparoscopic division of band was performed, followed by appendicectomy, and the patient had an uneventful recovery and was discharged on postoperative day 1. Conclusion: In highly selected patients and with appropriate expertise, laparoscopic management of ASBO is feasible and safe.

Keywords: bowel obstruction, adhesions, laparoscopy, open procedure

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Authors: Houda Khaled, Fredj Chaabani, Frederic Boulvain

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The Aptian series in north-central Tunisia was studied in detail regarding to lithology, microfacies, and magnetic susceptibility to provide new insights into the paleoenvironmental evolution and sea level changes in the carbonate platform. The study series is about 350 meters thick, and it consists of fives sequences of limestones, separated by four levels of marlstones and marly limestones. Petrographic study leads to the definition of 11 microfacies which are successively recorded along the Serdj section into the outer ramp, mid-ramp, inner ramp and coastal facies associations. The magnetic susceptibility of all samples was measured and compared with the facies and microfacies. There is a clear link between facies and magnetic susceptibility; the distal facies show high values while the proximal areas show lower values. The magnetic susceptibility profile reflects stratigraphic variations in response to relative changes in sea level and input of detrital materials. During the Aptian, kaolinite/illite intensity ratios show high values possibly indicating a warming trend followed then by decreasing values that may indicate a cooling trend. During the Albian, this cooling trend is reverted into humid/warming.

Keywords: Aptian, mineralogy, petrology, Serdj massif

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Authors: Srivilai Worametrachanon, Arunee Apichartsrangkoon, Jiranat Techarang, Boonrak Phanchaisri

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A human-digestive simulator consisted of four colon compartments, i.e., stomach, small intestine, proximal colon and distal colon used to harbor L. casei 01 plus either pasteurized ordinary-purple-rice drinks or germinated-purple-rice drinks. Accordingly, three treatment compositions had been set up and the effects of treatments on colon bacterial communities including their by-products were thoroughly examined. L. casei 01 plus purple-rice drinks gave rise to significantly high formation (P ≤ 0.05) of short-chain-fatty acids (SCFA) of which highest acetic acid was found followed by propionic and butyric acids, while the germinated-rice drink showed the greatest impact. Moreover, the effect was more pronounced upon prolonged fermentation. In addition, the influence of treatments on colon microbes was also demonstrated. Accordingly, desirable bacteria including colon Lactobacilli and Bifidobacteria were significantly increased (P ≤ 0.05) in both colons in comparison with the control and the effect was more prominent after adding purple-rice drink. On the other hand, undesirable Clostridia and coliforms were apparently diminished by the influence of treatment conditions, in which both compartments exhibited similar results.

Keywords: human-digestive simulator, Lactobacillus casei 01, Pasteurized-purple-rice drinks

Procedia PDF Downloads 191

Authors: W. G. Kim, C. H. Jo

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We analyzed the effects of variations in the diameter of silicone rubber and polyvinyl chloride (PVC) tubings on the likelihood of tubing rupture during modeling of accidental arterial line clamping in cardiopulmonary bypass with a roller pump. A closed CPB circuit constructed with a roller pump was tested with both PVC and silicone rubber tubings of 1/2, 3/8, and 1/4 inch internal diameter. Arterial line pressure was monitored, and an occlusive clamp was placed across the tubing distal to the pressure monitor site to model an accidental arterial line occlusion. A CCD camera with 512(H) x 492(V) pixels was installed above the roller pump to measure tubing diameters at pump outlet, where the maximum deformations (distension) of the tubings occurred. Quantitative measurement of the changes of tubing diameters with the change of arterial line pressure was performed using computerized image processing techniques. A visible change of tubing diameter was generally noticeable by around 250 psi of arterial line pressure, which was already very high. By 1500 psi, the PVC tubings showed an increase of diameter of between 5-10 %, while the silicone rubber tubings showed an increase between 20-25 %. Silicone rubber tubings of all sizes showed greater distensibility than PVC tubings of equivalent size. In conclusion, although roller-pump induced tubing rupture remains a theoretical problem during cardiopulmonary bypass in terms of the inherent mechanism of the pump, in reality such an occurrence is impossible in real clinical conditions.

Keywords: roller pump, tubing rupture, cardiopulmonary bypass, arterial line

Procedia PDF Downloads 263

Authors: Sanjaya N. Munasinghe, R. Gnanasekeram, Dimuthu Tennakoon

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During the last few years there has been a dramatic increase in the number of motorcyclists in Sri Lankan roads and thus an increase of motorcycle accidents (MCAs) with a heavy death and casualty toll. Extremity injuries due to MCAs cause a heavy burden on government hospitals. However, data on MCA injuries are limited. This study tries to determine the relationship between extremity injuries with protective gears and clothing motorcycle riders were wearing at the time of the accident. Data were collected from 410 motorcycle riders and passengers involved with MCAs and admitted to orthopedic and emergency observation wards in Teaching Hospital Kurunegala with extremity injuries between 1st February 2015 and 31st July 2015 using an interviewer administered questioner. Data were analyzed using SPSS version 17.0. Distal radial fracture is the most common upper extremity injury (12%), and Tibial fracture is the most common and severe lower extremity injury (23%). Very few participants were wearing safety gloves (2%) and jackets (10%). Most of the participants were wearing slippers (66%), short sleeved upper clothing (96%) and light cloth trousers (49%). According to Chi-square test associations were found between footwear and foot injuries (p-value - 0.001, Cramer's v-value - 0.203) and safety jacket and upper extremity injuries (p-value - 0.002, Cramer's v-value - 0.177). The results indicate that using safety gear can minimize the number of injuries in MCA victims. Thus it is necessary to ensure that motorcycle riders and pillion riders use proper safety gear.

Keywords: extremity injuries, fractures, motorcycle accidents, safety gear

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Authors: Chaiyawat Musikapan, Ratchatin Chancharoen, Saknan Bongsebandhu-Phubhakdi

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For many recent years, soft robotic fingers were used for supporting the patients who had survived the neurological diseases that resulted in muscular disorders and neural network damages, such as stroke and Parkinson’s disease, and inflammatory symptoms such as De Quervain and trigger finger. Generally, the major hand function is significant to manipulate objects in activities of daily living (ADL). In this work, we proposed the model of soft actuator that manufactured by full 3D printing without the molding process and one material for use. Furthermore, we designed the model with a technique of multi cavitation cells (MC-Cells). Then, we demonstrated the curvature bending, fluidic pressure and force that generated to the model for assistive finger flexor and hand grasping. Also, the soft actuators were characterized in mathematics solving by the length of chord and arc length. In addition, we used an adaptive push-button switch machine to measure the force in our experiment. Consequently, we evaluated biomechanics efficiency by the range of motion (ROM) that affected to metacarpophalangeal joint (MCP), proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP). Finally, the model achieved to exhibit the corresponding fluidic pressure with force and ROM to assist the finger flexor and hand grasping.

Keywords: biomechanics efficiency, curvature bending, hand functional assistance, multi cavitation cells (MC-Cells), range of motion (ROM)

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Authors: Nafdha Thajudeen

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Hijamah therapy is one of the leading alternative & complementary modalities in the World. It is a kind of detoxification, rejuvenation, and blood purification method. It comes under Ilaj bil Tadbeer (Regimental therapy) in the Unani medical system. In diabetes, hands and foot care in people is very important because of slow blood circulation, where blood sometimes is not able to fully penetrate the capillaries. Hijamah therapy works upon the following two principles- Tanqiyae Mawad (Evacuation of morbid humor) and Imalae Mawad (Diversion of humor). The aim of this study was to find out the effectiveness of hijamah therapy on the numbness of legs in a diabetic patient. This case study was carried out in Ayurvedic Research Hospital (Non-Communicable Diseases), Ninthavur, Sri Lanka. A 63 years old female diabetic patient came to the clinic with the complain of numbness in both feet for one year. The treatment history of the patient revealed that she had taken western medicine for her complaints for 7 months. In her first visit, wet cupping was done on local and distal points. The patient said there was a remarkable improvement; internal medicines were given to keep the sugar level in normal with some external applications. Every week, wet cupping was done on the same points, with repeating the same medicines. Foot numbness was fully cured within one month. The finding of this study shows that the complaint of numbness in the diabetic patient was treated with hijamah therapy with internal & external medicine. This case study can be concluded as hijamah therapy is very effective in treating diabetic numbness. This single case study may be the entrance for future clinical studies

Keywords: Hijamah therapy, Ilaj bil thadbeer, diabetes, numbness

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Authors: Vladyslav Povoroznyuk, Anna Musiienko, Nataliia Dzerovych, Roksolana Povoroznyuk

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Osteoporosis and obesity are widespread diseases in people over 50 years associated with changes in structure and body composition. Нigher body mass index (BMI) values are associated with greater bone mineral density (BMD). However, trabecular bone score (TBS) indirectly explores bone quality, independently of BMD. The aim of our study was to evaluate the relationship between the BMD and TBS parameters in Ukrainian men suffering from obesity. We examined 396 men aged 40-89 years. Depending on their BMI all the subjects were divided into two groups: Group I – patients with obesity whose BMI was ≥ 30 kg/m² (n=129) and Group II – patients without obesity and BMI of < 30 kg/m² (n=267). The BMD of total body, lumbar spine L₁-L₄, femoral neck and forearm were measured by DXA (Prodigy, GEHC Lunar, Madison, WI, USA). The TBS of L₁- L₄ was assessed by means of TBS iNsight® software installed on DXA machine (product of Med-Imaps, Pessac, France). In general, obese men had a significantly higher BMD of lumbar spine L₁-L₄, femoral neck, total body and ultradistal forearm (p < 0.001) in comparison with men without obesity. The TBS of L₁-L₄ was significantly lower in obese men compared to non-obese ones (p < 0.001). BMD of lumbar spine L₁-L₄, femoral neck and total body significantly differ in men aged 40-49, 50-59, 60-69, and 80-89 years (p < 0.05). At the same time, in men aged 70-79 years, BMD of lumbar spine L₁-L₄ (p=0.46), femoral neck (p=0.18), total body (p=0.21), ultra-distal forearm (p=0.13), and TBS (p=0.07) did not significantly differ. A significant positive correlation between the fat mass and the BMD at different sites was observed. However, the correlation between the fat mass and TBS of L₁-L₄ was also significant, though negative.

Keywords: bone mineral density, trabecular bone score, obesity, men

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Authors: Zeynep Karakoc, Hasan Ilhan Mutaf

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Plaque removal efficacy of different dental brushes and mouth wash during fixed orthodontic appliance therapy was evaluated in this single-blind, crossover and prospective study. Thirty orthodontic patients aged 18 and over undergoing fixed appliance therapy at the end of leveling stage were divided into three groups. Subjects brushed their teeth with a toothbrush under standardized conditions for a period of 30 days prior to inter-dental care products. The same procedure was repeated each time with a different, randomly assigned inter-dental care products in a crossover design. (Inter-dental brush, powered inter-dental brush and mouth wash). At start and end of each removal period, plaque indexes of participants were scored. Each brush achieved statistically significant plaque removal; however, there were no statistical differences among groups for all surfaces of teeth when the plaque score was evaluated. The mouth wash group presented significant improvement in reduction of visible plaque on mesial and distal surfaces of posterior teeth. (-60.9 %, P< .001) Plaque removal for right and left side of mouth showed no significant differences within groups, only mouth wash was more efficient in right side than left side. It is concluded that effectiveness of plaque removal may not be related to the kind of inter-dental products directly. However, toothbrush when used with inter-dental care products is significantly better at removing plaque deposits from fixed appliance patients.

Keywords: orthodontics, dental care, brush, plaque

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Authors: Alka Yadav, Mayank Jain, Rajan Saxena, Niraj Kumari, Narendra Krishnani, Ashok Kumar

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Purpose: To study the mismatch repair (MMR) protein expression and its clinicopathological correlation in colorectal cancer patients in North India. Methods: A prospective study was conducted on histologically proven 52 (38 males and 14 females) patients with adenocarcinoma of colorectum. MMR protein loss was determined by using immunohistochemistry for MLH1, MSH2, PMS2 and MSH6. Results: 52 patients (38 males and 14 females) underwent resection for colorectal cancer with the median age of 52 years (16-81 years). 35% of the patients (n=18) were younger than 50 years of the age. 3 patients had associated history of malignancy in the family. 29 (56%) patients had right colon cancer, 9 (17%) left colon cancer and 14 (27%) rectal cancer. 2 patients each had synchronous and metachronous cancer. Histology revealed well-differentiated tumour in 16, moderately differentiated in 10 and poorly differentiated tumour in 26 patients. MMR protein loss was seen in 15 (29%) patients. Seven (46%) of these patients were less than 50 years of age. Combined loss of MSH2 and MSH6 was seen most commonly and it was found in 6 patients. 12 (80%) patients with MMR protein loss had tumour located proximal to the splenic flexure compared to 3 (20%) located distal to the splenic flexure. There was no difference in MMR protein loss based on patients' age, gender, degree of tumour differentiation, stage of the disease and tumour histological characteristics. Conclusions: This study revealed that there was less than 30% MMR protein loss in colorectal cancer patients. The loss was most commonly seen in right sided colon cancer than left. A larger study is further required to validate these findings.

Keywords: colorectal cancer, mismatch repair protein, immunohitochemistry, clinicopathological correlation

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Authors: Bilal Wadood, Suleman Khan, Sajjad Ahmed

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The Late Cretaceous strata (Mughal Kot Formation) exposed in Central Indus Basin, Pakistan is evaluated for establishing sequence stratigraphic framework and potential of hydrocarbon accumulation. The petrographic studies and SEM analysis were carried out to infer the hydrocarbon potential of the rock unit. The petrographic details disclosed 4 microfacies including Pelagic Mudstone, OrbitoidalWackestone, Quartz Arenite, and Quartz Wacke. The lowermost part of the rock unit consists of OrbitoidalWackestone which shows deposition in the middle shelf environment. The Quartz Arenite and Quartz Wacke suggest deposition on the deep slope settings while the Pelagic Mudstone microfacies point toward deposition in the distal deep marine settings. Based on the facies stacking patterns and cyclicity in the chronostratigraphic context, the strata is divided into two 3rd order cycles. One complete sequence i.e Transgressive system tract (TST), Highstand system tract (HST) and Lowstand system tract (LST) are again replaced by another Transgressive system tract and Highstant system tract with no markers of sequence boundary. The LST sands are sandwiched between TST and HST shales but no potential porosity/permeability values have been determined. Microfacies and SEM studies revealed very fewer chances for hydrocarbon accumulation and overall reservoir potential is characterized as low.

Keywords: cycle, deposition, microfacies, reservoir

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Authors: Yalcin Kaya, Fatma Arslan, Ahmet Selim Kaya

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This study aimed to determine the undesirable hypertrophic anomalies in the body of females and to investigate how they can be affected by the exercise program according to the applied 8 week individual conditions. The research was carried out on 35 women who did not have any regular previous sports practice and had an approximate age of 30 ± 5.0 at the gymnasium because of their asymmetric structure and weight gain of the body. Measurements of width, depth, and periphery were taken from the participants' body, and the exercise protocol was applied for 8 weeks according to the individual measurements in accordance with the obtained measurements. After 8 weeks, the same measurements were applied again. Measurements were made by using ruler and paper tape. The findings were evaluated and differences were analyzed by paired sample t test. According to the findings obtained, ulnae distal proiecturas width averages were 44.77 ± 3.65 and 43.52 ± 3.47 pre- and post-exercise respectively. Bithorachanteric width averages were 29.3 ± 3.12 before exercise and 26.67 ± 3.27 after exercise. Average abdominal widths were observed as 18.64 ± 4.14 (before exercise) and 18.01 ± 6.27 (after exercise). The distances between the malleolus were measured as 16.98 ± 1.62 (before exercise) and 16.70 ± 1.64 (after exercise). The results were statistically significant (p < 0.05). The mean of pre-exercise Externus abdominis circumference was 93.97 ± 8.91, and the mean of post-exercise mean was 90.82 ± 8.24. The results are statistically significant (p < 0.05). In conclusion, findings of the study show that inactivity, daily uncontrolled activities or erroneous postural postures, malnutrition cause some anomalies in the human body. However, with consciously standardized and regular exercises, these abnormalities are reduced by an eight-week exercise protocol in parallel with the expulsion of excess kilos and can be removed when working much longer and fitter, it is proposed to be healthier and more beautiful in appearance.

Keywords: women, body, circumference-width and depth measurements, hypertrophy, exercise

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Authors: V. Viswanathan, Md. Irshad Ahmad, Prashant K. Singh, Nayeem Ahmad, Pradeep Sharma, Sujata Sharma, Tej P Singh

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Lactoperoxidase (LPO) is a heme containing mammalian enzyme which uses hydrogen peroxide (H2O2) to catalyze the conversion of substrates into oxidized products. LPO is found in body fluids and tissues such as milk, saliva, tears, mucosa and other body secretions. The previous structural studies have shown that LPO converts substrates, thiocyanate (SCN‾) and iodide (I‾) ions into oxidized products, hypothiocyanite (OSCN‾) and hypoiodite (IO‾) ions, respectively. We report here a new structure of the complex of LPO with an oxidized product, nitrite (NO2‾). This product was generated from NO using the two step reaction of LPO by adding hydrogen peroxide (H2O2) in the solution of LPO in 0.1M phosphate buffer at pH 6.8 as the first step. In the second step, NO gas was added to the above mixture. This was crystallized using 20% (w/v) PEG-3350 and 0.2M ammonium iodide at pH 6.8. The structure determination showed the presence of NO2‾ ion in the distal heme cavity of the substrate binding site of LPO. The structure also showed that the propionate group, which is linked to pyrrole ring D of the heme moiety, was disordered. Similarly, the side chain of Asp108, which is covalently linked to heme moiety, was also split into two components. As a result of these changes, the conformation of the side chain of Arg255 was altered, allowing it to form new interactions with the disordered carboxylic group of propionate moiety. These structural changes are indicative of an intermediate state in the catalytic reaction pathway of LPO.

Keywords: lactoperoxidase, structure, nitric oxide, nitrite ion, intermediate, complex

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Authors: Magdy Al Shourbagi

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Diabetes mellitus is the commonest cause of neuropathy. The common pattern is a distal symmetrical sensory polyneuropathy, associated with autonomic disturbances. Less often, Diabetes mellitus is responsible for a focal or multifocal neuropathy. Common causes for non-healing of diabetic foot are the infection and ischemia. Diabetes mellitus is associated with a defective cellular and humoral immunity. Particularly, decreased phagocytosis, decreased chemotaxis, impaired bacterial killing and abnormal lymphocytic function resulting in a reduced inflammatory reaction and defective wound healing. Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society as a treatment in which a patient intermittently breathes 100% oxygen and the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute). The pressure increase may be applied in mono-place (single person) or multi-place chambers. Multi-place chambers are pressurized with air, with oxygen given via face mask or endotracheal tube; while mono-place chambers are pressurized with oxygen. Oxygen gas plays an important role in the physiology of wound healing. Hyperbaric oxygen therapy can raise tissue oxygen tensions to levels where wound healing can be expected. HBOT increases the killing ability of leucocytes also it is lethal for certain anaerobic bacteria and inhibits toxin formation in many other anaerobes. Multiple anecdotal reports and studies in HBO therapy in diabetic patients report that HBO can be an effective adjunct therapy in the management of diabetic foot wounds and is associated with better functional outcomes.

Keywords: hyperbari oxygen therapy, diabetic foot, neuropathy, multiplace chambers

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Authors: K. Hinde, R. Bookun, P. Tran

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Percutaneous CT guided biopsies provide a fast, minimally invasive, cost effective and safe method for obtaining tissue for histopathology and culture. Standards for diagnostic yield vary depending on whether the tissue is being obtained for histopathology or culture. We present a retrospective audit from Western Health in Melbourne Australia over a 12-month period which aimed to determine the diagnostic yield, technical success and complication rate for CT guided bone biopsies and identify factors affecting these results. The digital imaging storage program (Synapse Picture Archiving and Communication System – Fujifilm Australia) was analysed with key word searches from October 2015 to October 2016. Nineteen CT guided bone biopsies were performed during this time. The most common referring unit was oncology, work up imaging included CT, MRI, bone scan and PET scan. The complication rate was 0%, overall diagnostic yield was 74% with a technical success of 95%. When performing biopsies for histologic analysis diagnostic yield was 85% and when performing biopsies for bacterial culture diagnostic yield was 60%. There was no significant relationship identified between size of lesion, distance of lesion to skin, lesion appearance on CT, the number of samples taken or gauge of needle to diagnostic yield or technical success. CT guided bone biopsy at Western Health meets the standard reported at other major clinical centres for technical success and safety. It is a useful investigation in identification of primary malignancy in distal bone metastases.

Keywords: bone biopsy, computed tomography, core biopsy, histopathology

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Authors: Houda Khaled, Frederic Boulvain, Fredj Chaabani

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This paper focuses on the sedimentological and mineralogical studies of Aptian series outcrops in the Serdj and Bellouta Mountain situated in north-central Tunisia. In the Serdj Mountain, the Aptian series is about 590 meters thick and it is defined by tow formations corresponding respectively to the Sidi Hamada formation (Barremian-Gragasian) and the Serdj formation (Middle Gragasian-Late Clansaysian). This later is consisting of five limestones sequences separated by marly levels limestones associated to some siltstones bed. The Bellouta section is especially composed of carbonate rocks and it is attributed to the Middle Gragasian - Late Clansaysian. These sections are studied in detail regarding lithology, micropaleontology, microfacies, magnetic susceptibility and mineralogical composition in order to provide new insights into the paleoenvironmental evolution and paleoclimatological implications during Aptian. The following facies associations representing different ramp palaeoenvironments have been identified: mudstone-wackestone outer ramp facies; skeletal grainstone-packstone mid-ramp facies, packstone-grainstone inner-ramp facies which include a variety of organisms such as ooliths, rudists ostracods associated to athor bioclats. The coastal facies is especially defined by a mudstone -wackestone texture coastal rich with miliolidea and orbitolines. The magnetic susceptibility (Xin) of all samples was compared with the lithological and microfacies variation. The MS curves show that the high values are correlated with the distal facies and the low values are registred in the coastal environment. The X-ray diffractometer analysis show the presence of kaolinite and illite.

Keywords: Aptian, Serdj formation, mineralogy, petrography

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Authors: Keivan Jamshidi

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Distal swelling and eventual degeneration of axon in the CNS and PNS have been considered to be the characteristic neuropathological effects of acrylamide (ACR) neuropathy. This study was conducted to determine the neurotoxic effects of different doses of ACR (0.5, 5, 50, 100, and 500 mg/kg per day × 11days i. p.) on hypothalamus of rat using the de Olmos amino cupric-silver stain and electron microscopy. For this purpose 60 adult male rats (Wistar, approximately 250 g) were randomly assigned in 5 treatment groups as A, B, C, D, E) exposed to 0.5, 5, 50, 100, and 500 mg/kg per dayx11days i. p. and one control group as F received daily i. p. injections of 0.9% saline (3ml/kg). As indices of developing neurotoxicity, weight gain, gait scores and landing hindlimb foot splay were determined. After 11 days, two rats for silver stain, and two rats for EM were randomly selected; dissected and proper samples were collected from hypothalamus. Results did show no neurological behavior in groups A, B and F were observed in group C. Rats in groups D and E died within 1-2 hours due to sever toxemia. In histopathological studies based on de Olmos technique no argyrophilic neurons or processes were observed in stained sections obtained from hypothalamus of rats belong to groups A, B, and F while moderate to severe argyrophilic changes were observed in different nuclei and regions of stained sections obtained from hypothalamus of rats belong to group C. In ultra-structural studies some variations in the myelin sheet of injured axons including decompactation, interlaminar space formation, disruption of the laminar sheet, accumulation of neurofilaments, vacculation, and clumping inside the axolem, and finally complete disappearance of laminar sheet were observed.

Keywords: acrylamide, hypothalamus, rat, de Olmos amino cupric, silver stain, electron microscopy

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Authors: Shivani Kuttuva, Bridget Fergie, Andrew Mishreki, Shovkat Mir, Fintan Bergin

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Diaphragm disease (DD) of the small bowel is a condition wherein the bowel lumen is divided into a series of short compartments by multiple circumferential membranes of mucosa and submucosa, leading to pinhole lumen and subsequent obstruction. It is a rare condition commonly attributed to non-steroidal anti-inflammatory drugs (NSAIDs) usage. Herein we present a 31-yr-old-female with a history of NSAIDs usage for one year following neurosurgery, who presented with recurrent idiopathic small bowel obstruction, recalcitrant anaemia, and impaction of capsule endoscope on investigating for anaemia. The capsule endoscopy images demonstrated multiple circumferential strictures with ulcers at its tip and villous atrophy in the proximal bowel, suggestive of NSAIDs related damage. However, due to the lack of awareness of the detrimental effects of NSAIDs on bowel mucosa distal to the duodenum, the underlying aetiology of this clinical presentation remained a mystery for a significant duration. The patient had to undergo repeated laparotomies in order to relieve the symptoms of recurring acute small bowel obstruction. Upon examining the resected specimen under microscopy, the histopathological hallmark of expanded, fibrotic, and congested submucosa was picked up, leading to the confirmation of diaphragm disease. Thus, this case report aims to widen the awareness among clinicians and aid surgeons in devising a management plan for young individuals presenting with recurring episodes of obstruction due to Diaphragm disease.

Keywords: capsule endoscopy, diaphragm disease, NSAIDs, recurrent small bowel obstruction

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Authors: Johanna Lundqvist

Abstract:

Third cycle supervision is a multifaceted and complex task for supervisors in higher education. It progresses over several years and is affected by several proximal and distal factors. It can result in positive learning outcomes for doctoral students and high-quality publications. However, not all doctoral students thrive during their doctoral studies; nor do they all complete their studies. This is problematic for both the individuals themselves as well as society at large: doctoral students are valuable and important in current research, future research and higher education. The aim of this literature review is to elucidate what responsible third cycle supervision can include and be in practice. The question posed is as follows: according to recent literature, what is it that characterises responsible third cycle supervision in which doctoral students can thrive and develop their research knowledge and skills? A literature review was conducted, and the data gathered from the literature regarding responsible third cycle supervision was analysed by means of a thematic analysis. The analysis was inspired by the notion of responsible inclusion outlined by David Mitchell. In this study, the term literature refers to research articles and regulations. The results (preliminary) show that responsible third cycle supervision is associated with a number of interplaying factors (themes). These are as follows: committed supervisors and doctoral students; a clear vision and research problem; an individual study plan; adequate resources; interaction processes and constructive feedback; creativity; cultural awareness; respect and research ethics; systematic quality work and improvement efforts; focus on overall third cycle learning goals; and focus on research presentations and publications. Thus, responsible third cycle supervision can occur if these factors are realized in practice. This literature review is of relevance to evaluators, researchers, and management in higher education, as well as third cycle supervisors.

Keywords: doctoral student, higher education, third cycle supervisors, third cycle programmes

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