Eril's Branch-Based Perforator Plus Chondro-Cutaneous Flap for Reconstruction of Upper Third Helico-Scaphal Defects: A Clinical and Cadaver Study.

Reconstruction of upper third helico-scaphal defects (HSDs) exacts the expertise of the reconstructive surgeon. These three-dimensional defects deviate from normal facial form and cause a significant impact on the psyche of the patients. The origin, course, and dimensions of the perforators of the Eril's branch arising from superficial temporal vessels (EBSTV) were delineated by dissection and injection study. They were examined in twenty-four adult specimens. A prospective cohort study was conducted from March 2017 to March 2020, including six patients whose upper third HSDs were reconstructed with perforator plus chondro cutaneous flap based on EBSTV. After the debridement of the defect, the perforator plus chondro cutaneous flap was harvested from retro auricular sulcus skin with attached cartilages from triangular fossa and interhelical groove. The donor site was closed primarily, and the flap was rotated onto the defect. Superficial temporal vessels give a constant Eril's branch at the level of the root of the helix (otobasion superioris), which in turn divides into two perforators -superficial (lateral) and deep (medial) perforators. All six patients with post-traumatic upper third HSDs (4 males and 2 females) after reconstruction were followed for an average period of 15 months. The average age was 36.5 yrs. On average, two cartilages of maximum dimensions 3 × 2.5 mm were included in the perforator plus chondro cutaneous flap based on the medial-deep perforator of the EBSTV. In all six cases, the flaps survived without any complications. The average final computed institutional objective and subjective score was 15.67 (excellent results) (chi-square test, the p value was (p = 0.035) significant). The perforator plus chondro-cutaneous flap based on deep medial perforator of EBSTV may be a useful addendum in the armamentarium of plastic surgery. This novel reconstruction technique of upper helical defects provides good shape, size, and aesthesis of the upper external ear.

Efficacy and Safety of Pregabalin Prolonged Release-Etoricoxib Combination Compared to Etoricoxib for Chronic Low Back Pain: Phase 3, Randomized Study.

INTRODUCTION: Currently available treatments for chronic lower back pain (CLBP) do not adequately address both nociceptive and neuropathic components of pain. We evaluated efficacy and safety of fixed-dose combination (FDC) of low-dose pregabalin prolonged release 75 mg-etoricoxib 60 mg to address both pain components. METHODS: This randomized phase 3 trial conducted at 12 centres across India evaluated efficacy (based on mean change in numeric rating scale [NRS], Roland-Morris disability questionnaire [RDQ], visual analogue scale [VAS], patient global impression of improvement [PGI-I], clinical global impression of improvement [CGI-I] and rescue medication consumption) and safety of FDC in comparison to etoricoxib alone in adult patients with CLBP. Treatment duration was 8 weeks. RESULTS: Of the 371 patients screened, 319 were randomized and considered for efficacy and safety analysis. Both treatment groups had no significant difference in terms of demography and baseline disease characteristics. Significantly better outcomes with FDC compared to etoricoxib were observed at week 4 onwards. At week 8, both groups showed significant reduction in mean NRS score from baseline (- 4.00 ± 1.65 in FDC; - 2.92 ± 1.59 in etoricoxib) with mean NRS score being significantly less in the FDC group compared to etoricoxib group (3.26 ± 1.56 vs 4.31 ± 1.56; p < 0.0001). The FDC was more effective than etoricoxib in terms of significantly greater reduction in RDQ score (- 9.28 ± 4.48 vs - 6.78 ± 4.34; p < 0.0001) and VAS score (- 37.66 ± 18.7 vs - 28.50 ± 16.31; p < 0.0001) at week 8. The FDC was also better in terms of significantly more patients reporting their condition as 'very much better' (36.9% vs 5.0%; p < 0.0001) and clinicians reporting patient's condition as 'very much improved' (36.3% vs 5.7%; p < 0.0001). Overall, study medications were well tolerated. CONCLUSION: FDC of pregabalin and etoricoxib provided significant benefits in reducing pain and improving functional status compared with etoricoxib alone in patients with CLBP. Pregabalin prolonged release-etoricoxib FDC could be one of the treatment options for early and sustained pain relief and improvement in quality-of-life in treating CLBP as it addresses both neuropathic and nociceptive components of pain. TRIAL REGISTRATION: CTRI/2018/10/015886.

Low back pain is one of the most common causes of loss of productivity worldwide. About 60% of Indians suffer from low back pain at some point. Low back pain that persists for more than 3 months is classified as chronic low back pain which mostly includes both nociceptive and neuropathic components. Monotherapies, if prescribed, are not completely effective, as they generally only target either nociceptive or neuropathic components of pain. Multiple drugs are usually needed at multiple times a day, at higher doses for optimal effectiveness, and in most cases they have significant side effects if taken over prolonged periods and also add to the pill burden. To minimize treatment-associated adverse effects, and to increase treatment compliance, while addressing both the components of pain, we developed a fixed-dose combination of low-dose pregabalin prolonged release and etoricoxib. A phase 3 trial was designed to assess the efficacy and safety of the fixed-dose combination in comparison with etoricoxib alone in treating chronic low back pain. The combination demonstrated statistically and clinically significant improvement in patient-reported outcomes­pain, functionality and quality of life­as early as 4 weeks after starting the medication. No severe or serious adverse effects were reported. Thus, the combination of low-dose pregabalin prolonged release and etoricoxib could provide an option for optimal management of chronic low back pain. This would provide multiple benefits, such as addressing both nociceptive and neuropathic components of chronic low back pain, reducing drug-related adverse effects because of low dose, reducing pill burden and thereby increasing drug compliance.

Two new species and two new records of the genus Tenuibaetis Kang & Yang, 1994 (Ephemeroptera: Baetidae) from Indian Himalaya.

As part of ongoing exploration of the mayflies of streams and rivers of Indian Himalayan regions, we describe two new species of the genus Tenuibaetis based on recently collected materials from Western Himalaya viz., Tenuibaetis himani Kubendran, Vasanth & Subramanian sp. nov. and Tenuibaetis kangi Kubendran, Vasanth & Subramanian sp. nov. Additionally, two new records from Eastern Himalaya viz., T. arduus (Kang & Yang, 1994) and T. inornatus (Kang & Yang, 1994) are presented. The biological notes of the stream/rivers are appended. A key to the known Indian species of the genus Tenuibaetis and a distribution maps are provided.

Contribution to the study of Epeorus Eaton, 1881 (Ephemeroptera: Heptageniidae) from India.

Seven species of the genus Epeorus Eaton, 1881 are described so far from India of which redescription is attempted herein for 3 species viz. E. (C.) psi Eaton 1883, E. (E.) gilliesi Braasch 1981, E. (E.) petersi Sivaruban, Venkataraman Sivaramakrishnan 2013 based on the fresh collections. Four species viz., E. (E.) aculeatus Braasch 1990, E. (E.) bifurcatus Braasch Soldán 1979, E. (E.) unicornutus Braasch 2006 and E. (E.) unispinosus Braasch 1980 are new records to this country. Totally, 11 species of the genus Epeorus from India are dealt with herein of which six belongs to the subgenus Epeorus viz. E. (E.) aculeatus Braasch 1990, E. (E.) bifurcatus Braasch Soldán 1979, E. (E.) gilliesi Braasch, 1981 and E. (E.) petersi Sivaruban, Venkataraman Sivaramakrishnan 2013, E. (E.) unispinosus Braasch 1980, E. (E.) unicornutus Braasch 2006 and four to the subgenus Caucasiron viz., E. (C.) kapurkripalanorum Braasch 1983, E. (C.) papillatus Braasch, 2006a, E. (C.) psi Eaton 1883 which larva is described in details for the first time and E. (C.) suspicatus Braasch, 2006b . The subgeneric status of E. lahaulensis Kapur Kripalani 1963 cannot be fixed due to non-availability of larval description. A dichotomous key to the larvae of available species in India is presented. Distribution of subgenera and species within India is discussed.

Overview of Indian Hyrtanellini (Ephemeroptera: Ephemerellidae), with new species and records from related regions.

The Hyrtanellini (Ephemeroptera: Ephemerellidae: Ephemerellinae) from India and related regions are reviewed, including three new species viz., Serratella palatovi Martynov, Selvakumar Jacobus, sp. nov., Torleya simbalbarensis Selvakumar, Subramanian, Martynov Jacobus, sp. nov., and Torleya dibruensis Selvakumar, Martynov Jacobus, sp. nov.; and first country records of Teloganopsis jinghongensis (Xu, You Hsu, 1984) and Hyrtanella grandipennis (Zhou, Su Gui, 2000). Description of Serratella palatovi sp. nov. is based on material from Thailand, India and Nepal; Torleya simbalbarensis sp. nov. and Torleya dibruensis sp. nov. are described based on material from India. For now, the tribe Hyrtanellini in India comprises eight species from the genera Serratella Edmunds, 1959, Torleya Lestage, 1917, Teloganopsis Ulmer, 1939 and Hyrtanella Allen Edmunds, 1976. Additional records of Teloganopsis jinghongensis from Thailand, Torleya nepalica (Allen Edmunds, 1963) and Torleya coheri (Allen Edmunds, 1963) from Nepal also are provided here. All Indomalayan Hyrtanellini species are discussed to some extent.

Overview of Indian and Nepali representatives of the Cincticostella nigra (Uéno, 1928) complex (Ephemeroptera, Ephemerellidae), with discussion about Cincticostella Allen, 1971 species complexes.

The concept of the Cincticostella nigra (Uéno, 1928) (Ephemeroptera: Ephemerellidae) complex is clarified and Indian and Nepali representatives of the complex are reviewed. Four new species are described viz. Cincticostella changfai Martynov & Palatov, sp. nov., Cincticostella funki Martynov, Selvakumar, Palatov & Vasanth, sp. nov., Cincticostella shinichii Martynov & Palatov, sp. nov. and Cincticostella wangi Selvakumar, Martynov & Subramanian, sp. nov. The larva of C. corpulenta (Braasch, 1981) is re-described, based on the holotype and paratypes. Cincticostella gosei (Allen, 1975) is recorded from India for the first time. Morphological differences of the species complexes of Cincticostella Allen, 1971 are analysed. A new species complex, Cincticostella gosei complex, is proposed. Summaries of distribution data and habitat preferences, as well as new larval diagnoses, are presented for all species of the Cincticostella nigra complex.

Three new species of Atalophlebiinae (Ephemeroptera: Leptophlebiidae) of India, with a new record of the genus Megaglena Peters and Edmunds, 1970.

Three new species of Leptophlebiidae viz., Choroterpes (Choroterpes) andamanensis Vasanth, Subramanian Selvakumar n. sp., Edmundsula meghamalaiensis Vasanth, Subramanian Selvakumar n. sp. and Megaglena agasthiya Vasanth, Subramanian Selvakumar n. sp. are described based on our recent exploration of mayflies from the streams of Andaman Island, Tamil Nadu and Kerala part of the southern Western Ghats. The genus Megaglena Peters Edmunds, 1970 has extended the distribution in southern peninsular India as represented by the occurrence of M. agasthiya n. sp. Larval key is provided to the known and new species of subgenus Choroterpes of India along with the distribution map of new species.

A new species of Notacanthurus Tshernova, 1974 (Ephemeroptera: Heptageniidae) from India.

A new species of Notacanthurus Tshernova, 1974 is described based on larvae from India. Notacanthurus pange Vasanth, Selvakumar Subramanian sp. nov. can be distinguished from all known species of Notacanthurus by the following combination of characters: (i) gill lamellae 5-6 with accessory lobe; (ii) dorsal surface of femora with scattered spatulate setae (iii) male genitalia having penis lobes fused, 'V' shaped apically blunt with me-dian pair of spine-like titillators subapically and mesally; (iv) labrum with anterior portion straight and laterally curved; and (v) lingua of hypopharynx apically broad and convex. The distribution map of the new species is also provided.

New record of the genus Baetiella Uéno, 1931 (Ephemeroptera: Baetidae) from India with description of a new species and new records for five species.

A new species of the genus Baetiella is described based on larvae collected from Arunachal Pradesh, India. Baetiella subansiri Vasanth, Selvakumar Subramanian n. sp. can be distinguished by the following combination of characters: (i) gills (or gill sockets) on segments I-VI; gills I-V elongate, without tracheation, with numerous scattered pores on the surface and smooth fine simple setae along margin; gill VI reduced; (ii) posterior margin of metanotum and abdominal terga I-II each with a single posteromedian protuberance, terga III-IX each with a pair of much longer protuberances; and (iii) claw with two rows of denticles, outer row with 6-7 acute denticles increasing in length apically, inner row with 6-7 short and blunt denticles medially, subequal in length. New records of Baetiella armata Braasch, 1983, B. ausobskyi Braasch, 1983, B. imanishii Braasch, 1983, B. marginata Braasch, 1983 and B. spathae Shi Tong, 2015 from Arunachal Pradesh, India are presented based on the collection of larvae. The four species of Baetiella described by Braasch (1983) are redescribed based on freshly collected material. The Known distribution of genus Baetiella from Arunachal Pradesh, India is also provided.

A new record of the family Isonychiidae (Insecta: Ephemeroptera) from the Western Ghats, India with a description of new species.

A new species belonging to the subgenus Isonychia, of the genus Isonychia Eaton, 1871, is described based on larvae and imagoes collected from Moyar River, Nilgiri District, Tamil Nadu, India. The imagoes of I. moyarensis n. sp. can be distinguished from other described Oriental species of Isonychia (Isonychia) by the combination of characters: (i) forewing with rusty brown maculae in the costal, subcostal, and median areas; (ii) femur and tibia brown, fore leg pale, apices of tarsal segments brownish; (iii) males with distal angles of penes rounded, without serrations; (iv) second segment of gonostylus uniformly convex; and (v) sterna of tenth abdominal segment in female deeply cleft. Isonychia (Isonychia) moyarensis n. sp. can be distinguished in the larval stage from other known Oriental species by the following combination of characters: (i) abdominal terga II-IX with median dark brown maculae progressively larger with dark brown slanting streaks in lateral margins; (ii) trachea of abdominal gills I-VII unbranched; (iii) posterolateral projections on abdominal segments I-VII blunt and progressively longer than those of segments VIII-IX, sharp and distinct; and (iv) abdominal terga X pale yellow in anterior ⅓, and dark brown in the posterior ⅔. A key to the known larvae of Oriental species of Isonychia is also provided.

Inflammatory Myositis-Secondary to SLE.

Inflammatory myositis involving the proximal muscles has been reported to occur in 5% to 11% of SLE patients and may develop at any time during the course of the disease. It can be secondary to internal malignancies also. We report one such patient who presented with generalised muscle weakness for 7 months. Erythematous hyperpigmented scaly patches were present over the scalp, face, trunk, upper limbs. We discuss the inflammatory myopathies secondary to SLE and internal malignancies. Most cases responds to low-dose corticosteroid treatment.

Review of the Cincticostella insolta (Allen, 1971) complex (Ephemeroptera: Ephemerellidae), with description of three new species from northern India and Nepal.

The Cincticostella insolta complex (Ephemeroptera: Ephemerellidae) is reviewed based on new and historic material, as well as new field observations. Three new species are described viz., C. richardi Martynov Palatov, sp. nov. and C. ranga Selvakumar Subramanian, sp. nov. from India, and C. sivaramakrishnani Martynov Palatov, sp. nov. from Nepal. A correction of the original description and some additional distinguishing features are given for C. braaschi Jacobus McCafferty, 2008. Cincticostella insolta (Allen, 1971), C. braaschi and C. bifurcata Xie, Jia, Chen, Jacobus Zhou, 2009 are recorded from the Indian subregion for the first time. Summaries of known distribution data and habitat preferences, as well as larval diagnoses, are presented for all seven species of the complex.

Gunn-Hilsum Effect in Mechanically Strained Silicon Nanowires: Tunable Negative Differential Resistance.

Gunn (or Gunn-Hilsum) Effect and its associated negative differential resistivity (NDR) emanates from transfer of electrons between two different energy subbands. This effect was observed in semiconductors like GaAs which has a direct bandgap of very low effective mass and an indirect subband of high effective mass which lies ~300 meV above the former. In contrast to GaAs, bulk silicon has a very high energy spacing (~1 eV) which renders the initiation of transfer-induced NDR unobservable. Using Density Functional Theory (DFT), semi-empirical 10 orbital (sp3d5s*) Tight Binding and Ensemble Monte Carlo (EMC) methods we show for the first time that (a) Gunn Effect can be induced in silicon nanowires (SiNW) with diameters of 3.1 nm under +3% strain and an electric field of 5000 V/cm, (b) the onset of NDR in the I-V characteristics is reversibly adjustable by strain and (c) strain modulates the resistivity by a factor 2.3 for SiNWs of normal I-V characteristics i.e. those without NDR. These observations are promising for applications of SiNWs in electromechanical sensors and adjustable microwave oscillators. It is noteworthy that the observed NDC is different in principle from Esaki-Diode and Resonant Tunneling Diodes (RTD) in which NDR originates from tunneling effect.

Review of Ptilomera (Ptilomera) (Hemiptera: Heteroptera: Gerridae) from India, with description of a new species.

The subgenus Ptilomera (Ptilomera) Amyot Serville, 1843 of India is reviewed and Ptilomera (P.) nagalanda Jehamalar Chandra, sp. nov. is described from Peren District, Nagaland, India. The new species can clearly be distinguished from its congeners in India by the presence of silvery white setae on the sub-lateral region of the meso- and metanota and the presence of a fringe of fine short setae of different lengths on the flexor region of the mid femur reaching beyond the middle in the male. Detailed illustrations of the apterous male of the new species and male and female of other species of Ptilomera, except P. occidentalis Zettel, are given. Distribution maps and a key to all known species of Ptilomera (Ptilomera) in India are given.

A new species of Thalerosphyrus Eaton 1881 (Ephemeroptera: Heptageniidae: Ecdyonurinae) from India.

A new species of Thalerosphyrus Eaton 1881 is described based on larvae collected from East Khasi Hills district and East Jaintia Hills district of Meghalaya. Thalerosphyrus meghalayensis Selvakumar & Chandra  n. sp. can be distinguished from other known species of the genus by the following combination of characters: (i) posterolateral expansions of segment VIII always shorter than those of segment VII; (ii) pronotum moderately enlarged laterally; (iii) bristles on the dorsal face of hind femora truncate or round at apex; (iv) hind tibia with a row of thin setae; (v) outer margin of superlinguae evenly covered with long setae ending at apex by minute setae and (vi) posterior margin of tergites with regularly pointed teeth, and numerous microdenticles. A modified larval key is provided for known species of this genus.

A new species of Choroterpes Eaton, 1881 (Ephemeroptera: Leptophlebiidae) from India.

A new species of Choroterpes Eaton, 1881 is described based on the larvae from India. Choroterpes (Choroterpes) kaegies sp. n. can be distinguished from other known species of the subgenus by the following combination of characters: (i) anteromedian emargination of labrum broad; (ii) each femur with a dark brown spot at middle and near apex; (iii) gill 1 single and slender and (iv) upper and lower lamellae of gills 2-7 with 3 apical processes, median process relatively slender and longer than laterals. A key to the known species of Choroterpes Eaton, 1881 in India is also provided.

A new species of Prosopistoma Latreille, 1833 and redescription of P. indicum Peters, 1967 (Ephemeroptera: Prosopistomatidae) from the Western Ghats, India.

Prosopistoma someshwarensis n. sp. is described based on larvae collected from the streams of central Western Ghats, and P. indicum Peters, 1967 is redescribed based on fresh material from additional localities of the southern and central Western Ghats of peninsular India. A brief discussion on their ecology and biogeography, and a key to the Indian species of Prosopistoma, are also provided. The Indian species may be distinguished from one another based on the segmentation of the antennae, carapace colourations, the setation of the tibiae and mandibular canines, and the morphology of gills 2.

A new species and a new record of the subgenus Dilatognathus Kluge 2012 (Ephemeroptera: Leptophlebiidae: genus Choroterpes Eaton, 1881) from India.

A new species belonging to the subgenus Dilatognathus of the genus Choroterpes is described based on larvae collected from Andaman and Nicobar Islands. Choroterpes (Dilatognathus) nicobarensis n. sp. can be distinguished from all other species of Dilatognathus by the absence of a tusk on the maxillary apex, has ventro-apical flange and dentiseta directed distally, as in Choroterpes other than Dilatognathus. Choroterpes (Dilatognathus) nigella (Kang & Yang 1994) is newly recorded based on larvae collected in Arunachal Pradesh, Meghalaya and West Bengal. Remarks on the evolution of the mouth apparatus of the subgenus Dilatognathus are given.

An Interesting Case of a Movement Disorder.

Neuroacanthocytosis is a genetic neurodegenerative disorder with syndromes of variable inheritance. These hyperkinetic movement disorders are reported to be very rare. It is associated with choreiform movements, orofacial and lingual dyskinesias and acanthocytes on peripheral smear and normolipoproteinemia. Here we present a similar case.

A new genus and species of Atalophlebiinae (Insecta: Ephemeroptera: Leptophlebiidae) from Palni hills of the southern Western Ghats, India.

A new genus and new species of Atalophlebiinae, Klugephlebia kodai Selvakumar, Subramanian & Sivaramakrishnan, are described based on male and female imagos and larvae from Palni hills of the southern Western Ghats of India. The imago of Klugephlebia gen. n. can be differentiated from all other genera of Atalophlebiinae by having the combination of vein MP forked slightly less than half of the distance from base to margin, MP2 attached at base to vein MP1 by a crossvein, a distinctive shape of the hindwing, dissimilar claws on each leg, and distinctive genitalia structures. The larva can be distinguished from other Atalophlebiinae larvae by having the combination of gills present on abdominal segments 1-7, dorsal and ventral portions of lamellae of gills 1 slender and lanceolate with branched tracheae, dorsal and ventral portions of lamellae of gills 2-7 wider & lanceolate and long & suddenly tapering at apex, fore and mid femora with regular rows of long thin setae on outer margins, denticles on claws progressively larger apically, a distinctive labrum, the maxillary palp short with long setae on third segment, and the third segment of the labial palp with distinct setation. The larvae cling to the underside of boulders in the middle of streams where the boulders lie amidst sand and silt. Updated keys to the genera of south Indian Leptophlebiidae are provided.