A Brief Review on Advanced Sandwich Structures with Customized Design Core and Composite Face Sheet.

Sandwich structures are a class of multifunctional high-performance structural composites that have the advantages of being lightweight, of a high strength-to-weight ratio, and of high specific energy absorption capabilities. The creative design of the core along with the apposite material selection for the fabrication of the face sheet and core are the two prerequisites with encouraging areas for further expedition towards the fabrication of advanced composite sandwich structures. The current review work focused on different types of core designs, such as truss, foam, corrugated, honeycomb, derivative, hybrid, hollow, hierarchical, gradient, folded, and smart core along with different composite materials accessible for face sheet fabrication, including fiber-reinforced composite, metal matrix composite, and polymer matrix composite are considered. The joining method plays a major role for the performance evolution of sandwich structures, which were also investigated. Further discussions are aligned to address major challenges in the fabrication of sandwich structures and further enlighten the future direction of the advanced composite sandwich structure. Finally, the work is summarized with a brief conclusion. This review article provides wider guidelines for researchers in designing and manufacturing next-generation lightweight multilayer core sandwich structures.

A Study of Morphological Characteristics of Lung Fissures and Trachea in the Indian Population.

Tracheal length and lung anatomy have been rarely studied; however, the anatomy of the lung has been shown to vary significantly. Moreover, the surgery regarding trachea are few, and hence the surgeons do not have extensive experience in the trachea. OBJECTIVE: We aimed to study the variations of the lung anatomy and the relation between tracheal length and body height in the Indian population. MATERIALS AND METHODS: This is an observational study to observe the tracheal length in relation to body height and sex and gross morphological anatomy of the lung in 70 cadavers. The data was collected from the forensic department of Bangalore Medical College and Research Institute (BMCRI), and further analysis was done at Kidwai Memorial Institute of Oncology. RESULTS: Deviation from normal lung morphology was seen in 37.86% of the specimens studied. The tracheal length (average, 9.97 cm) correlated with the body length (average, 147.02 cm) with a Pearson coefficient of 0.806 (p value=0.001) Conclusion: The study of lung fissure morphology guides clinicians in understanding and planning lung disease treatment, especially lobectomy/segmentectomy surgeries. The information of the average length of the trachea with respect to body height in a given ethnicity will help during endotracheal intubation and tracheal surgical planning.

Non-invasive evaluation of bladder outlet obstruction in benign prostatic hyperplasia: a clinical correlation study.

Objectives: To determine the utility of ultrasonography (US)-derived parameters (e.g. prostate volume [PV], bladder wall thickness [BWT], post-void residual urine volume [PVR], and intravesical prostatic protrusion [IPP]) and uroflowmetry for identifying bladder outlet obstruction (BOO) by correlating them with the results of pressure-flow urodynamic studies (UDS). Patients and methods: In all, 164 patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH), from May 2016 to December 2018, were included in this study. All had International Prostate Symptoms Score (IPSS), Quality-of-Life (QOL) index, uroflowmetry (including maximum urinary flow rate [Qmax]) and PVR measured by transabdominal US. Pressure-flow UDS were performed on all men and BOO was defined by a BOO Index (BOOI) >40. Men with a Qmax of ≥12.0 mL/s were considered to have 'good' flow. Results: Amongst the 164 men, the mean (SD) age, PV, BWT and Qmax were 66.72 (9.88) years, 51.91 (13.24) mm, 5.07 (0.91) mm, and 8.46 (3.59) mL/s, respectively. In all, 91 (55.49%) patients had BOO with a BOOI >40 and nine (5.49%) had equivocal BOO with a BOOI of 20-40. The IPP was a statistically significant predictor (P < 0.001) of BOO compared with other variables in the initial evaluation. In patients with BOO confirmed by the pressure-flow UDS, IPP Grade III was associated with a higher BOOI than was Grade I and II (P < 0.001). Conclusion: BWT, PV and PVR in conjunction with IPP are good predictors of clinically significant BOO due to BPH. Abbreviations: AUC: area under the curve; BOOI: BOO Index; BPO, benign prostatic obstruction; BWT, bladder wall thickness; IPP: intravesical prostatic protrusion; Pdet: detrusor pressure; PV: prostate volume; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QOL: quality of life; ROC: receiver operating characteristic; (TA)US: (transabdominal) ultrasonography; UDS: urodynamic studies.

Influence of 1-MCP on texture, related enzymes, quality and their relative gene expression in 'Amrapali' mango (Mangifera indica L.) fruits.

The mango fruits remain biologically active even after harvest as they continue respiration, transpiration and other bio-chemical processes. Being highly perishable, the fruit quality deteriorates fast under ambient conditions (30 ± 5 °C and 50 ± 5% RH), rendering them unmarketable within 5-6 days. In order to extend the shelf-life of 'Amrapali' mango fruits, we have treated them with three different concentrations (500, 750 and 1000 ppb) of 1-Methylcyclopropene (1-MCP) @ 20 °C and stored at ambient conditions. Among all the treatments, 1000 ppb was found to be an effective in extending shelf-life till twelfth day with minimum physiological loss in weight (19.24%), maximum firmness (10.43 N), highest retention of quality parameters such as soluble solid concentrates (27.88 °B), ascorbic acid (28.49 mg 100 g-1 FW) and total antioxidant activity (675.41 µmol Trolox g-1 FW) compared to untreated mango fruits (21.79%, 5.45 N, 23.17 °B, 19.55 mg 100 g-1 FW and 265.41 µmol Trolox g-1 FW, respectively). Gene expression studies have revealed that the texture related gene expansin was significantly repressed till fifth day of storage with increasing concentrations of 1-MCP.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi.

PURPOSE: To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. MATERIALS AND METHODS: The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. RESULTS: There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. CONCLUSION: Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

ABSTRACT Purpose To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. Materials and Methods The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. Results There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. Conclusion Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Ischemia-modified albumin levels in overt and subclinical hypothyroidism.

BACKGROUND: Free radical-mediated oxidative stress (OS) has been implicated in the pathogenesis of thyroid disorders. The ischemia-modified albumin (IMA) has been proposed as a marker of protein oxidative damage, which has been found to reflect hypoxic stress. AIM: Our aim was to evaluate IMA, malondialdehyde (MDA), and reduced glutathione (GSH) levels in patients with overt hypothyroidism (OHT) and subclinical hypothyroidism (SHT) in comparison to euthyroid controls. SUBJECTS AND METHODS: Albumin, IMA, IMA/albumin ratio, MDA, GSH, total cholesterol (TC), triglycerides (TG), HDL-Cholesterol were assessed in 105 subjects grouped into OHT, SHT patients, and euthyroid controls with 35 subjects in each group. RESULTS: MDA and IMA levels were significantly elevated while the GSH concentrations were significantly lower in OHT and SHT patients compared to controls (p < 0.01). When IMA values were normalized for albumin concentrations, the IMA/albumin ratio was also significantly elevated in both patient groups compared to controls (p < 0.01). These changes were more pronounced in the OHT group when compared to SHT group. In OHT group, thyroid-stimulating hormone (TSH) levels showed significant positive correlation with MDA (r = 0.470, p = 0.004), IMA (r = 0.530, p = 0.001), and IMA/albumin ratio (r = 0.525, p = 0.001). Both IMA (r = -0.342, p = 0.041), IMA/albumin ratio (r = -0.378, p = 0.023) showed significant negative correlation with GSH in OHT patients. No significant correlation between variables was, however, observed in SHT group. CONCLUSIONS: Increase of MDA and IMA levels with decreased antioxidant status indicate the presence of OS in hypothyroid patients, which was more pronounced in OHT patients. Elevated levels of IMA can be a clinically useful marker of protein oxidative damage and OS in hypothyroidism.

Molecular docking and dynamic simulation studies evidenced plausible immunotherapeutic anticancer property by Withaferin A targeting indoleamine 2,3-dioxygenase.

Indoleamine 2,3-dioxygenase (IDO) is emerging as an important new therapeutic drug target for the treatment of cancer characterized by pathological immune suppression. IDO catalyzes the rate-limiting step of tryptophan degradation along the kynurenine pathway. Reduction in local tryptophan concentration and the production of immunomodulatory tryptophan metabolites contribute to the immunosuppressive effects of IDO. Presence of IDO on dentritic cells in tumor-draining lymph nodes leading to the activation of T cells toward forming immunosuppressive microenvironment for the survival of tumor cells has confirmed the importance of IDO as a promising novel anticancer immunotherapy drug target. On the other hand, Withaferin A (WA) - active constituent of Withania Somnifera ayurvedic herb has shown to be having a wide range of targeted anticancer properties. In the present study conducted here is an attempt to explore the potential of WA in attenuating IDO for immunotherapeutic tumor arresting activity and to elucidate the underlying mode of action in a computational approach. Our docking and molecular dynamic simulation results predict high binding affinity of the ligand to the receptor with up to -11.51 kcal/mol of energy and 3.63 nM of IC50 value. Further, de novo molecular dynamic simulations predicted stable ligand interactions with critically important residues SER167; ARG231; LYS377, and heme moiety involved in IDO's activity. Conclusively, our results strongly suggest WA as a valuable small ligand molecule with strong binding affinity toward IDO.

Penile injuries: A 10-year experience.

We report our 10-year experience with penile injuries. We retrospectively reviewed the records of 156 cases of male external genitalia injuries between May 2002 and December 2012. Of these, only 26 patients presented without urethral injuries and were included in this study. Patients were divided into 4 groups: Group 1 (n = 12) with patients with penile fractures injuries; Group 2 (n = 5) with patients with penile amputation injuries; Group 3 (n = 2) with patients with penile penetrating injuries; and Group 4 (n = 7) with patients with penile soft tissue injuries. Grading of injury was done using the American Association for the Surgery of Trauma (AAST)-Organ injury scale of penile injury. Penile injuries without urethral injuries are urological emergencies which require immediate attention.

Effect of potassium magnesium citrate and vitamin B-6 prophylaxis for recurrent and multiple calcium oxalate and phosphate urolithiasis.

PURPOSE: To study the effects of long-term treatment with potassium magnesium citrate and vitamin B-6 prophylaxis (Urikind-KM6; 1,100-mg potassium citrate, 375-mg magnesium citrate, and 20-mg pyridoxine hydrochloride/5 mL) every 8 hours over 3 years. MATERIALS AND METHODS: A total of 247 patients with recurrent idiopathic hypocitraturia with or without hyperuricosuria and randomized controls were studied prospectively for 3 years. The total patients were divided into three groups. Control group 1 consisted of 61 patients (24.7%) who had moderate to severe hypocitraturia with or without hyperuricosuria and were recurrent stone formers but discontinued prophylaxis because of drug intolerance within 1 month of therapy. Control group 2 constituted 53 patients (21.5%) who were first-time stone formers and who had mild hypocitraturia with or without hyperuricosuria and were not put on prophylactic therapy and were followed for 3.16±0.08 years. Control group 3 constituted 133 patients (54.8%) who were recurrent stone formers who had moderate to severe hypocitraturia with or without hyperuricosuria and were put on prophylaxis therapy and were followed for 3.16±0.08 years. All patients were followed up at 6-month intervals. RESULTS: Potassium magnesium citrate prophylaxis produced a sustained increase in 24-hour urinary citrate excretion from initially low values (221.79±13.39 mg/dL) to within normal to high limits (604.04±5.00 mg/dL) at the 6-month follow-up. Urinary pH rose significantly from 5.62±0.2 to 6.87±0.01 and was maintained at 6.87±0.01. The stone recurrence rate declined from 3.23±1.04 per patient per year to 0.35±0.47 per patient per year. CONCLUSIONS: Potassium magnesium citrate prophylaxis was effective in reducing the recurrence of calcium oxalate and phosphate urolithiasis.

Prosthodontic treatment using vital and non vital submerged roots-two case reports.

Residual ridge resorption has been considered as an inevitable consequence after extraction of the teeth. There is a gradual loss of the alveolar bone due to the pattern of bone remodeling. In spite of the availability of newer treatment modalities like endodontic restoration and periodontic procedures for preservation of the remaining teeth they are not feasible for the patients in severe stages where restoration might not be possible. The only reliable method of preserving the remaining bone is by maintaining the functional health of the teeth. Over the years, many studies showed that roots which are fractured and left behind during extractions are retained into the alveolar bone with no evidence of pathosis. Over denture as a treatment option was developed in an effort to preserve the remaining alveolar bone by retaining the natural teeth or roots. In over denture treatment, the teeth selected as abutments are prone to caries and periodontal disease over a period of time, hence evolved the vital or non vital root submergence concept. After a thorough radiographic and clinical examination, few teeth without pathosis are retained that eventually are surgically submerged in the alveolar ridge. After healing, the over denture with reaining vital or non vital teeth preserve the integrity of the bone, making the treatment an effective and successfull preventive prosthodontic treatment.

Unusual penetrating injury to the male genitalia.

Various self-inflicted foreign bodies have been removed from the lower urinary tract and external male genitalia. In many cases foreign bodies were inserted or applied for autoerotic reasons which are frequently associated with mental health disorders. Here the author reports an unusual case of self insertion of a 6-cm long metal needle at penoscrotal junction of the erect penis for sexual pleasure. The stitching needle was inserted by a 20-year old male who was too ashamed to admit the motive at first. The caudal end of the needle was palpable at the root of the penis as it was below the urogenital diaphragm. The needle was successfully removed under fluoroscopic guidance with minor surgical exploration and with no complications.

CXCL13 activation of c-Myc induces RANK ligand expression in stromal/preosteoblast cells in the oral squamous cell carcinoma tumor-bone microenvironment.

CXC chemokine ligand-13 (CXCL13) has been implicated in oral squamous cell carcinoma (OSCC) tumor progression and osteolysis. The tumor necrosis factor family member RANKL (receptor activator of NF-κB ligand), a critical bone resorbing osteoclastogenic factor, has an important role in cancer invasion of bone/osteolysis. Here, we show high-level expression of CXCL13 in primary human OSCC tumor specimens; however, human bone marrow-derived stromal (SAKA-T) and murine preosteoblast (MC3T3-E1) cells produce at very low level. Recombinant CXCL13 (0-15 ng/ml) dose dependently induced CXCR5 expression in SAKA-T and MC3T3-E1 cells. Conditioned media obtained from OSCC cell lines increased the RANKL expression and an antibody against the CXCL13 specific receptor, CXCR5 markedly decreased RANKL expression in these cells. Furthermore, CXCL13 increased hRANKL-Luc promoter activity. Superarray screening identified c-Myc and NFATc3 transcription factors upregulated in CXCL13-stimulated SAKA-T cells. Immunohistochemical analysis of OSCC tumors that developed in athymic mice demonstrated RANKL and NFATc3 expression in tumor and osteoblast cells, however, showed p-c-Myc expression specific to osteoblastic cells at the tumor-bone interface. We further identified NFATc3 expression, but not c-Myc activation in primary human OSCC tumor specimens compared with adjacent normal tissue. Also, CXCL13 significantly increased p-ERK1/2 in SAKA-T and MC3T3-E1 cells. siRNA suppression of c-Myc expression markedly decreased CXCL13-induced RANKL and NFATc3 expression in preosteoblast cells. Chromatin-immuno precipitation assay confirmed p-c-Myc binding to the hRANKL promoter region. In summary, c-Myc activation through CXCL13-CXCR5 signaling axis stimulates RANKL expression in stromal/preosteoblast cells. Thus, our results implicate CXCL13 as a potential therapeutic target to prevent OSCC invasion of bone/osteolysis.

Atypical femoral shaft fracture in a patient with non-metastatic prostate cancer on zoledronic acid therapy: effect of therapy or coincidence?

There have been recent concerns of atypical non-spinal fractures in patients with osteoporosis who are on long-term bisphosphonate therapy. These fractures are less commonly reported in cancer patients on zoledronic acid therapy, where it is used in higher doses as compared to patients with osteoporosis. We report the case of a 70-year-old man with non-metastatic prostate cancer who was on androgen deprivation therapy following bilateral orchiectomy. He was on bone protection with intravenous zoledronic acid 4 mg monthly for a period of two years. He presented with spontaneous acute right mid-thigh pain. Radiograph of the right femur showed an atypical femoral shaft fracture, which was treated with intramedullary nailing and teriparatide. This case report raises concerns of atypical fractures in cancer patients who receive high doses of zoledronic acid. Patients receiving bisphosphonates who present with thigh or groin pain must undergo radiographic examination of the femur to rule out atypical femoral fractures.

Transgenic mice with OIP-1/hSca overexpression targeted to the osteoclast lineage develop an osteopetrosis bone phenotype.

Regulatory mechanisms operative in bone-resorbing osteoclasts are complex. We previously defined the Ly-6 gene family member OIP-1/hSca as an inhibitor of osteoclastogenesis in vitro; however, a role in skeletal development is unknown. In this study, we developed transgenic mice with OIP-1/hSca expression targeted to the osteoclast lineage that develop an osteopetrotic bone phenotype. Humeri from OIP-1 mice showed a significant increase in bone mineral density and bone mineral content. microCT analysis showed increased trabecular thickness and bone volume. OIP-1 mice have dense sclerotic cortical bone with absence of spongiosa and inadequate formation of marrow spaces compared to wild-type mice. Moreover, complete inhibition of osteoclasts and marrow cavities in calvaria suggests defective bone resorption in these mice. OIP-1 mouse bone marrow cultures demonstrated a significant decrease (41%) in osteoclast progenitors and inhibition (39%) of osteoclast differentiation/bone resorption. Western blot analysis further demonstrated suppression of TRAF-2, c-Fos, p-c-Jun, and NFATc1 levels in RANKL-stimulated osteoclast precursors derived from OIP-1 mice. Therefore, OIP-1 is an important physiological inhibitor of osteoclastogenesis and may have therapeutic value against bone loss in vivo.

Etiologic factors in Paget's disease of bone.

Paget's disease of bone is a chronic focal skeletal disorder characterized by increased bone resorption by the osteoclasts. Paramyxoviral gene products have been detected in pagetic osteoclasts. Paget's disease is an autosomal dominant trait with genetic heterogeneity. Several mutations in the ubiquitin-associated (UBA) domain of sequestosome 1 (SQSTM1/p62) have been identified in patients with Paget's disease. Similarly, mutations in the valosin-containing protein (VCP) gene have been shown to cause inclusion body myopathy associated with Paget's disease of bone and frontotemporal dementia. In addition, gene polymorphisms and enhanced levels of cytokine/growth factors associated with Paget's disease have been identified. However, the etiologic factors in Paget's disease remain elusive. A cause and effect relationship for the paramyxoviral infection and SQSTM1/ p62 gene mutations responsible for pagetic osteoclast development and disease severity are unclear. This article will highlight the etiologic factors involved in the pathogenesis of Paget's disease.

Management of temporo-mandibular joint ankylosis in growing children.

Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

Primary squamous cell carcinoma of the submandibular salivary gland.

Malignant tumors of the submandibular salivary glands are rare in occurrence, among which primary squamous cell carcinoma of the submandibular salivary gland is unusual and the documented evidence is 2 to 5% among malignant tumors A case of primary squamous cell carcinoma of submandibular salivary gland is being presented for its rarity.

Occurrence of Tobacco streak virus on Peanut (Arachis hypogaea) in India.

A virus disease of peanut (groundnut, Arachis hypogaea L.), characterized by necrosis of the stem and terminal leaflets followed by death, caused severe crop losses in Andhra Pradesh, India during the rainy season of the year 2000. The disease was referred to as peanut stem necrosis disease (PSND). Cowpea (Vigna unguiculata, cv. C-152) and Phaseolus vulgaris (cv. Topcrop) were found to be suitable for propagating the virus. In laboratory inoculation tests, the virus was found to infect a large number of plants. In laboratory tests, the virus was transmitted by the thrips Frankliniella schultzei. Virus particles were purified by differential centrifugation and sucrose density gradient centrifugation from infected cowpea plants and were used to elicit the production of a rabbit polyclonal antiserum with high titer. Extracts of infected plants reacted with antiserum to Tobacco streak virus (TSV). Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of proteins extracted from purified virus particles showed them to contain a major protein of 28 kDa and a minor, though prominent, protein of 57 kDa. Gel electrophoresis of RNA extracted from virus particles resolved it into four species with estimated sizes of 3.7, 3.1, 2.2, and 0.9 kb. Complementary DNA (cDNA) was made using as template a sample of the 2.2-kb RNA 3 and as primer an oligonucleotide complementary to sequence in RNA 3 of TSV. Following second strand synthesis, the cDNA was cloned in pBluescript and the nucleotide sequence was obtained for 868 nt of the cDNA. The sequence was 88.4% identical to the sequence in RNA 3 of TSV (strain WC). The results indicate that the causal agent of PSND is TSV. The same virus also was found to cause sunflower necrosis, an economically important disease in India. Studies on the epidemiology of PSND and the identification of virus-resistant peanut genotypes have been initiated to devise strategies to control PSND.