Perineal body squamous cell carcinoma treated with radical radiotherapy - a case report.

Introduction: Perianal tumours are a rare site of malignancy, and tumours primarily involving the perineal body without vaginal and anal canal involvement are uncommon. Case summary: A 67-year-old woman presented with a lesion involving the perineum and rectovaginal septum without extension into vaginal or anorectal mucosa and with skip lesions in the vulva. Biopsy was confirmative of squamous cell carcinoma, with p16 positive. A complete metastatic workup with MRI of the pelvis and CECT thorax and abdomen was done. She was diagnosed with perianal carcinoma stage cT2N0M0 Stage II (American Joint Committee on Cancer 8th Edition of Cancer Staging) since the lesion reached the anal verge. Given the location of the tumour (perineal body), comorbidities and advanced age, she received radical radiotherapy with an intensity-modulated radiotherapy technique - 56 Gy in 28 fractions with the intention of organ preservation. The response assessment with MRI at 3 months showed a complete tumour response. She has been disease-free for 3 years and is on regular follow-ups. Conclusion: Isolated perineal body squamous cell carcinomas are unusual, and synchronous vulvar skip lesion makes this case unique. Radical radiotherapy achieved organ preservation with tumour control and minimal toxicity in an elderly frail patient.

De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release.

PURPOSE: Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD: 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS: The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION: We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.

The residually stressed unloaded state of arteries: Membrane and thin cylinder approximations.

A solution is obtained for incompressible non-linearly elastic membranes that describes the bending of a cylindrical sector to form a perfect cylinder for a wide class of materials that includes isotropic materials and orthotropic materials reinforced by two families of mechanically equivalent fibres that are wound helically about the axial direction. Despite the relative simplicity of the physical problem, the solution of the corresponding boundary value problem for thick cylinders requires a numerical solution for even the simplest models. It is shown, however, that the thin shell solution provides an excellent approximation to the solution of the problem for cylindrical sectors whose thicknesses are an order of magnitude greater than that assumed for membranes. The approximate stress distribution in such thin shells is obtained. In these residually stressed cylinders, the radial stress is approximately zero but the hoop and axial stresses are finite. Estimates of the residual stresses in the unloaded state are obtained. A closed-form solution for the bending moment necessary to effect the deformation is also obtained.

Inflation of residually stressed Fung-type membrane models of arteries.

Elastic arteries are idealised as being incompressible orthotropic nonlinearly elastic cylinders. They are further idealised as being membranes in order to analyse the effect of the experimentally observed pre-stressing of arterial tissue on inflation. The pre-stress is modelled here using the opening-angle method. It is shown that there can be multiple unloaded states of arterial segments of Fung materials, suggesting the corresponding set of material parameters will not yield reliable predictions of arterial stress in three dimensions as there is no experimental evidence to support this non-uniqueness. It is also shown that the circumferential pre-strain has a simple magnifying scaling effect on the pressure-radial strain relation and on the axial force needed to maintain the membrane length during inflation; the effect of the axial pre-strain is more nuanced.

Enhanced Biosynthesis Synthesis of Copper Oxide Nanoparticles (CuO-NPs) for their Antifungal Activity Toxicity against Major Phyto-Pathogens of Apple Orchards.

PURPOSE: The present study made an attempt to develop copper nanoparticles (Cu-NP) with antifungal property using green synthesis method. Copper oxide nanoparticles (CuO-NPs) botanically synthesized using Neem leaf extract (Azadirachta indica A. Juss) were characterized by using different techniques like; UV-visible spectrophotometry, FTIR, XRD, SEM and TEM. METHODS: Materials were chosen the disease free and fresh Azadirachta indica A. Juss were collected and identified at Center of Biodiversity and Taxonomy. The plant samples were vigorously washed with distilled water then shade dried followed by sterilization with 0.1% mercuric chloride for 20 s and again it was washed with distilled water. 15 g powder form of plant material was added to 200 ml double distilled, CO2 free and deionized water and kept in shaker at 80°C and 1500 rpm for six hours. After agitation, the extract was separated by regular centrifugation at 10,000 rpm followed by filtration by using whatmann filter paper. The final volume of 100 ml of supernatant was collected as pure extract and stored in cool place for further use. RESULTS: The final results confirm a significant inhibition of CuO-NPs for the test fungi. Additionally, CuO-NPs demonstrated an enhanced effect when combined with Neem leaf extract. A total of 20-30% improvement in activity was noticed after combination, which correlates with commonly used synthetic fungicides. The toxicity results reveal that A. indica extract and their combined fractions with CuO-NP were less toxic to the test seeds of experimental plant while as bulk Cu followed by biosynthesized CuO-NPs influenced the germination rate as compared to control pots. CONCLUSIONS: The study drops a concern of research and offers a promising route of developing Copper based green fungicides that can help to combat with modern issues of synthetic fungicides. An average size of 80 ± 15 nm monoclinic cupric oxide (CuO) and cubic cuprous oxides (Cu2O) nanocrystals that existed in mixed form were successfully developed.

Automatic Segmentation of Lumen Intima Layer in Longitudinal Mode Ultrasound Images.

We propose an automated method for the segmentation of lumen intima layer of the common carotid artery in longitudinal mode ultrasound images. The method is hybrid, in the sense that a coarse segmentation is first achieved by optimizing a locally defined contrast function of an active oblong considering its five degrees-of-freedom, and subsequently the fine segmentation and delineation of the carotid artery are achieved by post-processing the portion of the ultrasound image spanned by the annulus region of the optimally fitted active oblong. The post-processing includes median filtering and Canny edge detection to retain the lumen intima representative points followed by a smooth curve fitting technique to delineate the lumen intima boundary. The algorithm has been validated on 84 longitudinal mode carotid artery ultrasound images provided by the Signal Processing laboratory, Brno university. The proposed technique results in an average accuracy and Dice similarity index of 98.9% and 95.2%, respectively.

Computer-aided diagnosis of liver lesions using CT images: A systematic review.

BACKGROUND: Medical image processing has a strong footprint in radio diagnosis for the detection of diseases from the images. Several computer-aided systems were researched in the recent past to assist the radiologist in diagnosing liver diseases and reducing the interpretation time. The aim of this paper is to provide an overview of the state-of-the-art techniques in computer-assisted diagnosis systems to predict benign and malignant lesions using computed tomography images. METHODS: The research articles published between 1998 and 2020 obtained from various standard databases were considered for preparing the review. The research papers include both conventional as well as deep learning-based systems for liver lesion diagnosis. The paper initially discusses the various hepatic lesions that are identifiable on computed tomography images, then the computer-aided diagnosis systems and their workflow. The conventional and deep learning-based systems are presented in stages wherein the various methods used for preprocessing, liver and lesion segmentation, radiological feature extraction and classification are discussed. CONCLUSION: The review suggests the scope for future, work as efficient and effective segmentation methods that work well with diverse images have not been developed. Furthermore, unsupervised and semi-supervised deep learning models were not investigated for liver disease diagnosis in the reviewed papers. Other areas to be explored include image fusion and inclusion of essential clinical features along with the radiological features for better classification accuracy.

Effect of Extremely Low Power Time-Varying Electromagnetic Field on Germination and Other Characteristics in Foxtail Millet (Setaria italica) Seeds.

The ability of extremely low, time-varying electromagnetic field (EMF) to improve germination efficacy was studied in Foxtail millet (Setaria italica) seeds using response surface methodology. An optimal factorial central composite design was chosen to optimize the EMF with three critical factors, viz. frequency, intensity, and duration. The adequacy of the model and fitness was evaluated by analysis of variance and regression coefficients. This model suggested that the factors, frequency, and intensity had a significant impact on germination. Optimal conditions for germination were observed to be 10 Hz frequency, 30,007 nT intensity, and 30-min duration with an observed germination percentage of 93.0, and a predicted germination percentage of 92.92. Magneto-priming was found to increase the germination efficacy (15.66%), shoot length (27.78%), total seedling length (20.30%), seedling dry mass (26.49%), and water uptake (34.48% at 80 min) showing significant output when compared with the control and positive controls. Remarkable improvements were observed in germination parameters such as vigor index-1 (39.14%), vigor index-2 (46.28%), speed of germination (27.52%), and emergence index (12.50%). Magneto-priming was found to reduce the levels of germination-specific enzymes, viz. α-amylase, protease, and dehydrogenase, while it enhanced the levels of antioxidant enzymes, viz. catalase (114.63%) and superoxide dismutase (19.62%), triggering fast germination and early vigor of seedlings. This study clearly showed that EMF priming significantly improved the germination effect and other characteristics of Foxtail millet seeds. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.

Segmental Variations in the Peel Characteristics of the Porcine Thoracic Aorta.

Aortic dissection occurs predominantly in the thoracic aorta and the mechanisms for the initiation and propagation of the tear in aortic dissection are not well understood. We study the tearing characteristics of the porcine thoracic aorta using a peeling test and we estimate the peeling energy per unit area in the ascending and the descending segments. The stretch and the peel force per unit width undergone by the peeled halves of a rectangular specimen are measured. We find that there can be significant variation in the stretch within the specimen and the stretch between the markers in the specimen varies with the dynamics of peeling. We found that in our experiment the stretch achieved in the peeled halves was such that it was in the range of the stretch at which the stress-stretch curve for the uniaxial experiment starts deviating from linearity. Higher peeling energy per unit area is required in the ascending aorta compared to the descending aorta. Longitudinal specimens required higher peeling energy per unit area when compared to the circumferential specimens.

Comparison of MRI & direct MR arthrography with arthroscopy in diagnosing ligament injuries of wrist.

INTRODUCTION: Ligament injuries around the wrist leading to chronic wrist pain are often a diagnostic dilemma.Various imaging modalities like wrist radiographs, CT and MRI have been used to improve the diagnostic accuracy. The objective of this study was to assess the value of MRI & direct magnetic resonance arthrography (MRA) of the wrist for detecting & evaluating tears of the triangular fibrocartilage complex (TFCC) & scapholunate & luno triquetral interosseous ligament (LTIL & SLIL) injuries in comparison with arthroscopy of the wrist. MATERIALS & METHODS: All patients presenting with chronic wrist pain of more than 3 months duration with suspected ligament injuries were included. MRI was performed with 8 channel wrist coil on 1.5 T machine. (PHILIPS, Netherlands). MRA was performed after obtaining consent. Retrospective MR findings were then correlated with results in those patients who underwent arthroscopy. Arthroscopic correlation was obtained in 22 (46.8%) cases out of the 45 patients who underwent both MRI & MRA. RESULTS: The gold standard arthroscopic procedure diagnosed 15 peripheral & 6 central TFCC tears in 22 patients. 4 scapholunate ligament tears were also identified. MRI diagnosed 16 peripheral & 5 central TFCC tears in these 22 patients. MRA identified 9 central tears and 14 peripheral tears. The sensitivity in diagnosing an overall TFCC tears with MRI as well as MRA was 94.4 & 100%. The specificity of the MRI and MRA in diagnosing an overall TFCC tear was 100% & 75% respectively. DISCUSSION & CONCLUSIONS: Direct MRA has better sensitivity in detecting TFCC central tears. In view of 'substantial' agreement between MRI & MRA with Kappa analysis, conventional MRI can be relied on, in diagnosing TFCC injury. With comparatively low specificity, caution and restraint is advised in interpreting MRA, which may influence decision on surgery.

Comparison of Conventional Techniques and Higher Imaging Modalities in the Evaluation of Relation between the Third Molar and Inferior Alveolar Nerve Canal: A Pilot Study.

CONTEXT: Mandibular third molars are the most commonly impacted teeth, and their surgical removal can be associated with inferior alveolar nerve (IAN) injury. To avoid the deleterious complication of nerve injury on patients, a thorough visualization of IAN and its localization are essential. AIMS AND OBJECTIVES: The aims and objectives of this study were to evaluate the efficacy of two conventional localization techniques in determining the relationship of mandibular third molars to IAN and to assess its reliability in comparison with computed tomography (CT). SETTINGS AND DESIGN: Panoramic radiograph (PR) was taken using Kodak 8000C Digital Panoramic and Cephalometric system. Intraoral periapical radiographs (IOPAs) were taken using Kodak 2200 Intraoral X-ray machine. CT scan images were taken using multidetector CT scans. MATERIALS AND METHODS: Two IOPAs (0° and -20° vertical angulation) and PR and CT scan images of thirty mandibular third molars were taken. Two combinations were used (i) a combination of two IOPAs and (ii) a combination of PR and IOPA (-20°). Tube-shift localization technique was applied to both these combinations to derive the relation between third molar and IAN canal as "in contact," "separate," "buccal," "lingual," and "in line with the apex" and the results were compared with CT images. STATISTICAL ANALYSIS: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using SPSS software version 15.0. RESULTS: The combination of PR and IOPA radiographs showed 14 teeth to be in contact with IAN. This gave a sensitivity of 100%, specificity of 94.1%, PPV of 92.9%, and a NPV of 100% in determining the relation as "in contact" or "separate." 78.3%, 85.7%, 94.7%, and 54.5% were the sensitivity, specificity, PPV, and NPV in localizing it as "buccal," "lingual," or "in line with apex." These results were better than that of the combination of the two IOPAs. CONCLUSIONS: Localization using PR and IOPA could better deduce the relation between IAN and mandibular third molar.

Serum Uric Acid Levels in Type 2 Diabetes Mellitus: Is There a Linear Relationship with Severity of Carotid Atherosclerosis?

AIMS: The aim of this study was to correlate serum uric acid (SUA) levels and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (DM). SETTINGS AND DESIGN: This study was a cross-sectional observational study on 103 diabetic patients conducted from September 2015 to May 2017. SUBJECTS AND METHODS: We screened 103 patients with type 2 DM between the ages of 30-65 years. SUA levels and the CIMT were measured. The patients were divided into quartiles based on uric acid level. The CIMT of the quartiles is compared and analyzed. STATISTICAL ANALYSIS USED: Chi-squared test, Analysis of Variance, and Pearson's correlation. RESULTS: Uric acid levels were positively associated with CIMT (P = 0.001). The association remained significant after further adjustment for potential confounders. Strong correlation was found among them as depicted by correlation coefficient (r = 0.779). CONCLUSIONS: Carotid atherosclerosis as measured by IMT is associated with SUA levels in patients with type 2 DM.

Hand dysfunction in type 2 diabetes mellitus: Systematic review with meta-analysis.

BACKGROUND: People with type 2 diabetes mellitus frequently show complications in feet and hands. However, the literature has mostly focused on foot complications. The disease can affect the strength and dexterity of the hands, thereby reducing function. OBJECTIVES: This systematic review and meta-analysis focused on identifying the existing evidence on how type 2 diabetes mellitus affects hand strength, dexterity and function. METHODS: We searched MEDLINE via PubMed, CINHAL, Scopus and Web of Science, and the Cochrane central register of controlled trials for reports of studies of grip and pinch strength as well as hand dexterity and function evaluated by questionnaires comparing patients with type 2 diabetes mellitus and healthy controls that were published between 1990 and 2017. Data are reported as standardized mean difference (SMD) or mean difference (MD) and 95% confidence intervals (CIs). RESULTS: Among 2077 records retrieved, only 7 full-text articles were available for meta-analysis. For both the dominant and non-dominant hand, type 2 diabetes mellitus negatively affected grip strength (SMD: -1.03; 95% CI: -2.24 to 0.18 and -1.37, -3.07 to 0.33) and pinch strength (-1.09, -2.56 to 0.38 and -1.12, -2.73 to 0.49), although not significantly. Dexterity of the dominant hand did not differ between diabetes and control groups but was poorer for the non-dominant hand, although not significantly. Hand function was worse for diabetes than control groups in 2 studies (MD: -8.7; 95% CI: -16.88 to -1.52 and 4.69, 2.03 to 7.35). CONCLUSION: This systematic review with meta-analysis suggested reduced hand function, specifically grip and pinch strength, for people with type 2 diabetes mellitus versus healthy controls. However, the sample size for all studies was low. Hence, we need studies with adequate sample size and randomized controlled trials to provide statistically significant results.

The impact of anticancer activity upon Beta vulgaris extract mediated biosynthesized silver nanoparticles (ag-NPs) against human breast (MCF-7), lung (A549) and pharynx (Hep-2) cancer cell lines.

The present study tried for a phyto-synthetic method of producing silver nanoparticles (Ag-NPs) with size controlled as and eco-friendly route that can lead to their advanced production with decorative tranquil morphology. By inducing temperature fluctuation of the reaction mixture from 25 to 80°C the plasmon resonance band raised slowly which had an ultimate effect on size and shape of Ag-NPs as shown by UV-visible spectroscopy and TEM results. The biosynthesized nanoparticles showed good cytotoxic impact against MCF-7, A549 and Hep2 cells compared to normal cell lines. Compared to control plates, the percentage of cell growth inhibition was found to be high with as concentrations of Ag-NPs becomes more as determined by MTT assay. The AO/EtBr staining observations demonstrated that the mechanism of cell death induced by Ag-NPs was due to apoptosis in cancer cells. These present results propose that the silver nanoparticles (Ag-NPs) may be utilized as anticancer agents for the treatment of various cancer types. However, there is a need for study of in vivo examination of these nanoparticles to find their role and mechanism inside human body. Further, studies we plan to do biomarker fabrication from the green synthesized plant extract nanoparticles like silver, gold and copper nanoparticles with optimized shape and sizes and their enhancement of these noble nanoparticles.

Synthesis of silver nanoparticles (Ag NPs) for anticancer activities (MCF 7 breast and A549 lung cell lines) of the crude extract of Syzygium aromaticum.

In the present report, silver nanoparticles were synthesized using Piper nigrum extract for in vitro cytotoxicity efficacy against MCF-7 and HEP-2 cells. The silver nanoparticles (AgNPs) were formed within 20min and after preliminarily confirmation by UV-Visible spectroscopy (strong peak observed at ~441nm), they were characterized by using FT-IR and HR-TEM. The TEM images show spherical shape of biosynthesized AgNPs with particle size in the range 5-40nm while as compositional analysis were observed by EDAX. MTT assays were carried out for cytotoxicity of various concentrations of biosynthesized silver nanoparticles and Piper nigrum extract ranging from 10 to 100µg. The biosynthesized silver nanoparticles showed a significant anticancer activity against both MCF-7 and Hep-2 cells compared to Piper nigrum extract which was dose dependent. Our study thus revealed an excellent application of greenly synthesized silver nanoparticles using Piper nigrum. The study further suggested the potential therapeutic use of these nanoparticles in cancer study.

Draft Genome Sequence of Lactobacillus plantarum Kanjika 2007, Isolated from Kanjika, a South Indian Traditional Food.

The draft genome sequence of Lactobacillus plantarum Kanjika 2007, isolated from the South Indian staple, medicinal, and traditional food kanjika, is reported here. The whole genome consists of 3.16 Mb with a G+C content of 44.7% and 3,009 protein-coding genes, 78 tRNAs, and 4rRNAs (5S-23S-16S).

On a possible methodology for identifying the initiation of damage of a class of polymeric materials.

In this paper, we provide a possible methodology for identifying the initiation of damage in a class of polymeric solids. Unlike most approaches to damage that introduce a damage parameter, which might be a scalar, vector or tensor, that depends on the stress or strain (that requires knowledge of an appropriate reference configuration in which the body was stress free and/or without any strain), we exploit knowledge of the fact that damage is invariably a consequence of the inhomogeneity of the body that makes the body locally 'weak' and the fact that the material properties of a body invariably depend on the density, among other variables that can be defined in the current configuration, of the body. This allows us to use density, for a class of polymeric materials, as a means to identify incipient damage in the body. The calculations that are carried out for the biaxial stretch of an inhomogeneous multi-network polymeric solid bears out the appropriateness of the thesis that the density of the body can be used to forecast the occurrence of damage, with the predictions of the theory agreeing well with experimental results. The study also suggests a meaningful damage criterion for the class of bodies being considered.

WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198.

OBJECTIVES: To determine the pattern of mutations of the WISP3 gene in clinically identified progressive pseudorheumatoid dysplasia (PPD) in an Indian population. PATIENTS AND METHODS: A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the WISP3 gene. Screening for mutations was done by conformation-sensitive gel electrophoresis, beginning with the fifth exon and subsequently proceeding to the remaining exons. Sanger sequencing was performed for both forward and reverse strands to confirm the mutations. RESULTS: In all, two of the 15 patients had compound heterozygous mutations: one a nonsense mutation c.156C>A (p.C52*) in exon 2, and the other a missense mutation c.677G>T (p.G226V) in exon 4. All others were homozygous, with three bearing a nonsense mutation c.156C>A (p.C52*) in exon 2, three a missense mutation c.233G>A (p.C78Y) in exon 2, five a missense mutation c.1010G>A (p.C337Y) in exon 5, one a nonsense mutation c.348C>A (p.Y116*) in exon 3, and one with a novel deletion mutation c.593_597delATAGA (p.Y198*) in exon 4. CONCLUSION: We identified a novel mutation c.593_597delATAGA (p.Y198*) in the fourth exon of the WISP3 gene. We also confirmed c.1010G>A as one of the common mutations in an Indian population with progressive pseudorheumatoid dysplasia.Cite this article: V. Madhuri, M. Santhanam, K. Rajagopal, L. K. Sugumar, V. Balaji. WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198* Bone Joint Res 2016;5:301-306. DOI: 10.1302/2046-3758.57.2000520.

Efficacy of low level laser therapy on painful diabetic peripheral neuropathy.

BACKGROUND & AIMS: Diabetic peripheral neuropathy (DPN) accounts for most common complications of T2DM. Painful DPN is associated with functional limitation & poor quality of life. Therefore, objective of the study is to find the effect of low level laser therapy on painful diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) Materials & methods: The study design is pre-post observational design. After obtaining ethical clearance and informed consent, 19 T2DM subjects were screened and confirmed for peripheral neuropathy in an outpatient setting with biochemical parameter, pain scale and Michigan Neuropathy Screening Instrument (MNSI). Low Level Laser therapy was irradiated through scanning mode with dosage of 3.1J/cm(2) on the plantar and dorsum of the foot and 3.4j/cm(2) with contact method for 10days and all subjects were reassessed at the end of the 10 day. Descriptive statistics and paired' test was used to analyze the pre-post finding within the group. Level of significance was set at p<0.05 RESULTS: The result analysis showed significant reduction in Pain using VAS scale (6.47 ± 0.84 to 1.21 ± 0.78 (p<0.001), MNSI (5.52 ± 1.26 to 2.71 ± 0.97 (reduction in Vibration perception threshold (32.68 ± 6.08 to 24.84 ± 4.29 (<0.001) and a significant increase in the temperature from baseline to post intervention (30.01 ± 2.11 to 31.75 ± 1.03 (p<0. 001). CONCLUSION: In the present study, Low level laser therapy was found to be effective in type 2 DM with peripheral neuropathy.