Advanced buffer materials for indoor air CO2 control in commercial buildings.

In this study, we evaluated solid sorbents for their ability to passively control indoor CO2 concentration in buildings or rooms with cyclic occupancy (eg, offices, bedrooms). Silica supported amines were identified as suitable candidates and systematically evaluated in the removal of CO2 from indoor air by equilibrium and dynamic techniques. In particular, sorbents with various amine loadings were synthesized using tetraethylenepentamine (TEPA), poly(ethyleneimine) (PEI) and a silane coupling agent 3-aminopropyltriethoxysilane (APS). TGA analysis indicates that TEPA impregnated silica not only displays a relatively high adsorption capacity when exposed to ppm level CO2 concentrations, but also is capable of desorbing the majority of CO2 by air flow (eg, by concentration gradient). In 10 L flow-through chamber experiments, TEPA-based sorbents reduced outlet CO2 by up to 5% at 50% RH and up to 93% of CO2 adsorbed over 8 hours was desorbed within 16 hours. In 8 m3 flow-through chamber experiments, 18 g of the sorbent powder spread over a 2 m2 area removed approximately 8% of CO2 injected. By extrapolating these results to real buildings, we estimate that meaningful reductions in the CO2 can be achieved, which may help reduce energy requirements for ventilation and/or improve air quality.

Etanercept decreases synovial expression of tumour necrosis factor-α and lymphotoxin-α in rheumatoid arthritis.

OBJECTIVES: Etanercept is an effective tumour necrosis factor (TNF)-α inhibitor drug with the unique ability to block not only TNF-α but also lymphotoxin (LT)-α, at least in vitro. We aimed to investigate the in vivo effect of etanercept on synovial expression of TNF-α and LT-α. METHOD: Synovial biopsies from 12 rheumatoid arthritis (RA) patients started on etanercept and 11 RA patients started on infliximab were obtained at baseline and 8 weeks after treatment initiation. Synovial expression of TNF-α and LT-α was evaluated by immunohistochemistry followed by computer-assisted image analysis. Differences between paired samples were analysed by the Wilcoxon test and between groups by the Mann-Whitney test. A p-value < 0.05 was considered statistically significant. RESULTS: Six out of the 12 of the patients started on etanercept achieved an American College of Rheumatology (ACR)50 response. Macroscopic evaluation of the joints during arthroscopy revealed a significant decrease of local inflammation mainly in good ACR50 responders. Synovial expression of both LT-α and TNF-α decreased but the differences did not reach statistical significance at a group level. By contrast, a significant decrease in both LT-α and TNF-α was observed when only good ACR50 responders were analysed. Despite higher levels of baseline synovial TNF-α in the good responders, neither baseline LT-α nor TNF-α could predict clinical response after 8 weeks. A decreasing trend of the synovial levels of LT-α was also observed in good responders to infliximab, but the difference did not reach statistical significance. CONCLUSIONS: Etanercept treatment modulates the synovial expression of both TNF-α and LT-α in vivo, a mechanism that might partly explain its clinical efficacy in RA.

Bone morphometry.

OBJECTIVES: To compare anatomical measurements with that of radiological measurements. BACKGROUND: The radiological measurements are commonly used in clinical practice. It is well known that the anatomical measurements are more accurate than radiological. The comparison of anatomicoradiological measurements is not reported hitherto. METHODS: One human adult cadaveric femur bone was used for the present study. It was measured both anatomically and radiologically. RESULTS: In digital X- ray measurements, the length from the upper lip of fovea capitis to the most prominent part of greater trochanter was 87.2 mms, from the upper most part of greater trochanter to the isthmus it was 147.9 mms, mediolateral width of medullary cavity at the isthmus was 8.9 mms, the mediolateral width at the distal root of lesser trochanter was 18.5 mms, anteroposterior width of medullary cavity at the isthmus was 11.5 mms, the anteroposterior width at the distal root of lesser trochanter was 16.8 mms. The same measurements were 91.2 mms, 154.6 mms, 11.8 mms, 19.7 mms, 11.9 mms and 18.5 mms when taken anatomically using the digital vernier caliper. CONCLUSION: The present study showed that in all the parameters measured the radiological values were slightly lesser than the anatomical values. Considering the variations in the values, the implants can be designed for a particular case in orthopedic surgery. We believe that this study adds an important reference in the scientific literature (Tab. 1, Fig. 2, Ref. 5).

Morphometric analysis of clavicle in nepalese population.

BACKGROUND: Determining the sex of deceased is easy when a complete skeleton is available for examination. On the whole, the bones are heavier, larger and markings of muscular attachments are more pronounced in the male than in the female. OBJECTIVE: The purpose of this study was attempted to evolve an easily applied formula to enable the assessment of sex in an unknown clavicles and to know about comparative differences between the right and left clavicles, from certain metrical parameters. METHODS: The study was an observational, cross-sectional and descriptive in nature. The present study was conducted on 257 adult clavicles out of which, 135 were of the right side and 122 of left side. The maximum length of the clavicle (in mm) was taken. RESULTS: The length of the right clavicles varies from 108 mm to 178 mm with an average of 143.21 mm ± 11.13 mm S.D. The length of the left clavicles varies from 111 mm to 181 mm with an average 145.53 mm ± 11.04 mm S.D. It has been observed that the left clavicle was longer than the right clavicle by 2.32 mm. There was no such single character which can determine the sex of all clavicles. Depending on the length alone, the sex can be decided in 13.33% male and 4.44% female right clavicles and 16.39% male and 9.83% female bones if the left clavicle is considered. CONCLUSION: The left clavicle was longer than the right clavicle. The determination of sex from the clavicle has a great medico legal significance to the toxicologists. It also helps the anthropologists in their study of evolution of mankind and migration of races.

Morphology of the medial meniscus of the knee in human fetuses.

OBJECTIVES: The objectives were to study the morphology of the medial menisci in human fetal knee joints and to verify the developmental etiology of the discoid meniscus. MATERIAL AND METHODS: The study was carried out on 106 fetal knee joints and the morphological variants of the shapes of the medial menisci were macroscopically noted and classified. RESULTS: From our observations, 46.2% of the medial menisci were crescentic shaped, 23.6% were sided V-shaped, 13.2% had sided U-shape, 9.4% of them were sickle shaped, and 7.5% were C-shaped. In 54.71% of the cases, the medial meniscus shape was different on either side knees of the fetuses. No discoid medial menisci were seen. CONCLUSIONS: The majority of the knees were having crescentic or semi lunar shaped medial menisci and the shape of the medial meniscus was different on right and left side knee joint of the fetuses in more than fifty percent of the cases. The observations favor Kaplan's theory, as there were no discoid medial menisci observed from the fetuses of various gestational ages. Even the youngest fetus (CRL 88 mm, 14 weeks of gestation) exhibited the medial tibial plateau incompletely covered by the menisci, which did not exhibit the discoid shape. The discoid meniscus must be an abnormal finding and is due to abnormal morphogenesis.

An anomalous belly of sternothyroid muscle and its significance.

The sternothyroid muscle and other infrahyoid muscles play a vital role in the process of vocalization, swallowing and mastication by mobilizing the hyoid bone and thyroid cartilage. During routine dissection of a 70-year-old male cadaver, we observed an anomalous sternothyroid muscle. It was arising from the posterior surface of the manubrium sterni and partly from the cartilage of the first rib. After a distance of 3.3 cm, the belly of sternothyroid muscle was divided into lateral and medial fibers. The lateral belly was inserted above the oblique line on the lamina of the thyroid cartilage, but the medial additional belly turned into a tendon, which was crossing over the thyroid artery and inserted to the hyoid bone and intermediate tendon of digastric muscles. The superior thyroid artery was below the above tendon on its way to the thyroid gland. The muscle was innervated by a branch from the ansa cervicalis.

Duplication of falx cerebelli, occipital sinus, and internal occipital crest.

The incidence of variations of falx cerebelli was studied in 52 adult cadavers of south Indian origin, at Kasturba Medical College Mangalore, after removal of calvaria. In eight (15.4%) cases, we observed duplicated falx cerebelli along with duplicated occipital sinus and internal occipital crest. The length and the distance between each of the falces were measured. The mean length of the right falces cerebelli was 38 mm and the left was 41 mm. The mean distance between these two falces was 20 mm. No marginal sinus was detected. Each of the falces cerebelli had distinct base and apex and possessed a distinct occipital venous sinus on each attached border. These sinuses were noted to drain into the left and right transverse sinus respectively. After detaching the dura mater from inner bony surface of the occipital bone, it was noted that there were two distinct internal occipital crests arising and diverging inferiorly near the posterolateral borders of foramen magnum. The brain from these cadavers appeared grossly normal with no defect of the vermis. Neurosurgeons and neuroradiologists should be aware of such variations, as these could be potential sources of hemorrhage during suboccipital approaches or may lead to erroneous interpretations of imaging of the posterior cranial fossa.

The palmaris longus muscle: its anatomic variations and functional morphology.

The functional morphology and evolution of the superficial forearm flexor, the palmaris longus, have long fascinated kinesiologists, physical anthropologists and anatomists alike. The anomalies, agenesis, variations and polymorphic presentation of the muscle, coupled with its biomechanical role in the performance of flexion and supination through distal articulations in the upper limb, have formed the base for many studies found in medical literature. We present data from published sources, along with our observations on the kinetics of palmaris longus, drawn from a series of dissections done on 30 cadavers. Complete agenesis was seen in four limbs. Reversal in the muscle-tendon orientation was seen in two limbs and duplication in one limb. The functional dynamics of the muscle and the clinical implication of its modifications in humans are discussed. We believe that every surgeon must be aware of the variations, since this, otherwise unimportant muscle, provides a very useful graft in tendon surgery.

Additional branches of celiac trunk and its clinical significance.

The anatomical variations of the abdominal arteries are important due to its clinical significance. Various types of vascular anomalies are frequently found in human abdominal viscera, during cadaveric dissection and diagnostic radiological imaging. The present report describes a variation in the celiac trunk as found during routine dissection in a 59-year-old male cadaver. The celiac trunk (CT) was unusually lengthy and took origin from the left antero-lateral surface of the abdominal aorta. Altogether, there were five branches, including three classic branches of CT. The left phrenic artery (LPA) was the first branch of the CT. The remaining four branches were left gastric artery (LGA), splenic artery (SA), common hepatic artery (CHA) and gastroduodenal artery (GDA). There was an arterial loop between the posterior branches of the superior pancreatico-duodenal artery (SPDA), arising from the GDA, and the posterior branch of the inferior pancreatico-duodenal artery (IPDA), arising from the superior mesenteric artery (SMA). The arterial loop formed by the above arteries, supplied the head of the pancreas and duodeno-jejunal flexure. The embryological and clinical significance of above variations has been described.

Multiple muscular anomalies of upper extremity: a cadaveric study.

During routine cadaveric dissection, we encountered multiple muscular anomalies in a 58-year-old embalmed male cadaver. All the variations were encountered on the flexor compartment of right upper limb. The anomalies include an axillary arch (Aa) in the axilla, a third head of biceps brachii (Thb) in the arm, a reverse palmaris longus (Rpl) and a Gantzer's muscle (Gm) in the forearm and an unusually large palmaris brevis muscle (Pbm) in the palm. Anatomical description is achieved by measuring the length, width and attachments of the above-mentioned variants. The morphological and clinical significance of the anomalous muscles are discussed.

Morphometry of posterior cerebral artery: embryological and clinical significance.

Posterior cerebral artery, terminal branch of basilar artery joins the posterior communicating artery to help complete the circulus arteriosus cerebri in human beings. A study of 89 formalin-fixed brain specimen of either sex and of Indian origin has showed that the mean length and diameter of the posterior cerebral artery was 6.75 +/- 1.482 mm and 1.7 +/- 0.7 mm respectively. Anomalous origin of the posterior cerebral artery was the only variation found during the present study. The incidence of occurrence of the particular variant was 2.2%. The variation did not have any sex or side predilection.

Multiple variations of the extensor tendons of the forearm.

Anatomic variations of the extensor tendons of the forearm are frequent and its knowledge is important to assess the diseased and traumatized hand. During routine cadaveric dissection in the Department of Anatomy, Kasturba Medical College, Mangalore, India, we came across unusual variations in the left upper limb of a 51-years-old male cadaver. The variants are, the complete absence of the extensor pollicis brevis (EPB), the abductor pollicis longus (APL) having six slips of insertion with additional muscle slip from the brachio-radialis (BR). The extensor digitorum communis (EDC) had five tendon slips, the extra tendon splits close to the metacarpo-phalangeal (MP) joint and contribute to the tendons of the ring and little fingers. The number of accessory tendons of APL has functional significance in the development of de Quervain's stenosing tendovaginitis. The present case is unique in the sense that, all the three variations are present in the ipsilateral upper limb. The occurrence of these anomalies and its clinical and embryological significance are discussed.

Clinical significance of a mysterious clival canal.

During routine osteology demonstration of the posterior cranial fossa we noticed a transverse bony canal in the middle third of the clivus of an adult male skull. The canal was situated 1.8 cm in front the anterior border of the foramen magnum. The length of the canal was 0.6 cm long. The possible embryological basis and clinical significance of the variation was discussed.

Multiple anomalies involving testicular and suprarenal arteries: embryological basis and clinical significance.

Variations in the origin of arteries in the abdomen are very common but with the invention of new operative techniques within the abdominal cavity, the anatomy of abdominal vessels has assumed much more clinical importance. During routine dissection of the abdominal cavity, we came across multiple arterial anomalies involving testicular and suprarenal arteries. On the right side, there was double testicular artery (medial and lateral) and the right inferior suprarenal artery aroused from the medial testicular artery. The right inferior phrenic artery (IPA) and middle suprarenal artery took origin from a common trunk just above the origin of right renal artery (RRA). On the left side, the left testicular artery was arching over the lower tributary of the left renal vein proper (LRVP). Apart from the developmental and morphological interest in arching gonadal arteries, they are of practical importance from a clinical and surgical viewpoint. The embryological and clinical significance of above variations has been described.

Anomalous channels draining the internal iliac veins: embryological and clinical significance.

During a routine cadaver dissection, we have encountered an anomalous formation of inferior vena cava and abnormal channels communicating the two internal iliac veins with the inferior vena cava in a 67 year old male cadaver. The said channels which had a caliber of 5 mm on the left side and 15 mm on the right arose at a distance of 26 mm on the left and 35 mm on the right from the internal iliac vein termination. Both the said channels moved medially and joined one another and formed a common stem (Cs) which finally terminated at the junction of the termination of right iliac vein into the inferior vena cava. The lumen of the terminal part had a diameter of 18 mm and it was 20 mm in length. Anomalies of the inferior vena cava and renal veins occur infrequently but if unidentified can lead to significant morbidity during surgical exploration. An understanding of the embryologic development of the vena cava and its tributaries is necessary to understand the genesis of these sometimes complex anomalies and their accompanying anatomic variants.

Arcuate foramen of atlas: incidence, phylogenetic and clinical significance.

Arcuate foramen is less known trait of the human atlas vertebra formed by a delicate bony spiculum, which arches backward from the posterior end of the superior articular process. Examination of 1044 human atlas vertebra revealed that the trait was present in 13.8% of the samples. The mean length of the arcuate foramen form was 7.16 mm on the left side and 9.99 mm on the right side in bilateral positive samples while it was 8.14 mm and 9.26 mm respectively in unilateral positive samples. The mean vertical height of this foramen was 6.57 mm on the left side and 6.52 mm on the right side in bilateral positive samples while it was 4.91 mm and 5.38 mm respectively in unilateral positive samples. The sides did not show any statistical significant differences. The importance of the arcuate foramen lies in the external pressure it may cause on the vertebral artery as it passes from the foramen transversarium of the first cervical vertebra to the foramen magnum of the skull.

Population distance between Dakshina Kannada (South India) and Gujarati (North India) population using infracranial nonmetric traits.

Infracranial nonmetric variations have been considered for determining population distance between different regions and continents, in recent times. We studied different infracranial nonmetric traits from the Dakshina Kannada (South India) region to compare with the data available from the Gujarati (North India) region. The mean measure of divergence between the two different geographic regions showed significant variation. In our study, the incidence like i) Allen's fossa of the femur, ii) plaque formation in the upper end of the femur, iii) exostosis in trochanteric fosse of femur, iv) third trochanter of femur, v) os trigonum of talus, vi) medial talar facet, vii) peroneal tubercle of calcaneus, viii) bipartite transverse foramen in the cervical vertebra, too showed significant side difference.

Atezolizumab: A novel PD-L1 inhibitor in cancer therapy with a focus in bladder and non-small cell lung cancers.

In recent years, immunotherapy has come to the forefront as a major development in cancer treatment. Evasion of the immune system by tumor cells has been identified as one of the hallmarks of cancer and multiple therapies have been developed to counter this process. Programmed cell death 1 ligand 1 (PD-L1), a ligand to programmed cell death protein 1 (PD-1), is expressed by many cancer cells and the binding of PD-L1 to PD-1 results in the suppression of T-cell-mediated immune response against cancer cells. Atezolizumab is a monoclonal antibody that binds to PD-L1 and blocks its interaction with PD-1, thereby enhancing T-cell activity against tumor cells. Atezolizumab has been shown to be well tolerated with no dose-limiting toxicities in phase I trials. Atezolizumab was approved by the U.S. Food and Drug Administration in 2016 for the treatment of platinum-resistant metastatic non-small cell lung cancer (NSCLC) and urothelial cancer based on phase II and preliminary phase III studies that have shown significant improvement in objective response rate and median overall survival. There are 117 ongoing clinical trials of atezolizumab currently. Given its efficacy in NSCLC and urothelial carcinoma, atezolizumab holds much potential in the future of cancer therapeutics.

The increasing challenge of never smokers with adenocarcinoma lung: Need to look beyond tobacco exposure.

BACKGROUND: Lung cancer continues to remain as one of the leading causes of morbidity and mortality worldwide, despite the decreasing trends in smoking prevalence worldwide. An earlier study from the authors' institute reported the increasing trends of "Nonsmoking associated lung cancers." MATERIALS AND METHODS: All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014-October 2015) were included in this current prospective study. RESULTS: Seven hundred and thirteen patients presented with clinicoradiologically suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients, and this cohort was further analyzed. The mean age of presentation was 57.76 years; the male to female ratio was approximately 2.5:1. Interestingly, 55.35% of the patients were nonsmokers. Adenocarcinoma (63%) was the predominant histology. Never smokers, both among men (P = 0.02) and women (P = 0.001), presented more frequently with adenocarcinoma histology. Further, 84.9% (45/53) of rural and 76.1% (19/25) of urban women who were never smokers reported exposure to indoor air pollution (secondhand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology. CONCLUSION: Our study confirmed our initial observation of the changing epidemiology of lung cancer in the Indian subcontinent, paralleling the global trends of rise in adenocarcinoma. Lung cancer in never smokers outnumbering that among smokers was another interesting observation. The take-home message for both the clinicians as well as the policymakers is to study factors beyond tobacco exposure to understand the direction of the current lung cancer epidemic.

Chemotherapy delivery for resected colorectal cancer liver metastases: Management and outcomes in routine clinical practice.

BACKGROUND: International guidelines recommend peri-operative chemotherapy for patients with resectable colorectal cancer liver metastases (CRCLM). Chemotherapy delivery in routine practice is not well described. METHODS: All cases of CRC who underwent resection of LM in 2002-2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified chemotherapy delivered within 16 weeks before or after hepatectomy. All pathology reports were reviewed to describe extent of LM. Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional hazards model and propensity score analysis were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall (OS) survival. RESULTS: We identified 1310 patients. Sixty-two percent of cases (815/1310) received peri-operative chemotherapy; 25% (200/815) pre-operative, 45% (366/815) post-operative, and 31% (249/815) pre- and post-operative. Utilization of chemotherapy increased over time from 51% in 2002 (57/112) to 73% in 2009 (157/216, p < 0.001). Fifty-four percent of patients received FOLFOX, 41% FOLFIRI, and 10% 5-FU monotherapy. Factors that were independently associated with greater utilization of post-operative chemotherapy included younger age (p < 0.001), female sex (p = 0.050), shorter disease-free interval (p = 0.006), and no prior adjuvant chemotherapy (p < 0.001). Utilization of chemotherapy varied substantially across geographic regions (from 24% to 71%, p = 0.001). Post-operative chemotherapy was associated with improved CSS (HR 0.58, 95%CI 0.44-0.76) and OS (HR 0.49, 95%CI 0.38-0.61); results were consistent in propensity score analysis. CONCLUSION: Utilization of chemotherapy for resected CRCLM in routine practice has evolved with emerging evidence. Post-operative chemotherapy is associated with improved survival in the general population.