Can site-specific nutrient management improve the productivity and resource use efficiency of climate-resilient finger millet in calcareous soils in India?

Finger millet, an important 'Nutri-Cereal' and climate-resilient crop, is cultivated as a marginal crop in calcareous soils. Calcareous soils have low organic carbon content, high pH levels, and poor structure. Such a situation leads to poor productivity of the crop. Site-specific nutrient management (SSNM), which focuses on supplying optimum nutrients when a crop is needed, can ensure optimum production and improve the nutrient and energy use efficiency of crops. Moreover, developing an appropriate SSNM technique for this crop could offer new insights into nutrient management practices, particularly for calcareous soils. A field experiment was conducted during the rainy seasons of 2020 and 2021 in calcareous soil at Dr. Rajendra Prasad Central Agricultural University, Pusa, India. The experiment consisted of 8 treatments, viz. control, nitrogen (N)/phosphorus (P)/potassium (K)-omission, 75 %, 100 %, and 125 % recommended fertilizer dose (RFD), and 100 % recommended P and K + 30 kg ha-1 N as basal + rest N as per GreenSeeker readings. From this study, it was observed that the GreenSeeker-based SSNM resulted in the maximum grain yield (2873 kg ha-1), net output energy (96.3 GJ ha-1), and agronomic efficiency of N (30.6 kg kg-1), P (68.9 kg kg-1), and K (68.9 kg kg-1). The application of 125 % RFD resulted in ∼7 % lower yield than that under GreenSeeker-based nutrient management. Approximately 12 % greater energy use efficiency and 21-36 % greater nutrient use efficiency were recorded under GreenSeeker-based nutrient management than under 125 % RDF. The indigenous supplies of N, P, and K were found to be 14.31, 3.00, and 18.51 kg ha-1, respectively. Thus, 100 % of the recommended P and K + 30 kg ha-1 N as basal + rest N according to GreenSeeker readings can improve the yield, nutrient use efficiency, and energy balance of finger millet in calcareous soils.

Health-related quality of life in patients with generalized pustular psoriasis: A systematic literature review.

Generalized pustular psoriasis (GPP) is a rare, chronic, neutrophilic inflammatory skin disease characterized by episodes of widespread eruption of sterile, macroscopic pustules that can be accompanied by systemic inflammation and symptoms. A systematic literature review and narrative synthesis were conducted to determine the impact of GPP on patients' health-related quality of life (HRQoL) and patient-reported severity of symptoms and to compare its impact to patients with plaque psoriasis (plaque PsO). Searches were undertaken in Embase, MEDLINE and the Cochrane Library from 1 January 2002 to 15 September 2022. Screening was carried out by two reviewers independently. Outcome measures included generic (e.g. EQ-5D, SF-36) and dermatology-specific (e.g. DLQI) clinical outcome assessments, and other relevant patient-reported outcome measures (PROMs) (e.g. severity of pain measured by a numerical rating scale). Overall, 20 studies were found to be eligible for inclusion, of which seven also had data for plaque PsO. The DLQI was the most frequently reported outcome measure (16 out of 20 studies). When reported, mean DLQI (SD) scores varied from 5.7 (1.2) to 15.8 (9.6) across the studies, indicating a moderate to very large effect on HRQoL; the wide range of scores and large SDs were explained by the small population sizes (n ≤ 12 for all studies except two). Similar ranges and large SDs were also observed for other measures within individual studies. However, in general, people with GPP reported a greater impact of their skin condition on HRQoL, when compared to people with plaque PsO (i.e. higher DLQI scores) and higher severity for itch, pain and fatigue. This systematic review highlighted the need for studies with a larger population size, a better understanding of the impact of cutaneous and extracutaneous symptoms and comorbidities on HRQoL during and between GPP flares, and outcome measures specifically tailored to the unique symptoms and the natural course/history of GPP.

Posterior communicating artery infundibulum with oculomotor nerve palsy treated with microvascular decompression: a case report and 2-dimensional technical operative video.

Oculomotor nerve palsies are typically associated with posterior communicating artery (PcommA) aneurysms. We report a rare case of an oculomotor nerve palsy caused by a PcommA infundibular dilatation. Although there are cases of infundibular dilatations causing cranial nerve palsies, only reports of three involving the PcommA exists. We review these reported cases in the literature and discuss their treatments as well as other non-aneurysmal compressive etiologies that may cause oculomotor nerve palsies. We present the case of a 53-year-old female with transient oculomotor nerve palsy that was initially diagnosed with a PcommA aneurysm. She underwent a craniotomy with plans of microsurgical clipping; however, the dilatation was identified correctly as an infundibulum intraoperatively. The operation was completed as a microvascular decompression and her oculomotor nerve palsy has not returned at the 1-year follow-up. We provide a detailed microsurgical report and video detailing the operative technique and relevant anatomy for this operation. Although rare and not as life-threatening as aneurysms, infundibular dilatations as a cause of oculomotor nerve palsy should remain as a differential diagnosis. Given the difference in natural history and treatment of these two entities, it is important to diagnose and treat them appropriately. Multimodal imaging such as thin-sliced computed tomography angiogram (CTA) and 3-dimensional (3D) rotational angiography can aid in diagnosis.

Stochastic gradient descent algorithm for the predictive modelling of grate combustion and boiler dynamics.

Pressure and water level control are quite challenging in grate-fired boilers due to higher combustion lag. Fluctuation in the pressure and the water level is more evident in the coal-fired grate boilers due to the presence of lower volatile and higher char. This results in suboptimal operation and poor performance of the boiler. This paper presents a novel predictive and dynamic simulation model for the drum dynamics analysis of a grate-fired boiler by combining a data-driven model and a thermodynamic model. A data-driven methodology is employed for the estimation of combustion, heat transfers, and circulation performance of the boiler. A novel thermodynamic model is proposed for the boiler dynamics of a hybrid boiler. The proposed data-driven model has been integrated with the thermodynamic model to reduce the randomness and improve consistency. Pressure and water level errors are estimated by comparing the predicted value and experimental result and the multi-objective optimisation technique is employed for the minimisation of errors. The Stochastic Gradient Descent algorithm is proposed for its ability to quick learning and adaptation to variations in fuel and combustion characteristics. The model demonstrates good accuracy in predicting the combustion and boiler dynamics of a grate-fired boiler. The proposed model has good potential to be used for the reciprocating grate solid-fuel boiler control in fluctuating load conditions.

Primary intracranial extraosseous Ewing's sarcoma of the skull base in an elderly adult: illustrative case.

BACKGROUND: Primary extraosseous intracranial Ewing's sarcoma, also known as a peripheral primitive neuroectodermal tumor or "small round blue cell tumor," is an extremely rare entity with limited representation in the literature beyond the pediatric population. OBSERVATIONS: A 67-year-old male suffering occipital headache, nausea, and gait disturbance was found to have a large, avidly contrast-enhancing cerebellopontine angle mass extending into the cervical spinal canal with associated mass effect on medulla, cerebellum, fourth ventricle, and cervical spinal cord. This mass was not present on the imaging from 8 years prior. He underwent surgical debulking and pathology results demonstrated a malignant small round cell tumor showing diffuse immunopositivity for cytokeratins, CD99 and NKX2.2 with EWRS1-FLI1 rearrangement in 84% of the nuclei confirmatory of Ewing's sarcoma. After 14 cycles of chemotherapy and 6 weeks of radiotherapy, 22 months after discovery, the patient remains in clinical and radiographic remission with complete return to his baseline functioning. LESSONS: Primary skull base extraosseous Ewing's sarcoma should be considered in the differential diagnosis even in the elderly population when imaging studies demonstrate aggressive tumor growth patterns. Tumor debulking to establish a diagnosis followed by adjuvant chemoradiation therapy can result in clinical improvement with remission.

Urine Specific Gravity Measurement for Fluid Balance in Neonates on Intravenous Fluids in a Neonatal Intensive Care Unit: An Open Label Randomized Controlled Trial.

Background: Urine specific gravity reflects hydration status and correlates well with urine osmolality. OBJECTIVE: To compare intravenous fluid therapy guided with and without inclusion of urine specific gravity to the standard parameters for maintaining postnatal weight loss within permissible limits in neonates admitted to the intensive care unit. METHODS: An open-label randomized controlled trial was conducted, including neonates requiring intravenous fluids for ≥72 hours, randomized into the study (urine specific gravity guided fluids) and control arms. The outcomes of the study were to determine proportion of neonates with weight loss within permissible limits, mean percentage weight loss and number of days to reach maximum weight loss. RESULTS: 80 preterm and term neonates (40 in each arm) were enrolled. A comparable proportion of neonates had weight loss within permissible limits in study arm and in control arms [39 (97.5%) vs 36 (90%); P=0.165]. The (mean (SD) percentage weight loss was significantly less in the study arm compared to control arm [All neonates: 7.2(2.6) vs 9.3(3.5); P=0.004); preterm neonates: 7.7 (2.8) vs 11 (3.9); P=0.008)]. Preterm neonates in the study arm attained nadir weight significantly earlier than in the controls (P=0.03) and attained complete enteral feeding earlier. Urine specific gravity showed a moderate negative correlation with the percentage weight loss. CONCLUSION: Using urine specific gravity to regulate intravenous fluids in neonates resulted in a significant reduction in postnatal weight loss, especially in preterm neonates.

Practices and issues of moulting programs for laying hens: a review.

1. Moulting is a natural physiological process in birds when they shed their old feathers and replace them with new ones, and it is followed by reproductive quiescence resulting in reduced egg production. Different birds undergo moulting at different points in their life. Some birds have seasonal moulting while some moult at the end of their breeding cycle. This review will mainly focus on moulting practices associated with commercial layer birds because, in all other bird types, this is not managed.2. Commercial farms commonly analyse the cost-benefit ratio to decide the time and method to adopt for moulting. Commercial layer farms adopt different practices to force birds out of moult and restart the production cycle. Animal welfare groups consider this as stressful and against animal welfare, raising questions about the ethics of this practice.3. Many studies have been conducted using complete or partial feed withdrawal and non-feed withdrawal programs to measure their effectiveness in maintaining animal welfare, economy, and post-moult performance in mind.4. Animal welfare should not be compromised during moulting. The United States Egg Producers and other such groups from the United Kingdom and Europe have decided to sell eggs produced only through a non-feed withdrawal moulting programs.

The role of oligosaccharides and polysaccharides of xylan and mannan in gut health of monogastric animals.

Apart from its role as a digestive and absorptive organ, the gastrointestinal (GI) tract is a vital immune organ that encompasses roughly 70 % of the total immune cells of the body. As such, the physical, chemical and nutrient composition of the diet influences overall GI function, effectively as an immune organ. With the improvement in feed technology, agro-industrial co-products that are high in fibre have been widely used as a feed ingredient in the diets of pigs and poultry. Arabinoxylan (AX) and mannan are the most abundant hemicellulosic polysaccharides present in cereal grain and co-product ingredients used in the livestock industry. When monogastric animals consume diets containing high amounts of AX and mannans, stimulation of GI immune cells may occur. This involves the activation of several cellular and molecular pathways of the immune system and requires a considerable amount of energy and nutrients to be expended by the animal, which may ultimately influence overall health and growth performance of animals. Therefore, a better understanding of the role of AX and mannan in immune modulation will be helpful in modulating untoward GI immune responses, thereby minimising nutrient and energy expenditure toward this effort. This review will summarise pertinent research on the role of oligosaccharides and polysaccharides containing AX and mannans in immune modulation in order to preserve gut integrity.

Giant Granular Cell Tumor of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Note and Review of Literature.

BACKGROUND: Granular cell tumors (GCT) are rare soft tissue neoplasms with a nerve sheath origin, most often found in female adult populations. When these tumors arise in the central nervous system, they most commonly appear intradurally in the thoracic or lumbar spine. GCT malignancy rates vary and recurrence rates can be relatively high, thereby necessitating complete resection. CASE DESCRIPTION: We present an exceedingly rare case of an intradural, extramedullary GCT originating in the anterior cervical spine of a male pediatric patient who presented with progressive neck pain and gait instability. CONCLUSIONS: The patient underwent an anterior C7 corpectomy for resection of the tumor, followed by stabilization and fusion, and recovered without neurologic deficit. A literature review of spinal GCTs is provided.

Placement of C1 Lateral Mass Screw-Alternative Technique: 2-Dimensional Operative Video.

This operative video demonstrates a C1 lateral mass instrumentation technique that is an alternative to the traditional Goel and Harms techniques.1,2 The advantages of the alternative technique include minimized blood loss from the rich venous plexus surrounding the C2 dorsal root ganglia (DRG), avoidance and preservation of the C2 DRG, and placement of a robust fully threaded screw without risking neuralgia. These are discussed in detail and presented through a case of atlantoaxial instability. Patient's consent was obtained for creating this surgical video. The patient is a 50-yr-old woman with a 17-yr history of rheumatoid arthritis. She presented with 1 yr of neck pain that failed conservative measures. Flexion-extension radiographs demonstrated an atlantodental index (ADI) that reduced from 7 mm on flexion to 0 mm on extension. The patient underwent a C1-C2 posterior instrumented fusion using the alternative technique of C1 lateral mass instrumentation.2 The steps of this technique are explained in great detail through a microsurgical video. The patient's postoperative course was uneventful. Postoperative radiographs and computed tomography (CT) scan demonstrated reduction of ADI and well-placed instrumentation and fusion construct. Her neck pain was completely resolved by 3 mo following surgical stabilization. In the senior author's experience with placing over 120 C1 lateral mass screws with this alternative technique, there have been no instances of vascular injury, sacrifice of C2 DRG, or instrumentation failure. The alternative technique for placement of C1 lateral mass screw is safe, efficient, and holds certain advantages in comparison to the traditionally described method. Images within the video have been reproduced from AOSpine section of the AO Surgery Reference, www.aosurgery.org, with permission from AO Surgery. Copyright by AOSpine International, Switzerland; and reprinted from World Neurosurgery, 78(1-2), Kang MM et al, C2 Nerve Root Sectioning in Posterior C1-2 Instrumented Fusions, 170-177, Copyright 2012, with permission from Elsevier.

Effects of Cold Stimulation Induced Pain on Cardiopulmonary Parameters: A Gender Based Study.

Background Cold pressor induced pain elicits sympathetic responses which can be monitored by measuring blood pressure, heart rate and respiratory rate after exposure to the cold stress. Objective This study was done to evaluate gender difference in acute pain induced by cold pressor test on blood pressure, heart rate and respiratory rate of healthy individuals. Method Our study was cross sectional study with the sample size of 40 including 20 male and 20 female undergraduates. Acute pain was induced by immersion of hand in cold water at 4o C. Changes in blood pressure, heart rate and respiratory rate were recorded by the digital sphygmomanometer and AD Instruments (Model: ML856, Serial: T26-4025) and analysis was done by Lab Chart 7 Pro v 7.3.3 respectively. Acute pain parameter like pain threshold was also recorded. Statistical analysis was done by using Paired "t" test and non-parametric test. Result The present study enrolled 40 participants, aged between 18 - 24 years, and body mass index from 15.78 - 36.06 kg/m2 . The respiratory rate was increased in both males (17.30±3.19 to 19.0±3.21, P=0.01) and females (18.60±1.98 to 19.90±2.82, P= 0.01) however significant increase in heart rate was only found in females (77.80±8.07 to 80.70±7.80, P=0.03) after cold pressor test. The systolic as well as diastolic blood pressure did not increase significantly after cold pressor test. The pain thresholds ranged from 25.2 to 105.8 seconds (61.60±23.26, male Vs. 52.69±18.49, female, p = 0.188). Conclusion Our findings point towards autonomic adjustments suggesting more of sympathetic over activity immediately after cold pressor test.

Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by jolts of pain along the distribution of the trigeminal nerve. If patients fail conservative management, microvascular decompression (MVD) is the next step in treatment. MVD is largely done by placing implant pads between the nerve and compressing vessels. We conducted a literature review to assess effectiveness and safety of Teflon™ and Ivalon® sponges for treatment of TN with MVD. METHODS: In January 2019, PubMed was searched for manuscripts published in English using permutations of "Microvascular decompression", "Teflon", "Ivalon", "Granuloma", "Polytetrafluoroethylene", "Trigeminal Neuralgia", and "Exploration". Success and relapse rates, causes of relapse, and complication rates were analyzed. We analyzed for relationships with ANCOVA at an alpha threshold of .05. RESULTS: Thirty-six studies representing 4273 patients fit inclusion criteria. Twenty-five dealt with initial MVD, 12 with re-do MVD. Initial MVD initial success rates were 85% in patients receiving Teflon™ (57-100%*) and 91% in patients receiving Ivalon® (79-100%*). Recurrence rates were 12% in Teflon™ patients (0*-30%) and 9.1% in Ivalon® patients (0*-19%). In patients with relapses, implants were the cause in 49% of Teflon™ patients (0*-100%*) and 50% of Ivalon® patients (0*-100%*). Complication rates for patients receiving Teflon™ were 12% (0*-34%) and 19% for patients receiving Ivalon® (0*-40%). CONCLUSION: Teflon™ and Ivalon® are two materials used in MVD for TN. It is an effective treatment with long-term symptom relief and recurrence rates of 1-5% each year. Ivalon® has been used less than Teflon™ though is associated with similar success rates and similar complication rates.

Facial Nerve Schwannoma Complicated by Acute Hemorrhage After Treatment with Stereotactic Radiosurgery.

BACKGROUND: Facial nerve schwannomas (FNSs) are rare benign tumors that arise from Schwann cells of the facial nerve. FNSs are similar to vestibular schwannomas in many aspects, yet their infiltrative nature into the facial nerve fascicles warrants a more conservative management approach. In the last decade, stereotactic radiosurgery (SRS) has shown promise in stabilizing or shrinking FNSs. CASE DESCRIPTION: A 71-year-old woman presented with mild facial paresis. Tumor growth after a period of watchful waiting warranted treatment with SRS, which was complicated by an acute posterior fossa hemorrhage and brainstem compression, necessitating microsurgical hematoma evacuation, tumor resection, and facial nerve substitution. CONCLUSIONS: SRS has led to better facial nerve function and outcomes and is currently considered a reasonable alternative to microsurgical resection in patients with FNSs. This is the first report to our knowledge of an acute, life-threatening hemorrhage after SRS in a patient with FNS.

Arterial Sling Decompression for Hemifacial Spasm.

Hemifacial spasm is a cranial nerve compression syndrome caused by impingement on the facial nerve most frequently by the anterior inferior cerebellar artery or the posterior inferior cerebellar artery. It can be treated with microvascular decompression (MVD) to separate the nerve from the offending artery. Rarely, a large-caliber vessel such as a dolichoectatic vertebrobasilar system may be implicated, requiring more than an MVD. One technique involves placing a sling around the offending vessel to decompress the facial nerve. We find our "neck-tie" technique to be unique and present it in this detailed video. A 36-year-old-woman presented with a 3-month history of severe left hemifacial spasm refractory to medical management. Imaging demonstrated compression of the left facial nerve and its root entry zone by a dolichoectatic vertebrobasilar complex and anterior inferior cerebellar artery. A left retrosigmoid craniotomy was performed. A Dacron sling was placed around the offending vertebral artery in a "neck-tie" fashion. This sling was used to displace the vertebral artery off of the facial nerve and the sling was then sutured in its final position to the petrous dura. In addition, MVD was performed around the facial nerve's root entry zone. Following sling placement and MVD, neuromonitoring demonstrated absence of abnormal motor responses. Postoperative course was uneventful, she remained neurologically intact, and she remained free of symptoms at 6 months' follow-up. This video highlights the decision making for selecting the appropriate case of hemifacial spasm for sling decompression, the key technical nuances, and complication avoidance in these challenging cases.

Cerebral arteriovenous malformation rupture in pregnancy.

A 30-year-old nulliparous woman at 38 5/7 weeks of gestation developed a sudden, severe headache at work and subsequent loss of consciousness. She underwent evaluation in the emergency department. CT and CT angiogram head revealed a large intraparenchymal haematoma with intraventricular extension secondary to ruptured cerebral arteriovenous malformation (cAVM). She was intubated and transferred to a tertiary care centre. The patient underwent caesarean section followed by partial embolisation of the cAVM with planned second embolisation and resection 1 week later. Due to drowsiness and headache, the planned repeat embolisation and cAVM resection were performed 3 days earlier. The patient had a full recovery. Emergency medicine physicians and obstetrician-gynaecologists should be familiar with differential diagnosis of sudden headache in pregnancy and signs of a ruptured cAVM to facilitate early diagnosis, multidisciplinary team approach and timely treatment. Early diagnosis and management of ruptured cAVM are important due to associated morbidity and mortality.

Effects of a combination of xylanase, amylase and protease, and probiotics on major nutrients including amino acids and non-starch polysaccharides utilization in broilers fed different level of fibers.

This study evaluated the effects of a combination of xylanase, amylase, and protease (XAP), with probiotics (3 Bacillus spp.) supplementation on apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of nutrients in Cobb 500 broilers from 0 to 21 d. A completely randomized 2 × 4 factorial design (2 levels of fiber; 4 types of supplements) with 8 replicate cages (6 birds/cage) was used. Each low and high-fiber diet contained 500 FTU/kg Buttiauxella sp. phytase and was supplemented with: (a) none (control), (b) XAP (2,000 U xylanase + 200 U amylase + 4,000 U protease/kg diet), (c) probiotics (75,000 CFU/g of Bacillus spp.), or (d) XAP + probiotics. High fiber decreased (P < 0.05) nitrogen-corrected apparent metabolizable energy (AMEn), AID of all amino acids (AA), AID and ATTD of dry matter (DM), crude protein (CP), starch, and gross energy (GE). High fiber increased (P < 0.01) the flow of total non-starch polysaccharides (NSP) in both ileum and total tract. The XAP + probiotics increased (P < 0.01) AMEn as well as AID and ATTD of DM, CP, GE, starch, while alone, XAP yielded similar improvement except for DM compared with control. The supplemental XAP alone improved (P < 0.01) the digestibility of most of the AAs compared with control. Moreover, XAP + probiotics increased (P < 0.05) AID of all AA except arginine and serine compared with control. A fiber × supplements interaction (P < 0.05) was found for AID of histidine and threonine, and their digestibility in high-fiber diet was improved to a level comparable to low-fiber diet by XAP + probiotics. The flow of NSP in XAP group was 5 to 6% lower than in control while NSP flow in XAP + probiotic group was further 4% lower than that of XAP group (P < 0.01). The results infer that the combination of XAP and probiotics can effectively optimize the nutrient digestibility in broilers fed both low and high-fiber diets.

Changes in middle ear transmission characteristics secondary to altered bone remodelling.

Alteration in the process of bone remodelling results in conditions like osteopenia and osteoporosis in which the bones become susceptible to fracture. The functioning of middle ear bones in such individuals were assessed in this study and it was found that the middle ear bones are equally susceptible to micro-fractures and can cause reduction in the transmission of sound energy. INTRODUCTION: Alteration in the process of bone remodelling or increase in the number of osteoclasts cells as it occurs in osteoporosis and osteopenia are likely to affect the middle ear bones in the same way it affects the skeletal bones. Whether these micro-structural changes occurring at the level of the middle ear secondary to altered bone remodelling cause any significant impairment in its functioning is not explored. Thus, the present study aimed at assessing the different aspects of middle ear functioning in individuals with reduced BMD. METHODS: The study included 25 normal, 39 osteopenic and 40 osteoporotic participants. The participants underwent pure-tone audiometry, otoscopic examination, conventional immittance evaluation using a 226 Hz probe tone, multi-component and multi-frequency tympanometry and acoustic reflex threshold testing. None of the participants had any current or previous history of middle ear effusion. RESULTS: A significantly higher proportion of participants in the clinical group had hearing loss compared to the normal group. The clinical group participants also had reduced middle ear resonance frequency, elevated static compliance values and elevated or absent acoustic reflexes compared to the normal participants. There was no difference among the three groups for the proportion of participants having conductive hearing loss. CONCLUSIONS: There is a detrimental impact of reduction in bone mineral density on middle ear transmission characteristics which may go unnoticed initially. Treatment of osteoporosis may potentially mitigate hearing loss from middle ear fractures due to reduced bone mineral density. Absence of significant air-bone gap with the presence of reduced middle ear resonance frequency may be early signs of reduced BMD.

Skin Conductance and RR Interval for Regulated Discrete Physiological Stimuli: A Two Prong Strategy to Detect Sympathetic Activation.

Background Several studies have found skin conductance a good indicator for detection of sympathetic response. But, valid and reliable tool for detection of sympathetic outflow in health and disease is still a quest. Thereby, comparison of superficial and, at core sympathetic effluence induced by deliberately supplied discrete external stimuli has been attempted in this study. Objective To assess the degree of sympathetic outflow for discrete cognitive and physical stimuli through perturbations in skin conductance and variations in heart rate in healthy adults. Method Quantitative and cross-sectional study was performed in 104 healthy subjects following random sampling method. Induction of sympathetic activity was realized by providing separate time bound cognitive exercises intervened with change in posture. Recordings to detect sympathetic responses at rest and, for supplied stimuli were made by electrocardiogram and galvanic skin response. Result Cognitive performance and postural change shifts baseline effluence and increases the sympathetic outflow significantly (p=0.000). There occurs no detectable rise in sympathetic effluence at the core (p=0.362) but, eventuate significantly appreciable sympathetic outflow to sweat glands in skin (p=0.000), when compared cognitive versus physical stimuli. Conclusion Sympathetic outflow induced by cognitive challenge and physical change in posture is readily assessable through sympathetic skin response yet core sympathetic effluence for latter stimuli is steady and unwavering. Differential effluence for sympathetic response called upon by discrete stimuli is operational for maintenance of steady state in healthy subjects.

Carcinoma of the Tongue in Renal Transplant Recipients: An Unusual Spectrum of De novo Malignancy at a Tertiary Care Center in India Over a Period of 26 Years.

Renal transplant recipients are at a higher risk of malignancy. We report our experience and the critical differences in the presentation of malignancy in kidney transplant patients performed at our tertiary care center and followed up over the period of 1990-2015. A total of 338 live donor transplants performed in 332 patients were analyzed. Induction immunosuppression was used in 22 cases with interleukin-2 (IL-2) receptor antibody. Overall 299 patients were continued on calcineurin inhibitor (CNI)-based triple drug immunosuppression, 33 were off CNI with 13 of them receiving sirolimus additionally. A total of 16 malignancies including post transplant lymphoproliferative disease (5), oral cancer (5), lung cancer (2), hepatobiliary cancer (2), colon cancer (1), and skin cancer (1) were diagnosed in 15 patients. Over the 26-year follow up, 138 patients died of whom 12 died due to cancer. Cancer occurred in 4.7% of patients but accounted for 9.4% of deaths. Oral cancer occurred after a significantly longer latency of over 10 years (212 vs. 94 months, P = 0.00652). Despite the longer latency, oral cancer patients were younger at diagnosis (44.0 vs. 52 years, P = 0.01016) and had better outcome (Fisher's exact test, P = 0.0275). This was despite a longer overall follow-up for the oral cancer patients, reflecting the better outcome for these patients (24 vs. 4 months, P = 0.0278). This might be the result of relatively early diagnosis of oral cancers.