Anatomage - the virtual dissection tool and its uses: A narrative review.

Advancement in technology has given students and institutes an educational, interactive, and diagnostic aid with virtual reality functionality known as the Anatomage table. This review analyses the various spheres of the medical field where the 3D virtual tool is being used and assesses its acceptability, convenience, and practical application. A search for relevant studies in various databases namely Pubmed, Embase, Wiley Library, and Google Scholar was performed, and the data was compiled to understand the use of the Anatomage table. The search yielded a total of 24 studies that focused on the use of the Anatomage table. Eleven articles focused on using Anatomage as a learning tool and 13 described the perception of the Table. Anatomage table offers an excellent tool for learning anatomy by virtual dissection. The tool is not only used as a teaching aid, but also as a diagnostic and planning tool in residency programs. Adding the tool as an educational aid boosts the existing curriculum and helps to counter the challenges with cadaveric dissection. The equipment cost and its maintenance charges may be a deciding factor for the underutilization of the tool in developing countries.

Complete resolution of constrictive pericarditis after coronary bypass surgery.

Classical constrictive pericarditis (CP) is an unusual and rare complication after coronary artery bypass grafting. It can be transient, progressive or fixed form of cardiac constriction. However recently recognized transient variant of constrictive pericarditis can be managed with medical therapy, though other progressive and irreversible forms may require pericardiectomy. We describe a 65-year-old male patient who developed a classical but a very early transient CP, just within two weeks as a result of post cardiac injury syndrome after coronary bypass surgery. The patient had a complete recovery following medical treatment.

Case report: robotic thoracic surgery of posterior mediastinal mass.

We report a 39-year-old male with accidental findings of posterior mediastinum mass at right superior aspects, located at T2 with close proximity to trachea, superior vena cava, azygus vein, right subclavian artery and oesophagus. Apart from intermittent right shoulder pain, there was no other significant symptom. He opted for conservative management initially, given the benign nature and proximity to important structures. We postulated that robotic approach will be of advantage for this particular case which was successfully performed with uneventful recovery. This case illustrated the advantages of robotic-assisted surgery, compared to conventional VATS in otherwise potentially difficult case to undertake.

Helicobacter Pylori Stool Antigen Assay in Hyperemesis Gravidarum.

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy that seriously affects the pregnancy outcome. It is a disease with unknown etiology and varieties of contributing factors like hormonal changes, psychological and immunological factors. A significantly high prevalence of Helicobacter pylori among pregnant women with Hyperemesis gravidarum has been revealed recently. A descriptive, cross-sectional study was carried out at antenatal ward, Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh for a period of twenty-one months among purposively selected thirty-six patients with Hyperemesis gravidarum with a view to assess the involvement of H. pylori in Hyperemesis gravidarum. Data were collected through interview, physical examinations and laboratory investigations by using case record form. Statistical analysis was performed using SPSS version 20.0 for Windows. Highest number 16(44.44%) of respondents were in age group 20 to 24 years with a mean of 23.81 years and a standard deviation (SD) of 4.55 years. Majority 29(80.56%) of the women had education less than 12 years, as many as 28(77.78%) women were housewives, and at least 14(38.89%) women had unplanned pregnancies. An overwhelming majority 29(80.56%) of women had their pregnancy duration between 8 to 12 weeks with a mean duration of 10.64 weeks and a standard deviation of 2.35 weeks. Majority 20(55.56%) of women were pregnant for first time, as many as 19(52.78%) women had duration of illness for 5 to 9 weeks. Of 16 multi-gravid women, 7(43.75%) had history of similar condition in their previous pregnancies. As many as 9 (25.00%) women had family history of similar condition in their mothers and sisters. First trimester was time of manifestation of the condition.At least 11 (30.56%) stool samples were positive for H. pylori stool antigen. Family history of Hyperemesis gravidarum and presence of H. pylori stool antigen are statistically associated (p<0.05). Pregnancy at young age, low educational status of women, nulliparity, unplanned pregnancy, past history, family history and H. pylori infection are the identified risk factors of Hyperemesis gravidarum.

A cohort study of the morbidity of combined anterior-posterior cervical spinal fusions: incidence and predictors of postoperative dysphagia.

PURPOSE: To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery. METHODS: A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia. RESULTS: The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554). CONCLUSION: Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.

Enhancing ethanol production from cellulosic sugars using Scheffersomyces (Pichia) stipitis.

Studies were performed on the effect of CaCO3 and CaCl2 supplementation to fermentation medium for ethanol production from xylose, glucose, or their mixtures using Scheffersomyces (Pichia) stipitis. Both of these chemicals were found to improve maximum ethanol concentration and ethanol productivity. Use of xylose alone resulted in the production of 20.68 ± 0.44 g L(-1) ethanol with a productivity of 0.17 ± 0.00 g L(-1) h(-1), while xylose plus 3 g L(-1) CaCO3 resulted in the production of 24.68 ± 0.75 g L(-1) ethanol with a productivity of 0.21 ± 0.01 g L(-1) h(-1). Use of xylose plus glucose in combination with 3 g L(-1) CaCO3 resulted in the production of 47.37 ± 0.55 g L(-1) ethanol (aerobic culture), thus resulting in an ethanol productivity of 0.39 ± 0.00 g L(-1) h(-1). These values are 229 % of that achieved in xylose medium. Supplementation of xylose and glucose medium with 0.40 g L(-1) CaCl2 resulted in the production of 44.84 ± 0.28 g L(-1) ethanol with a productivity of 0.37 ± 0.02 g L(-1) h(-1). Use of glucose plus 3 g L(-1) CaCO3 resulted in the production of 57.39 ± 1.41 g L(-1) ethanol under micro-aerophilic conditions. These results indicate that supplementation of cellulosic sugars in the fermentation medium with CaCO3 and CaCl2 would improve economics of ethanol production from agricultural residues.

Variations of Weight of Prostate Gland in Different Age Groups of Bangladeshi Cadaver.

Now a days, benign prostatic hyperplasia and carcinoma of the prostate are the most common disorders in men. A cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh to find out the difference in weight of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories - Group A (upto 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed according to standard autopsy techniques. The weight of the prostate gland were measured and recorded. The mean weight of the prostate gland was 10.13gm in Group A, 17.27gm in Group B and 22.50gm in Group C. Variance analysis shows that mean differences of weight of the prostate were highly significant among all age groups. The weight of prostate gland was found to increase with increased age. For statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the weight of prostate gland of Bangladeshi people.

Histomorphological Study on Number of Acini of the Prostate Gland of Bangladeshi Cadaver.

The prostate is made up of 30 to 50 compound tubuloalveolar glands that are embedded in a framework of fibromuscular tissue and arranged in three concentric groups (mucosal, submucosal and main prostatic gland). The prostate consists of peripheral, central and transitional zone accounting for approximately 70%, 20% and 5% of the glandular substances. Benign prostatic hyperplasia affects the transitional zone and carcinoma of the prostate affects the peripheral zone. The glandular tissue consists of numerous acini with frequent internal papillae. Follicular epithelium is variable but predominantly columnar and either single-layered or pseudostratified. This cross sectional descriptive study was conducted in Department of Anatomy, Mymensingh Medical College, Mymensingh, Bangladesh to find out the difference in number of acini of the prostate gland of Bangladeshi people in relation to age. The present study was performed on 67 postmortem human prostate gland collected from the morgue in the Department of Forensic Medicine, Mymensingh Medical College by non random purposive sampling technique. The specimens were collected from Bangladeshi cadaver of age ranging from 10 to 80 years. All the specimens were grouped into three categories: Group A (up to 18 years), Group B (19 to 45 years) and Group C (above 45 years) according to age. Dissection was performed following standard autopsy techniques. In the present study, total 60 slides were made for histological study from both central and peripheral zone of the prostate which were examined under low power objectives. The number of the acini of the prostate gland were counted and recorded. The mean number of the acini of the prostate gland was 16.45, 43.54 and 42.45 in Group A, B and C respectively in central zone and 30.08, 51.35 and 44.16 in Group A, B and C respectively in peripheral zone of the prostate. Variance analysis shows that mean differences were highly significant between Group A & B and Group C & A and non significant between Group B & C in central zone of the prostate. Mean differences were non significant among all three groups in peripheral zone of the prostate. The number of the acini of prostate gland was increased up to certain age limit but decreased in extreme age. In statistical analysis, differences between age groups were analyzed by using students unpaired 't' test. The present study will help to increase the information pool on the number of the acini of the prostate gland of Bangladeshi people at different age group.

Progression pattern and adverse events with bevacizumab in glioblastoma.

BACKGROUND: The use of bevacizumab in the management of glioblastoma multiforme (gbm) remains controversial. In Canada, bevacizumab is approved for the treatment of recurrent gbm. We describe a pattern of progression across treatment lines in gbm. METHODS: During 2008-2014, 64 patients diagnosed with gbm were treated with bevacizumab at McGill University hospitals. Of those patients, 30 (46.9%) received bevacizumab in the first line (B1L), and 34 (53.1%) received it in the second line and beyond (B2L+). The average length of treatment with bevacizumab was 24.4 weeks (range: 0-232.7 weeks). The patterns of progression were categorized as local, distant, diffuse, multifocal, or multi-pattern. RESULTS: Local progression was seen in 46.7% of B1L patients and 26.5% of B2L+ patients, distant in 3.3% and 2.9%, diffuse in 20% and 47%, multifocal in 10% and 8.8%, and multi-pattern in 3.3% and 11.8%. No differences between the groups were observed for the distant (p = 0.3) or diffuse (p = 0.4) patterns. Grades 3 and 4 adverse events in the B1L and B2L+ groups were fatigue (33.3% vs. 17.6% respectively), hypertension (26.7% vs. 5.9%), thrombocytopenia (26.7% vs. 11.8%), neutropenia (26.7% vs. 11.8%), anemia (23.3% vs. 11.8%), leucopenia (20% vs. 8.8%), deep vein thrombosis (23.3% vs. 5.9%), seizure (16.7% vs. 8.8%), brain hemorrhage (6.7% vs. <1%), and delayed wound healing (6.7% vs. 2.9%). More total grades 3 and 4 adverse events occurred in the B1L group (p = 0.000519). CONCLUSIONS: In our cohort, patterns of progression were not different in B1L and B2L+ patients. Moreover, both groups experienced similar adverse events, although more grades 3 and 4 events occurred in the B1L group, implying that severe adverse events in B1L patients could negatively affect survival outcomes.

Association genetics, geography and ecophysiology link stomatal patterning in Populus trichocarpa with carbon gain and disease resistance trade-offs.

Stomata are essential for diffusive entry of gases to support photosynthesis, but may also expose internal leaf tissues to pathogens. To uncover trade-offs in range-wide adaptation relating to stomata, we investigated the underlying genetics of stomatal traits and linked variability in these traits with geoclimate, ecophysiology, condensed foliar tannins and pathogen susceptibility in black cottonwood (Populus trichocarpa). Upper (adaxial) and lower (abaxial) leaf stomatal traits were measured from 454 accessions collected throughout much of the species range. We calculated broad-sense heritability (H(2) ) of stomatal traits and, using SNP data from a 34K Populus SNP array, performed a genome-wide association studies (GWAS) to uncover genes underlying stomatal trait variation. H(2) values for stomatal traits were moderate (average H(2) = 0.33). GWAS identified genes associated primarily with adaxial stomata, including polarity genes (PHABULOSA), stomatal development genes (BRASSINOSTEROID-INSENSITIVE 2) and disease/wound-response genes (GLUTAMATE-CYSTEINE LIGASE). Stomatal traits correlated with latitude, gas exchange, condensed tannins and leaf rust (Melampsora) infection. Latitudinal trends of greater adaxial stomata numbers and guard cell pore size corresponded with higher stomatal conductance (gs ) and photosynthesis (Amax ), faster shoot elongation, lower foliar tannins and greater Melampsora susceptibility. This suggests an evolutionary trade-off related to differing selection pressures across the species range. In northern environments, more adaxial stomata and larger pore sizes reflect selection for rapid carbon gain and growth. By contrast, southern genotypes have fewer adaxial stomata, smaller pore sizes and higher levels of condensed tannins, possibly linked to greater pressure from natural leaf pathogens, which are less significant in northern ecosystems.

Sling for correcting uterine prolapse: twelve years experience.

Pelvic organ prolapse is a common morbidity among Bangladeshi women. Both patient and surgeon prefer vaginal hysterectomy for the treatment of this condition and occasionally they choose Fothergill's operation. Uterine suspension is suitable for the young women to preserve the uterus. This observational study was carried out in three teaching hospitals and two other non government hospitals for the period of 12 years among 280 patients with 1st, 2nd and 3rd degree uterine prolapse. Follow up done at 6th week , 6th month, 1st year, 5th year, 10th year and 12th year for recurrence of prolapse, dragging pain and dyspareunia. Among 280 patients >60% patients were of 26-30 years age group. In last follow up at 12th year 2(0.71%) women complained feeling of some descend of uterus, 1(0.36%) complained dragging pain in abdomen and I (0.36%) complained dyspareunia. All patients expressed satisfaction which indicates psychological well being. Uterine sling is an effective procedure to save uterus in young women to improve their quality of life.

Physico-chemical evaluation of bitter and non-bitter Aloe and their raw juice for human consumption.

In addition to Aloe vera which is bitter in taste, a non-bitter Aloe is also found in arid part of Rajasthan. This non-bitter Aloe (NBA) is sporadically cultivated as vegetable and for health drink. In spite of its cultivation and various uses, very little information is available about its detailed botanical parameters and chemical characters. This study aims to evaluate the physico-chemical characters of NBA through employing floral morphology, leaf characters and leaf gel and to compare them with those of A. vera. Of eleven floral characters studied, eight characters of NBA were significantly different from that of A. vera. Most visible difference was observed in their reproductive shoots which are highly branched in NBA (5.21 inflorescence/shoot) as compared to A. vera (1.5 inflorescence/shoot). NBA produces less leaf-biomass (-29.32 %) with less leaf-thickness (-31.44 %) but higher leaf length, width, and no. of spine/side by 17.56 %, 21.34 % and 16.11 %, respectively, with significant difference as compared to A. vera. But its polysaccharide content (0.259 %) is at par with that of A. vera. The raw juice from the leaf of NBA has very low aloin content (4.1 ppm) compared to that from A. vera (427.3 ppm) making it a safer health drink compared to the one obtained from A. vera. Thus, NBA raw juice emerged as suitable alternative to A. vera juice for human consumption.

Design of experiment approach to identify the dominant geometrical feature of left coronary artery influencing atherosclerosis.

Background and Objective. Coronary artery geometry heavily influences local hemodynamics, potentially leading to atherosclerosis. Consequently, the unique geometrical configuration of an individual by birth can be associated with future risk of atherosclerosis. Although current researches focus on exploring the relationship between local hemodynamics and coronary artery geometry, this study aims to identify the order of influence of the geometrical features through systematic experiments, which can reveal the dominant geometrical feature for future risk assessment.Methods. According to Taguchi's method of design of experiment (DoE), the left main stem (LMS) length (lLMS), curvature (kLMS), diameter (dLMS) and the bifurcation angle between left anterior descending (LAD) and left circumflex (LCx) artery (αLAD-LCx) of two reconstructed patient-specific left coronary arteries (LCA) were varied in three levels to create L9 orthogonal array. Computational fluid dynamic (CFD) simulations with physiological boundary conditions were performed on the resulting eighteen LCA models. Average helicity intensity (h2) and relative atheroprone area (RAA) of near-wall hemodynamic descriptors were analyzed.Results. The proximal LAD (LADproximal) was identified to be the most atheroprone region of the left coronary artery due to higherh2,large RAA of time averaged wall shear stress (TAWSS < 0.4 Pa), oscillatory shear index (OSI ∼ 0.5) and relative residence time (RRT > 4.17 Pa-1). In both patient-specific cases, based onh2and TAWSS,dlmsis the dominant geometric parameter while based on OSI and RRT,αLAD-LCxis the dominant one influencing hemodynamic condition in proximal LAD (p< 0.05). Based on RRT, the rank of the geometrical factors is:αLAD-LCx>dLMS>lLMS>kLMS, indicating thatαLAD-LCxis the most dominant geometrical factor affecting hemodynamics at proximal LAD which may influence atherosclerosis.Conclusion. The proposed identification of the rank of geometrical features of LCA and the dominant feature may assist clinicians in predicting the possibility of atherosclerosis, of an individual, long before it will occur. This study can further be translated to be used to rank the influence of several arterial geometrical features at different arterial locations to explore detailed relationships between the arterial geometrical features and local hemodynamics.

Genetic associations of psoriasis in a Pakistani population.

BACKGROUND: Genetic predisposition to psoriasis, an inflammatory skin disease affecting 0·2-4% of the world population, is well established. Thus far, 41 psoriasis susceptibility loci reach genome-wide significance (P ≤ 5 × 10(-8) ). Identification of genetic susceptibility loci in diverse populations will help understand the underlying biology of psoriasis susceptibility. OBJECTIVES: The primary objective of this study was to examine psoriasis susceptibility associations previously reported in Chinese and caucasian populations in a Pakistani cohort. METHODS: Blood samples and phenotype data were collected from psoriasis cases and controls in Islamabad, Pakistan. DNA was isolated and genotypes of selected susceptibility markers were determined. The data were analysed using χ(2) tests or logistic regression for psoriasis association. RESULTS: HLA-Cw6 showed the strongest association [odds ratio (OR) 2·43, P = 2·3 × 10(-12) ]. HLA-Cw1 showed marginally significant association (OR 1·66, P = 0·049), suggesting that the HLA-Cw1-B46 risk haplotype may be present in the Pakistani population. Three other loci (IL4/IL13, NOS2, TRAF3IP2) showed nominally significant association (P < 0·05). CONCLUSIONS: HLA-Cw6 is strongly associated with psoriasis susceptibility in the Pakistani population, as has been found in every other population studied. In addition, HLA-Cw1 showed marginal association, reflecting the relative geographical proximity and thus likely genetic relatedness to other populations in which the HLA-Cw1-B46 haplotype is known to be associated. A larger cohort and a denser marker set will be required for further analysis of psoriasis associations in the South Asian population.

Seasonality and phenology alter functional leaf traits.

In plant ecophysiology, functional leaf traits are generally not assessed in relation to phenological phase of the canopy. Leaf traits measured in deciduous perennial species are known to vary between spring and summer seasons, but there is a knowledge gap relating to the late-summer phase marked by growth cessation and bud set occurring well before fall leaf senescence. The effects of phenology on canopy physiology were tested using a common garden of over 2,000 black cottonwood (Populus trichocarpa) individuals originating from a wide geographical range (44-60ºN). Annual phenological events and 12 leaf-based functional trait measurements were collected spanning the entire summer season prior to, and following, bud set. Patterns of seasonal trait change emerged by synchronizing trees using their date of bud set. In particular, photosynthetic, mass, and N-based traits increased substantially following bud set. Most traits were significantly different between pre-bud set and post-bud set phase trees, with many traits showing at least 25% alteration in mean value. Post-bud set, both the significance and direction of trait-trait relationships could be modified, with many relating directly to changes in leaf mass. In Populus, these dynamics in leaf traits throughout the summer season reflected a shift in whole plant physiology, but occurred long before the onset of leaf senescence. The marked shifts in measured trait values following bud set underscores the necessity to include phenology in trait-based ecological studies or large-scale phenotyping efforts, both at the local level and larger geographical scale.

A friendly approach to repair fourth degree perineal tears.

This observational study was done to make the Gynecologists familiar with the procedure of continuous repair of rectal mucosa and repair of the anal sphincter by other than figure of 8 sutures and to assess the effectiveness of the procedure. This study was carried out in two teaching hospitals and other two private hospitals in Dhaka city and out side. Total 20 patients were included in this study. All had fourth degree perineal tear and were repaired with the new approach. Follow up was carried out at 6th week, 12th week, and 24th weeks. Among 20 patients a large number of women were mother of one child and were of 21-25 years age group. At post operative period - wound infection was nil. Perineums were well established in all cases. On follow up at 24th week - pain in perineum and dyspareunia was nil in all cases, though this was present at early weeks in few cases. Faecal incontinence was absent in all patients by 24 weeks postoperatively. In follow up visits there was no complaint of faecal incontinence. In few cases pain was present in early post operative periods but dyspareunia was absent. So, continuous repair of anal mucosa and repair of anal sphincters other than figure of eight seems better regarding technical easiness, better compliance for the surgeon and less traumatic to the rectal mucosa and ultimately better results.

Role of Serum Triglyceride to Detect Severity and Outcome in Acute Pancreatitis.

Though hypertriglyceridemia is an established risk factor for acute pancreatitis, the relationship between hypertriglyceridemia and pancreatitis-associated complications remains controversial. Serum triglyceride could be a simple, routinely available investigation if predictability of the outcome can be validated. Due to scarcity of related studies in Bangladesh, this study aimed to evaluate the role of serum triglyceride to detect severity and outcome in acute pancreatitis. This prospective observational study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), BIRDEM General Hospital, Dhaka from April 2019 to January 2021. A total of 153 patients with confirmed diagnosis of acute pancreatitis were selected as study cases according to selection criteria. Detailed clinical and demographic history of each patient was taken along with physical examination and relevant investigations. Developed complications and mortality were also assessed during hospital stay. Collected data were checked for errors and analyzed by using the statistical software SPSS 23.0. The mean age ±SD of the study population was 46.72±13.43 years with a majority in age group 41-50 years (30.10%). About 51.60% patients were male and 48.40% patients were female. Higher frequency of severe cases of acute pancreatitis (according to Glasgow score, BISAP score and Ranson score) was observed in patients with hypertriglyceridemia than patients with normal triglyceride with statistical significance (p<0.05). Mortality and complications were also more frequent in patients with acute pancreatitis with statistical significance (p<0.05). With a cut off value of 218mg/dl, serum triglyceride showed 68.66% sensitivity, 66.28% specificity and 67.32% accuracy for predicting outcome of acute pancreatitis. Findings of this study suggest that serum triglyceride might play a recommendable role in predicting the severity and outcome of patients with acute pancreatitis. However, further extensive study is recommended.

Dopant engineering for ZnO electron transport layer towards efficient perovskite solar cells.

The conventional electron transport layer (ETL) TiO2 has been widely used in perovskite solar cells (PSCs), which have produced exceptional power conversion efficiencies (PCE), allowing the technology to be highly regarded and propitious. Nevertheless, the recent high demand for energy harvesters in wearable electronics, aerospace, and building integration has led to the need for flexible solar cells. However, the conventional TiO2 ETL layer is less preferred, where a crystallization process at a temperature as high as 450 °C is required, which degrades the plastic substrate. Zinc oxide nanorods (ZnO NRs) as a simple and low-cost fabrication material may fulfil the need as an ETL, but they still suffer from low PCE due to atomic defect vacancy. To delve into the issue, several dopants have been reviewed as an additive to passivate or substitute the Zn2+ vacancies, thus enhancing the charge transport mechanism. This work thereby unravels and provides a clear insight into dopant engineering in ZnO NRs ETL for PSC.