Effect of a Customized Panchakarma (bio-purificatory) Treatment Plan in a Case of Urethral Stricture with Cystitis: A Case Report.

Objectives: Cystitis, inflammation of the bladder due to urinary tract infection, and Urethral stricture, narrowing of the urethra that obstructs the urine flow are conditions often aligned with the Ayurvedic concept of Mutraghata (urinary obstruction). This case report aims to evaluate the effectiveness of an Ayurvedic treatment protocol, including Udwartana (powder massage), Virechana (purgation), and Uttara Basti (enema) (urethral douche) on the parameters of Uroflowmetry. Methodology: A patient diagnosed with cystitis and urethral stricture underwent a series of Panchakarma (bio-purificatory) procedures. The protocol included Udwartana (powder massage), Avagaha Swedana (sitz bath), Virechana (purgation), Niruha Basti (enema) (decoction enema), Uttara Basti (enema) (urethral douche) using medicated decoctions and oils on alternate days. Post-discharge, the patient continued oral Ayurvedic medications at home. Uroflowmetry was employed to assess treatment effectiveness before and after the intervention. Results: Marked improvements were observed in Uroflowmetry parameters, including maximum flow rate, average flow rate, and voiding time along with a reduction in symptoms such as frequent urination, burning sensation during micturition, reduced flow, and the patient reported an enhanced quality of life, with better performances in daily activities. These improvements were sustained during the 60- day follow-up period. Conclusion: A combination of modified Uttara Basti (transurethral douche) and other panchakarma procedures, plus oral Ayurvedic medications was effective in relieving the symptoms of urethral stricture and improving Uroflowmetry parameters with sustained results during the 60-day follow-up period.

Clinical and Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding at a Tertiary Care Hospital.

Background Upper gastrointestinal (UGI) bleeding is a severe medical condition that requires prompt evaluation and management. Understanding the clinical and endoscopic findings in patients presenting with upper gastrointestinal bleeding is essential for accurate diagnosis and effective treatment. Objective To investigate the age and sex composition, clinical presentations, and endoscopic findings of patients with upper gastrointestinal bleeding at a tertiary care hospital. Method A total of 561 patients with upper gastrointestinal bleeding were included in the study. Data on age, sex, and clinical presentation were collected for each patient. Endoscopic findings were recorded, and the relative frequency of various upper gastrointestinal lesions was analyzed. Result The age distribution of patients revealed that 40.82% were between 15 and 45 years, 32.98% were aged 46 to 65 years, and 26.20% were above 65 years. Among the patients, 73.08% were male and 26.92% were female. Hematemesis was observed in 248 cases, while melena was present in 136 cases, and both were present in 171 cases. Recent onset anemia with positive occult blood was reported in 6 patients. The most common endoscopic finding was varices (39.39%), followed by ulcers (15.51%). Mallory Weiss tear was noted in 5.53% of cases. Conclusion According to our findings, varices are the most common endoscopic finding in individuals with upper gastrointestinal bleeding rather than peptic ulcer disease. The considerable increase in varices emphasizes the critical importance of early identification and care in high-risk individuals, as well as contributing to a better understanding of upper gastrointestinal bleeding.

Biomarkers of Electroconvulsive Therapy (ECT) Response in Treatment-resistant Schizophrenia (TRS).

Electroconvulsive therapy (ECT) is a well-established treatment option for individuals with treatment-resistant schizophrenia (TRS). However, predicting treatment response and identifying potential biomarkers to guide electroconvulsive therapy interventions in treatment-resistant schizophrenia remains a challenge. This review paper aims to explore the current literature on clinical biomarkers associated with electroconvulsive therapy in treatment-resistant schizophrenia. We discuss various potential biomarkers, including clinical, neuroimaging findings, EEG markers, and genetic markers, that have shown promise in predicting electroconvulsive therapy response and understanding the underlying mechanism of action. Additionally, we highlight the limitations and future directions for research in this field.

Monitoring macroplastics in aquatic and terrestrial ecosystems: Expert survey reveals visual and drone-based census as most effective techniques.

Anthropogenic litter, such as plastic, is investigated by the global scientific community from various fields employing diverse techniques. The goal is to assess and finally mitigate the pollutants' impacts on the natural environment. Plastic litter can accumulate in different matrices of aquatic and terrestrial ecosystems, impacting both biota and ecosystem functioning. Detection and quantification of macroplastics, and other litter, can be realized by jointly using visual census and remote sensing techniques. The primary objective of this research was to identify the most effective approach for monitoring macroplastic litter in riverine and marine environments through a comprehensive survey based on the experiences of the scientific community. Researchers involved in plastic pollution evaluated four litter occurrence and flux investigation methods (visual census, drone-based surveys, satellite imagery, and GPS/GNSS trackers) through a questionnaire. Traditional visual census and drone deployment were deemed as the most popular approaches among the 46 surveyed researchers, while satellite imagery and GPS/GNSS trackers received lower scores due to limited field validation and short performance ranges, respectively. On a scale from 0 to 5, visual census and drone-based surveys obtained 3.5 and 2.0, respectively, whereas satellite imagery and alternative solutions received scores lower than 1.2. Visual and drone censuses were used in high, medium and low-income countries, while satellite census and GPS/GNSS trackers were mostly used in high-income countries. This work provides an overview of the advantages and drawbacks of litter investigation techniques, contributing i) to the global harmonization of macroplastic litter monitoring and ii) providing a starting point for researchers and water managers approaching this topic. This work supports the selection and design of reliable and cost-effective monitoring approaches to mitigate the ambiguity in macroplastic data collection, contributing to the global harmonization of macroplastic litter monitoring protocols.

Primary central nervous system neuroblastoma mimicking a meningioma: A case report.

ABSTRACT: Neuroblastomas are the most common extracranial solid tumor in the pediatric age group (~8%-10% of childhood neoplasms). Most cases of intracranial neuroblastomas occur due to metastasis from some primary extracranial sites and are known as secondary neuroblastomas. However, the occurrence of primary central nervous system neuroblastomas (PCN-NB) is very rare, and only a few cases and case series have been reported in the literature. PCN-NB is mainly an intra-axial pathology, and extra-axial involvement is mainly due to metastasis from some extracranial primary site with involvement of the skull bone. Herein we report a case of a 23-year-old female having a large extra-axial space-occupying lesion in the right frontal region that was mimicking a meningioma, and surprisingly the histopathology was suggestive of a supratentorial neuroblastoma. A right frontal craniotomy was made, and Simpson's grade 1 excision of the tumor was done. The excised tissue was sent for histopathological examination. PCN-NB located extra-axially are extremely rare to occur. Due to inconsistent radiological imaging, it becomes very difficult to diagnose these tumors preoperatively, and these should be kept in mind as one of the differential diagnoses of extra-axial intracranial space-occupying lesions. Histopathological examination is crucial in diagnosing the intracranial neuroblastomas.

Role of maternal hyperoxygenation testing to predict need for balloon atrial septostomy in fetal d-transposition of great arteries.

OBJECTIVES: Predicting whether balloon atrial septostomy (BAS) will be necessary after birth for fetuses with d-transposition of the great arteries (d-TGA) remains challenging. We sought to determine whether measurements obtained during fetal maternal hyperoxygenation (MH) testing can improve our ability to predict need for postnatal BAS. METHODS: Forty-one mothers carrying fetuses with d-TGA with either intact ventricular septum or small ventricular septal defect measuring <3mm underwent MH testing between 33-38 weeks gestation. Patent foramen ovale (PFO) size, measured by 2D and color Doppler, patent ductus arteriosus (PDA) shunting (all antegrade versus bidirectional) was assessed in room air (RA) and during MH, blinded to postnatal outcome. BAS status and timing were recorded. RESULTS: Postnatally, 23 neonates underwent BAS while 18 did not, and 14 subjects underwent emergent BAS within 3 hours of life. By univariate analysis, PFO size measured both in RA and MH and all antegrade shunting in the PDA during MH predicted BAS. During MH testing, median PFO size by 2D measured 2.5mm (interquartile range, IQR, 2-3mm) in fetuses who underwent emergent BAS versus 4.1mm (IQR 3.4-5mm) in fetuses who did not undergo BAS (p<0.001). By cutpoint analysis, PFO size during MH testing ≤ 3.2mm predicted need for emergent BAS with sensitivity 93% and specificity 78%. CONCLUSIONS: In d-TGA, measurement of PFO size and direction of PDA shunting during MH testing improves our ability to predict need for BAS postnatally, although additional study is needed. We propose incorporating third trimester MH testing when planning deliveries of d-TGA fetuses. This article is protected by copyright. All rights reserved.

Patterns of quality assurance and treatment planning for stereotactic body radiation therapy in India - A survey.

AIM: The use of stereotactic body radiation therapy (SBRT) is an increasing trend in the country. The aim of this study is to gain knowledge on patterns of quality assurance (QA) and treatment planning (TP) aspects with respect to SBRT. MATERIALS AND METHODS: A questionnaire with multiple choice was designed to determine practices of SBRT covering areas such as years of experience, type of linear accelerator, tumor-motion strategies, calculation algorithm used in the TP system (TPS), the protocol used for small field dosimetry, the detector used for small field dosimetry and QA, respiratory management during delivery. The survey was sent to all radiotherapy institutes in the country having a minimum of one linear accelerator, and responses were analyzed. RESULTS: From June 2022 to December 2022, 265 responses to the SBRT survey were received with response rate as 60.4%. The most common reason for not adopting SBRT was reported as a lack of capability of treatment machines to deliver SBRT (61.6%). Lung (81.1%) was the most practiced site. The most common delivery unit was a conventional linear accelerator (83%); 6 MV FFF (85.7%) was mostly used energy; volumetric-modulated arc radiotherapy (VMAT) (91.5%) was mostly used delivery technique; most of the equipment (more than 91.5%) used multileaf collimator (MLC) leaf width ≤5 mm. The most popular methods used for motion strategies during computed tomography (CT) were motion-encompassing and breath-hold techniques used by 65 (62.5%) and 62 (59.6%) respondents, respectively. The most popular method used for respiratory management during delivery was breath-hold by 55 (52.4%) respondents. Most TPS are equipped with either Type-C or Type-B algorithms. Heterogeneity was observed in the QA protocol and acceptance criteria for analysis of patient-specific QA. CONCLUSION: The survey resulted in heterogeneity in QA and TP aspects among users of SBRT and demands for harmonizing the dosimetric aspects of SBRT in the country.

Correlation of palatal anatomic characteristics with dermatoglyphic heterogeneity in different growth patterns.

AIM AND OBJECTIVE: The study aimed to explore the correlation between dermatoglyphic patterns and quantitative palatal anatomic variables in individuals with different growth patterns. MATERIALS AND METHOD: A cross-sectional study was conducted involving 126 healthy patients aged 17-25 years. Participants were divided into three groups based on growth patterns: average, vertical, and horizontal. Dermatoglyphic patterns were recorded using an optical fingerprint sensor, and palatal characteristics were measured using digital software. Palatal characteristics, including intercanine width, intermolar width, and palatal depth, were measured using digital software. The results were statistically analyzed. RESULTS: Significant differences were observed in ridge counts among the three growth patterns. The average growth pattern showed lower ridge counts compared to the vertical and horizontal growth patterns. Dermatoglyphic patterns, such as double loops and tented arches, were significantly higher in the horizontal growth pattern. Weak correlations were found between certain dermatoglyphic patterns and palatal characteristics, with simple arch patterns showing a negative correlation with inter-canine width and symmetrical whorl patterns showing a positive correlation with palatal depth. Loop patterns, spiral patterns, double loop patterns, symmetrical whorl, and simple arch patterns were significant predictors of growth patterns. CONCLUSION: This study revealed distinct dermatoglyphic patterns and ridge counts among individuals with different growth patterns. Weak correlations were observed between dermatoglyphic patterns and palatal characteristics. However, the predictive value of dermatoglyphics for skeletal malocclusion requires further investigation. Understanding the relationships between dermatoglyphic patterns and craniofacial growth can provide valuable insights into genetic and developmental factors affecting dental and orthodontic conditions.

Frequency and classification of addenda in paediatric neuroradiological reports as part of quality assurance.

AIM: To determine the frequency and classification of addenda seen in paediatric brain magnetic resonance imaging (MRI) reports. MATERIALS AND METHODS: A retrospective review of the addenda of brain MRI reports from a large tertiary children's hospital was undertaken between January 2013 to December 2021 and a subset of above radiology reports was used to classify addenda over 6-month periods, October to March, spanning 2018 to 2021. A radiology fellow and a medical doctor classified the addenda into previously published categories using their best judgement. RESULTS: Out of 73,643 brain MRI reports over 9 years (108 months) included in the study, only 923 reports (1.25%) had addenda. There was a total of 13,615 brain MRI reports from 6-month periods, of which only 179 reports (1.31%) had an addendum. The number of errors according to categories were: observational 88/13,615 (0.65%); interpretational 16/13,615 (0.12%); non-observational and non-interpretative 82/13,615 (0.6%). Notifications to referring physician made in 29/13,615 (0.21%). CONCLUSIONS: The overall proportion of addenda to the brain MRI reports of children in the present study was low, at 1.25%. Categorisation of different addenda revealed the most common errors to be observational in 0.65%, including under-reading in the region of interest in 0.25%. Appropriate measures can now be introduced to minimise the error-based addenda further and improve MRI diagnosis in children. Other paediatric practices may choose to follow suit in evaluating their addenda and errors to improve practice.

Fine mapping of a new common bean anthracnose resistance gene (Co-18) to the proximal end of Pv10 in Indian landrace KRC-5.

KEY MESSAGE: Mapping and fine mapping of bean anthracnose resistance genes is a continuous process. We report fine mapping of anthracnose resistance gene Co-18 which is the first anthracnose gene mapped to Pv10. The discovery of resistance gene is a major gain in the bean anthracnose pathosystem research. Among the Indian common bean landraces, KRC-5 exhibit high levels of resistance to the bean anthracnose pathogen Colletotrichum lindemuthianum. To precisely map the anthracnose resistance gene, we used a Recombinant Inbred Line (F2:9 RIL) population (KRC-5 × Jawala). The inheritance test revealed that KRC-5 carries a dominant resistance gene temporarily designated as Co-18. We discovered two RAPD markers linked to Co-18 among 287 RAPD markers. These RAPD markers were eventually developed into SCARs (Sc-OPR15 and Sc-OPF6) and flank Co-18 on chromosome Pv10 at a distance of 5.3 and 4.2 cM, respectively. At 4.0-4.1 Mb on Pv10, we detected a SNP (single-nucleotide polymorphism) signal. We synthesized 58 SSRs and 83 InDels from a pool of 135 SSRs and 1134 InDels, respectively. Five SSRs, four InDels, and two SCARs were used to generate the high-density linkage map, which led to the identification of two SSRs (SSR24 and SSR36) that are tightly linked to Co-18. These two SSRs flank the Co-18 to 178 kb genomic region with 13 candidate genes including five NLR (nucleotide-binding and leucine-rich repeat) genes. The closely linked markers SSR24 and SSR36 will be used in cloning and pyramiding of the Co-18 gene with other R genes to develop durable resistant bean varieties.

One-pot synthesis of unsubstituted and methyl substituted-pyrazinyl diselenides and monoselenides: structural, optical property characterization and DFT calculations.

Organoselenium compounds have long been fascinated researchers owing to their wide range of applications, such as in anticancer, in catalysis, and as molecular precursors for metal selenides. In this view, herein, the one-pot synthesis of dimethyl substituted and unsubstituted dipyrazinyl monoselenides, [(2-pyz)2Se] and [(2,5-Me2-3-pyz)2Se], and the corresponding dipyrazinyl disenides, [(2-pyzSe)2] and [(2,5-Me2-3-pyzSe)2], is demonstrated by the reduction of selenium metal using sodium borohydride at room temperature and a subsequent alkylation using the corresponding pyrazinyl halide in ethanol. All the diselenides and monoselenides were characterized using IR, UV-vis, photoluminescence, and NMR (1H, 13C{1H}, and 77Se{1H}) spectroscopy. The molecular structures of the diselenides and monoselenides were unambiguously determined by single-crystal X-ray diffraction (SC-XRD). The optical properties, including absorption, excitation, emission, and quantum yield, of these organoselenium compounds were examined. Additionally, DFT calculations were performed to determine the HOMO and LUMO orbitals, band gap, and oscillator strength of these ligands.

In silico investigation on sensing of tyramine by boron and silicon doped C60 fullerenes.

The present communication deals with the adsorption of tyramine neurotransmitter over the surface of pristine, Boron (B) and Silicon (Si) doped fullerenes. Density functional theory (DFT) calculations have been used to investigate tyramine adsorption on the surface of fullerenes in terms of stability, shape, work function, electronic characteristics, and density of state spectra. The most favourable adsorption configurations for tyramine have been computed to have adsorption energies of - 1.486, - 30.889, and - 31.166 kcal/mol, respectively whereas for the rest three configurations, it has been computed to be - 0.991, - 6.999, and - 8.796 kcal/mol, respectively. The band gaps for all six configurations are computed to be 2.68, 2.67, 2.06, 2.17, 2.07, and 2.14 eV, respectively. The band gap of pristine, B and Si doped fullerenes shows changes in their band gaps after adsorption of tyramine neurotransmitters. However, the change in band gaps reveals more in B doped fullerene rather than pristine and Si doped fullerenes. The change in band gaps of B and Si doped fullerenes leads a change in the electrical conductivity which helps to detect tyramine. Furthermore, natural bond orbital (NBO) computations demonstrated a net charge transfer of 0.006, 0.394, and 0.257e from tynamine to pristine, B and Si doped fullerenes.

A Simplified Approach for Determination of Inflection Points of Flattening Filter-Free Photon Beam Using In-House Developed Software and Derivation of Reference Levels.

Aim: This article aimed to present the salient features of the in-house developed Java program for the determination of inflection point and dosimetric parameters of flattening filter-free (FFF) photon beam. Reference levels for the dosimetric parameters of the FFF photon beams were also presented. Materials and Methods: Beam profiles of 6 MV FFF and 10 MV FFF photon beams for a collimator setting of 20 cm × 20 cm measured at 10 cm depth in an isocentric setup acquired from various institutions were analyzed using an in-house developed Java program and manual method. The values of reference dose value (RDV), field size, penumbra, and degree of un-flatness (defined as the lateral separation between 90% [X90%], 75% [X75%], and 60% [X60%] dose points on the profile) were calculated and compared. The reference values of field size, penumbra, and degree of un-flatness were also determined for Varian and Elekta medical electron linear accelerators (LINACs). Results: The maximum differences for RDV determined using the Java method and manual method are 2.4% and 2.7% for 6 and 10 MV FFF photon beams, respectively. The maximum difference between the values of field size, penumbra, and degree of un-flatness determined using Java and manual methods is within 1.3 mm. The reference values of field size and penumbra for Varian LINACs are 19.94 ± 0.10 cm and 0.83 ± 0.08 cm (6 MV FFF) and 19.95 ± 0.10 cm and 0.83 ± 0.08 cm (10 MV FFF). Similarly, the reference values of field size and penumbra for Elekta LINACs are 20.02 ± 0.09 cm and 0.94 ± 0.12 cm (6 MV FFF) and 20.03 ± 0.11 cm and 0.97 ± 0.16 cm (10 MV FFF). Conclusions: A software program was developed in Java for analyzing the beam profiles of FFF photon beams. The results of Java-derived values of dosimetric parameters of FFF photon beams were found in good agreement with the values determined using the manual method. The reference values of these parameters were also derived and quoted using a large cohort of the data.

Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction.

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

Spray pyrolysis-derived robust ferroelectric BiFeO3 thin films.

Scalable and low-cost synthesis of high-quality ferroic films is critical for the development of advanced electronic devices and sensors. Here, we employ solution-based spray pyrolysis to fabricate bismuth ferrite thin films on glass substrates and explore the impact of annealing conditions to attain functional thin films of superior quality and switchable polarization. Optimised thin films display polycrystalline nanostructured grains with the highest X-ray diffraction intensity along the (110) orientation and a mixed Fe2+/3+ valence suggesting the presence of oxygen vacancies. The optimized films show a complex ferroelectric domain microstructure and exhibit robust nanoscale polarization switching in the range of several volts. Domains are found to scale with the sizes of nanocrystalline grains, which points to the role of surface-energy-related mechanisms affecting the domain patterns. Our results demonstrate the potential of spray pyrolysis for the fabrication of high-quality ferroelectric thin films and provide new opportunities for the development of low-cost scalable advanced electronic devices.

THE IMPACT OF SLEEP ON PHYSICAL AND MENTAL HEALTH: IMPORTANCE OF HEALTHY SLEEP HABITS.

Sleep is an important part of health, and when you go to sleep, how long you sleep, and how well you sleep all have a big impact on your health. Sleep may be required for regulating the body's metabolism, feelings, function, memory storage, brain recovery, and learning. Because of how important these processes are, sleep should be seen as just as important to health as what you eat and how much you exercise. Adults' sleep generally gets shorter and less restful, their sleep starts later and is more broken up, they have more sleep problems, and their rest-activity rhythms get weaker. In addition to receiving enough sleep (quality), healthy sleep habits also include maintaining a consistent sleep schedule. Ninety male college students with varying sleep schedules were analyzed for their physical and emotional well-being. By using factor analysis to categorize individuals' sleeping patterns across three dimensions regularity, quality, and quantity. We were able to develop sleep-habit measures. Clustering identified four distinct patterns of sleep behavior: good sleep was defined by regular, high-quality sleep despite being of comparatively brief duration; long sleep was predictable, fairly lengthy, but of minimal quality; short sleep was of excellent quality despite being short and irregular; and poor sleep was erratic, low-quality, and relatively long. The excellent sleepers also had reduced diastolic and systolic and a smaller means waist measurement. In addition, the poor sleepers had the lowest average MCS scores of all of the study groups. Poor sleepers also had the lowest mean scores on the Subjective Depression Scale (SDS). Issues involving glucose or lipid absorption were also more common in the short-term and long poor-sleep categories. Without restful sleep and a regular bedtime routine, it is impossible to maintain excellent mental and physical wellness, even if time and sleep are maintained constantly. Therefore, to produce suitable sleep recommendations for enhanced mental and physical health, we evaluated not only the quantity of sleep but also its consistency and high quality.

Donor complications of contralateral C7 nerve transfer in Brachial Plexus Birth Injury: a systematic review.

PURPOSE: Contralateral C7 (CC7) nerve transfer is a reconstructive option in the upper limb when there are limited donor options. Promising results have been reported in the adult population but its role in Brachial Plexus Birth Injury (BPBI) is unclear. A major concern with this technique is the potential impact on the contralateral, unaffected limb. Our aim was to review the available literature on the use of this transfer in BPBI, to determine the incidence of short- and long-term deficits at the donor site. METHODS: The relevant literature was identified from searches of Embase, Ovid Emcare and Ovid MEDLINE, for combinations of terms relating to CC7 nerve transfer and BPBI. RESULTS: Seventy-five patients were included in this review, from the eight papers that were eligible for inclusion, from a total of 16 papers identified. Patient age ranged from three to 93 months and the shortest follow-up period was six months. Post-operative motor deficits at the donor site included reduced range of shoulder abduction; triceps weakness; and phrenic nerve palsy. All motor deficits recovered within six months. The only sensory deficit reported was reduced sensation in the median nerve distribution which, in all cases, resolved within four weeks. Finally, synchronous donor limb motion and sensation were reported in 46.6% of patients. CONCLUSION: CC7 nerve transfer in BPBI appears to have few long-term donor limb complications. Sensory and motor deficits are reportedly transient. The impact of synchronous motion and sensation on upper limb function in this patient cohort is not yet known.

Paraneoplastic Manifestation of Primary Squamous Cell Cancer of the Thyroid Gland.

Paraneoplastic manifestation (PNM) of cancers is a non-metastatic, non-invasive systemic effect of malignancies due to chemokines and hormones produced by the primary neoplasm. Squamous cell cancers (SCCs) are known to present with PNM. Primary SCC of thyroid accounts for <1% of all thyroid malignancies and carries a very poor prognosis. We present a rare case of SCC arising from the thyroid gland who presented with fever, leukemoid reaction and hypercalcemia as part of PNM. A 67-year-old male patient presented with two months history of intermittent high-grade fever, weakness, loss of weight and appetite. Examination revealed a large (~10 cm) hard swelling over the right side of the neck. Investigations revealed neutrophilic leukocytosis, elevated C-reactive protein (CRP) and procalcitonin and hypercalcemia with a normal thyroid-stimulating hormone (TSH). The fever workup was negative for infection. Fine-needle aspiration cytology (FNAC) and core biopsy of the thyroid mass revealed malignant cells with squamous differentiation. An extensive search for possible other primary was ruled out by triple endoscopy. The combination of fever, neutrophilic leukocytosis, hypercalcemia and squamous malignancy was consistent with a diagnosis of PNM of SCC. A fluorodeoxyglucose-positron emission tomography (FDG-PET) CT scan showed a heterogeneously enhancing mass lesion in the right lobe of the thyroid with some retrosternal extension. He underwent total thyroidectomy with bilateral central compartment neck dissection. Final histopathology revealed moderately differentiated SCC of the thyroid. Concurrent chemoradiation was given. Despite continued chemotherapy, he succumbed to illness within six months of diagnosis. Primary SCC of thyroid (PSCCT) is a rare malignancy. It is a highly aggressive tumor having a poor prognosis with a median survival time of about 9-12 months and less clearly defined therapy due to its rarity. Paraneoplastic manifestation of PSCCT is known. As fever, leukemoid reaction and hypercalcemia can be a paraneoplastic manifestation, one should think of PSCCT.

Observation of Fast Current Redistribution in an Imploding Plasma Column.

Spectroscopic measurements of the magnetic field evolution in a Z-pinch throughout stagnation and with particularly high spatial resolution reveal a sudden current redistribution from the stagnating plasma (SP) to a low-density plasma (LDP) at larger radii, while the SP continues to implode. Based on the plasma parameters it is shown that the current is transferred to an increasing-conductance LDP outside the stagnation, a process likely to be induced by the large impedance of the SP. Since an LDP often exists around imploding plasmas and in various pulsed-power systems, such a fast current redistribution may dramatically affect the behavior and achievable parameters in these systems.