Can ARFI elastography be used to differentiate parathyroid from thyroid lesions?

OBJECTIVES: To assess if elasticity score (ES) and shear wave velocity (SWV) measurement obtained using ARFI elastography can differentiate between parathyroid lesions and thyroid nodules. MATERIALS AND METHODS: ARFI elastography was performed on patients with primary hyperparathyroidism or solid thyroid nodules who were being considered for surgery using virtual touch quantification and virtual touch imaging (VTI) software. Only patients with surgical histopathology (47 parathyroid lesions, 38 benign thyroid nodules and 55 malignant thyroid nodules) were included for final analysis. SWV and ES of the parathyroid and thyroid nodules were compared and their ability to differentiate between parathyroid and thyroid was analyzed using receiver operating characteristic curve analysis. RESULTS: There were 39 solitary adenomas, 2 double adenomas and 4 parathyroid hyperplasias with mean size of 19.6 ± 9.7 mm in 44 patients (21 male, 23 females) with primary hyperparathyroidism. The mean SWV of the parathyroid lesion (1.6 ± 0.78 m/s) was significantly different from benign (2.11 ± 0.8 m/s) and malignant (4.3 ± 2.71 m/s) thyroid nodules, p < 0.05; so was the ES, Chi square = 51.6, p < 0.001. The majority of parathyroid lesions (n = 37, 78.7%) had ES of 2 with speckled (n = 42, 89.3%) appearance, and none showed ES of 4. The diagnostic performance of speckled appearance on VTI, elasticity score and SWV measurements was 0.901, 0.724 and 0.797, respectively, to differentiate between parathyroid and thyroid lesions. CONCLUSIONS: Parathyroid lesions are softer than thyroid nodules. A shear wave velocity of 1.72 m/s can differentiate between parathyroid lesions and thyroid nodules.

"PAUSE": a method for communicating radiological extent of peritoneal malignancy.

Radiology reports of diffuse peritoneal disease should address key findings pertinent to the management of these patients. The reporting of radiology findings in patients with peritoneal malignancy is currently variable and poorly standardised. Using the acronym "PAUSE" we emphasise the key imaging features that a radiology report should include in a patient with peritoneal malignancy, focussing on the key elements determining feasibility and likely prognosis of surgery and potential benefits from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The term "PAUSE" incorporates the following: P, primary tumour and peritoneal carcinomatosis index (PCI) as estimated by imaging; A, ascites and abdominal wall involvement; U, unfavourable sites of involvement; S, small bowel and mesenteric disease; E, extra peritoneal metastases. Thus, "PAUSE" has the potential to standardise radiology reporting in this field.

Deterioration of coastal groundwater quality in Island and mainland regions of Ramanathapuram District, Southern India.

A study was carried out in the Island and mainland regions of Ramanathapuram District to characterize the physico-chemical characteristics of 87 groundwater samples in Island and 112 groundwater samples in mainland which include pH, EC, TDS, salinity, total alkalinity, calcium hardness, magnesium hardness, total hardness, chloride and fluoride. Heavy inorganic load in majority of the groundwater samples has been estimated due to the salinity, TDS, TH and chloride beyond the threshold level which substantiates the percolation of sea water into the freshwater confined zones. Although the groundwater sources are available in plenty, the scarcity of potable water is most prevalent in this coastal area. The Water Quality Index (WQI) and Langeleir Saturation Index (LSI) have also been calculated to know the potable and corrosive/incrusting nature of the water samples. The statistical tools such as principal component analysis, box plots and correlation matrix have also been used to explain the influence of different physico-chemical parameters with respect to one another among the groundwater samples. The percentage of groundwater samples in mainland was more than that in Island with respect to the acceptable limit of WHO drinking standard, especially in TDS, CH, TH and chloride but the converse is observed in the case of fluoride. About 8% of the mainland aquifers and 42% of Island aquifers were identified to have fluoride greater than 1.5 mg/l. The signature of salt-water intrusion is observed from the ratio of Cl/CO(3)(2-) + HCO(3) and TA/TH. A proper management plan to cater potable water to the immediate needs of the people is to be envisaged.

Cases of human fascioliasis in India: tip of the iceberg.

This report presents two cases of human fascioliasis from different states in India. Although only few cases of human fascioliasis have been reported from India previously, both these cases were encountered within a span of three months at this tertiary care centre. Case 1 had significant symptoms with episodes of fever, abdominal pain and eosiniphilia and underwent multiple diagnostic procedures before the correct diagnosis was reached. Case 2, who had few symptoms, had fascioliasis diagnosed with minimal evaluation. These different presentations seen at two ends of the clinical spectrum of disease along with findings of peripheral eosinophilia, and radiological findings led to a presumptive diagnosis that was then confirmed by microscopic examination of bile. Morphometric analysis of ova from these cases was suggestive of infestation with F. gigantica or a F. gigantica-like hybrid. Both patients were treated with triclabendazole which was imported from Geneva. The need to be aware of the possibility of occurrence of this disease and the inclusion of drugs used for treating the disease, in the Indian drug list, should be emphasized.

Synthesis and characterization of 4-Halobenzylidene malanonitriles for optical detection of Nickel (II) ions in aqueous solution.

In this work, we have developed fluorescent detection techniques for the determination of Ni2+ ions in aqueous medium with sensitivity using metal coordinating fluorescent molecules namely 4-Halobenzylidene malanonitrile. The halogen substituted benzylidene malanonitile were synthesised Knoevenagel condensation reaction of various halogen substituted aromatic aldehydes with malanonitrile and products were characterised by IR and NMR spectroscopy. The obtained benzylidene malanonitiles and are exhibited a fluorescent emission with a peak of 430 nm, 440 nm and 448 nm for chloro, bromo and fluoro substituted compounds, respectively. The intensity of optical emission of the studied molecules is increased proportional to the addition of Ni2+ ions. The effect of different halogen substitution on the fluorescence behaviour of benylidene malononitrile has also been investigated. The synthesised title compounds showed a lowest detection limit of 10-20 M for the Nickel (II) ions in aqueous solution under UV-Vis absorption spectra. The molecule 4- Bromobenzylidene malanonitrile exhibited a lowest detection limit of 10-19 M for the Nickel (II) ions in, aqueous solution, photoluminescence analysis.

PbS/graphene hybrid nanostructures coated glassy carbon electrode for the electrochemical sensing of copper ions in aqueous solution.

In this research, we have studied the electrochemical sensing of Cu(II) ions in aqueous solution using PbS/Graphene composite nanostructure coated glassy carbon electrode (GCE). The SEM-EDAX analysis revealed that the lead sulphide nanocrystals are homogeneously embedded on the graphene nanosheets with an uniform particle size of 100 nm, and the elements presents 92.32% and Lead content of 5.45% and Sulfur content of 0.91%. Raman spectra exhibits G with respect to the E2g sp2 hybridized C-C and D band with respect to the A1g mode in the disordered edge region of the GNS. The composite nanostructure coated GCE (PbS/Graphene/GCE) was prepared and its performance in the existence of metal ions such us Cd(II),Pb(II), Mg(II), Cu(II) and Ni(II) was studied using the current voltage curves in double distilled water within the scan rates of 25 to 300mVs-1. The PbS/Graphene coated carbon electrode exhibited the higher anodic and cathodic peak current for copper solution than the other metal ions studied, which various linearly proportional to concentration. The electrochemical sensing characteristics PbS/GNS/GCE was found to be significant towards detecting Cu2+ ion within the concentration range of 1 × 10-4 to 1 × 10-8 M, with a lowest sensing detection limit of 1 × 10-8 M.

2-(6-Methyl-2,3,4,9-tetra-hydro-1H-carbazol-1-yl-idene)propane-dinitrile.

In the title compound, C(16)H(13)N(3), the cyclo-hexene ring adopts a sofa conformation. An intra-molecular N-H⋯N hydrogen bond generates an S(7) ring motif. In the crystal, the mol-ecules are linked by pairs of N-H⋯N inter-actions, forming centrosymmetric dimers with an R(2) (2)(14) motif.

Imaging features of Robert's uterus: Case series of a rare Mullerian duct anomaly.

The diagnosis of Mullerian duct anomaly is crucial because of strong association with infertility, endometriosis and miscarriage. Robert's uterus is a rare variant of septate uterus. Patients present with recurrent abdominal pain and severe dysmenorrhoea. Magnetic resonance imaging is the investigation of choice. In this case series, we present the imaging features of four such cases.

4-Amino-pyridinium picrate.

In the title compound, C(5)H(7)N(2) (+)·C(6)H(2)N(3)O(7) (-), the 4-amino-pyridinium cation is essentially planar (r.m.s. deviation = 0.002 Å). The three nitro groups in the picrate anion are twisted away from the attached benzene ring [dihedral angles = 24.1 (1), 9.3 (3) and 21.4 (1)°]. In the crystal structure, the ions are linked into a three-dimensional network by N-H⋯O and C-H⋯O hydrogen bonds.

4-tert-Butyl-pyridinium picrate.

In the title compound, C(9)H(14)N(+)·C(6)H(2)N(3)O(7) (-), the three nitro groups of the picrate anion are twisted out of the plane of the attached benzene ring; the dihedral angles are 32.8 (2), 10.5 (4) and 12.3 (4)°. The pyridinium cations and picrate anions are linked via bifurcated N-H⋯(O,O) hydrogen bonds. The ionic pairs are linked into a ribbon-like structure along [101] by C-H⋯O hydrogen bonds.

2-(1,2,3,4-Tetra-hydro-9H-carbazol-1-yl-idene)propane-dinitrile.

In the title compound, C(15)H(11)N(3), the cyclo-hexene ring adopts a sofa conformation. An intra-molecular N-H⋯N hydrogen bond generates an S(7) ring motif. In the crystal, mol-ecules are linked by inter-molecular N-H⋯N, C-H⋯N and C-H⋯π inter-actions into a three-dimensional network.

Solid waste, its health impairments and role of rag pickers in Tiruchirappalli city, Tamil Nadu, Southern India.

In India, the significant increase in the generation of municipal solid waste (MSW) during the last few decades is due to the rapid population and economic development. Though the appropriate attempts are made through the 3-'R' principles, waste management still needs to be envisaged seriously by everybody for a cleaner and greener environment. Rag-pickers, who contribute to solid waste management to some extent, are the people who rummage through garbage bins to pick out 'rags' for their livelihood. These rag-pickers usually collect the materials that have good re-sale value as these materials are mostly recycled or reused. In the present study, the collection and the management of solid waste and the level of microbial pollution generated through air, soil and solid waste were studied. A questionnaire survey based on age, sex, educational status, socio-economic status, habits and health effects was conducted from 65 randomly selected rag-pickers from various places of Tiruchirappalli city The results revealed that they can be properly educated and trained to protect themselves from unhygienic practices and addiction. Either the Government or non-governmental organizations (NGOs) should devise a suitable proposal to monitor and make use of these unorganized rag-pickers who are indispensable to the society.

Outcomes of patients with metastatic clear-cell renal cell carcinoma treated with second-line VEGFR-TKI after first-line immune checkpoint inhibitors.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are being increasingly utilised in the front-line (1L) setting of metastatic clear-cell renal cell carcinoma (mccRCC). Limited data exist on responses and survival on second-line (2L) vascular endothelial growth factor-receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy after 1L ICI therapy. PATIENTS AND METHODS: This is a retrospective study of mccRCC patients treated with 2L VEGFR-TKI after progressive disease (PD) with 1L ICI. Patients were treated at MD Anderson Cancer Center or Memorial Sloan Kettering Cancer Center between December 2015 and February 2018. Objective response was assessed by blinded radiologists' review using Response Evaluation Criteria in Solid Tumours v1.1. Descriptive statistics and Kaplan-Meier method were used. RESULTS: Seventy patients were included in the analysis. Median age at mccRCC diagnosis was 59 years; 8 patients (11%) had international metastatic database consortium favourable-risk disease, 48 (69%) had intermediate-risk disease and 14 (20%) had poor-risk disease. As 1L therapy, 12 patients (17%) received anti-programmed death ligand-1 (PD-(L)1) monotherapy with nivolumab or atezolizumab, 33 (47%) received nivolumab plus ipilimumab and 25 (36%) received combination anti-PD-(L)1 plus bevacizumab. 2L TKI therapies included pazopanib, sunitinib, axitinib and cabozantinib. On 2L TKI therapy, one patient (1.5%) achieved a complete response, 27 patients (39.7%) a partial response and 36 patients (52.9%) stable disease. Median progression-free survival (mPFS) was 13.2 months (95% confidence interval: 10.1, NA). Forty-five percent of subjects required a dose reduction, and twenty-seven percent of patients discontinued treatment because of toxicity. CONCLUSIONS: In this retrospective study of patients with mccRCC receiving 2L TKI monotherapy after 1L ICI, we observed 2L antitumour activity and tolerance comparable to historical data for 1L TKI.

Synthesis, crystal growth, structural, thermal and optical properties of naphthalene picrate an organic NLO material.

Crystalline substance of naphthalene picrate (NP) was synthesized and single crystals were grown using slow evaporation solution growth technique. The solubility of the naphthalene picrate complex was estimated using different solvents such as chloroform and benzene. The material was characterized by elemental analysis, powder X-ray diffraction (XRD), nuclear magnetic resonance (NMR) and fourier transform-infrared (FT-IR) techniques. The electronic absorption was studied through UV-vis spectrophotometer. Thermal behavior and stability of the crystal were studied using thermogravimetric (TG) and differential thermal analysis (DTA) techniques. The second harmonic generation (SHG) of the material was confirmed using Nd:YAG laser.

Hydrogen bonded charge transfer molecular salt (4-chloro anilinium-3-nitrophthalate) for photophysical and pharmacological applications.

Radical scavenging activity against DPPH radical and binding properties of a hydrogen bonded charge transfer molecular salt 4-chloro anilinium-3-nitrophthalate(CANP) with calf thymus DNA has been studied by electronic absorption and emission spectroscopy. The molecular structure and crystallinity of the CANP salt have been established by carried out powder and single crystal X-ray diffraction analysis which indicated that cation and anion are linked through strong N+H…O- type of hydrogen bond. FTIR spectroscopic study was carried out to know the various functional groups present in the crystal. 1H and 13C NMR spectra were recorded to further confirm the molecular structure of the salt crystal. The thermal stability of the title salt was established by TG/DTA analyses simultaneously on the powdered sample of the title crystal. Further, the CANP salt was examined against various bacteria and fungi strains which showed a remarkable antimicrobial activity compared to that of the standards Ciproflaxin and Clotrimazole. The results showed that the CANP salt could interact with CT-DNA through intercalation. Antioxidant studies of the substrates alone and synthesized CANP salt showed that the latter has been better radical scavenging activity than that of the former against DPPH radical. The third order nonlinear susceptibility of the CANP salt was established by the Z-scan study.

Comparative effectiveness of venous thromboembolism prophylaxis options for the patient undergoing total hip and knee replacement: a network meta-analysis.

Essentials Despite trial data, guidelines have not endorsed direct oral Xa inhibitors above other options. We provide profiles of venous thromboembolism and hemorrhage risk for 12 options. Direct oral Xa inhibitors had a favorable profile compared with low-molecular-weight heparin. Other options did not have favorable profiles compared with low-molecular-weight heparin. SUMMARY: Background There are numerous trials and several meta-analyses comparing venous thromboembolism (VTE) prophylaxis options after total hip and knee replacement (THR and TKR). None have included simultaneous comparison of new with older options. Objective To measure simultaneously the relative risk of VTE and hemorrhage for 12 prophylaxis options. Methods We abstracted VTE and hemorrhage information from randomized controlled trials published between January 1990 and June 2016 comparing 12 prophylaxis options. We then constructed networks to compute the relative risk for each option, relative to once-daily dosing with low-molecular-weight heparin (LMWH) Low. Results Main: Relative to LMWH Low, direct oral Xa inhibitors had the lowest risk of total deep vein thrombosis (DVT)-asymptomatic and symptomatic- (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.35-0.57), translating to 53-139 fewer DVTs per 1000 patients. Vitamin K antagonists (VKAs) titrated to International Normalized Ratio [INR] 2-3 predicted 56% more DVT events (OR, 1.56; 95% CI, 1.14-2.14). Aspirin performed similarly (OR, 0.80; 95% CI, 0.34-1.86), although small numbers prohibit firm conclusions. Direct oral Xa inhibitors did not lead to significantly more bleeding (OR, 1.21; 95% CI, 0.79-1.90). Secondary: Relative to LMWH Low, direct oral Xa inhibitors prevented 4-fold more symptomatic DVTs (OR, 0.25; 95% CI, 0.13-0.47). Conclusions Relative to LMWH Low, direct oral Xa inhibitors had a more favorable profile of VTE and hemorrhage risk, whereas VKAs had a less favorable profile. The profile of other agents was not more or less favorable. Clinicians should consider these profiles when selecting prophylaxis options.

Pharmacological investigation of 2-aminobenzothiazolium-4-methylbenzenesulphonate: Synthesis, spectral characterization and structural elucidation.

An organic charge transfer complex, 2-aminobenzothiazolium-4-methylbenzenesulphonate (ABPTS) was synthesized and single crystals grown by slow solvent evaporation solution growth technique at ambient temperature. The single crystal X-ray diffraction analysis was carried out to establish the molecular structure of the title crystal. FT-IR spectral study was carried out to identify the various functional groups present in the crystal. The (1)H and (13)C spectra were recorded to further confirm the molecular structure of the CT complex. The TG/DTA analyses were carried out to establish the thermal stability of the complex. The antibacterial and antifungal activities of synthesized complex were examined against various bacteria and fungi strains, to identify the antibacterial and antifungal activity. The DNA binding profile of the complex has been investigated through absorption spectroscopy and complex has intrinsic binding constant 3.6 × 10(4) M(-1). A gel electrophoresis assay demonstrated the ability of the complex to cleave the pBR322 DNA. The free radical scavenging activity of the complex has been determined against DPPH, OH and ABTS radicals.

Retropharyngeal haematoma causing airway obstruction: a multidisciplinary challenge.

A case of post-traumatic retropharyngeal haematoma causing airway obstruction in an elderly man on anticoagulant therapy is described. The importance of managing the airway, cervical spine and haemostatic problem with the help of a multidisciplinary team is discussed.

Differences in active avoidance behaviour of hypoactive and hyperactive rats subjected to immobilisation stress.

Open field activity was studied in Wistar rats. Animals with low scores of ambulatory and rearing behaviours were grouped as hypoactive and those with high scores as hyperactive. Acquisition of active avoidance learning in a shuttle box was studied in the two groups. Hyperactive rats in contrast to hypoactive rats showed a better acquisition of avoidance learning. Learning was suppressed in both groups by domperidone, but was facilitated by immobilisation stress in the hypoactive group only. The two groups did not differ in the basal and stress evoked heart rates. These observations suggest that immobilisation stress favours enhancement of the dopaminergic related behaviour like avoidance learning in hypoactive rats.

Rapid Dot enzyme immuno assay for the quantitation of rabies antibodies.

A rapid dot enzyme immuno assay (Dot ELISA) for rabies antibody estimation has been standardized in which nitrocellulose sheet has been used as a solid support absorbing a commercial tissue culture rabies vaccine as antigen. The test was compared with a standard plate ELISA test. The results were comparable and the student "t' test for proportion revealed that plate ELISA test is significantly better (P 0.05) when compared to Dot ELISA for the number of sera with titre < 0.5 Iu/ml and in the case of > 0.5 IU/ml Dot ELISA is found to be better over plate ELISA test at the same significance level.