Optimize an effective triboelectric nanogenerator surface morphology to harvest the human wrist pulse pressure: A numerical study on finite element method.

This paper presents the optimized surface morphology to enhance transferred charge between the mental and dielectric of the modelled triboelectric nanogenerator. The structured shape of the dielectric layer is a vital factor in enhancing the output performance of the triboelectric nanogenerator. In this study, flat, cone, circular and rectangular shapes are structured on the dielectric surface of TENG. Its output performance is examined by conducting a numerical study on the finite element method in COMSOL Multiphysics software. Among the above stated structured surface TENGs, the structured rectangular surface triboelectric nanogenerator produces an improved output open-circuit voltage of 26 V for an externally given 3K Pascal pulse pressure as input. Hence, the result indicates that the structured surface TENGs can make a portable self-powered healthcare device such as heart rate, respiratory rate, and blood pressure measurement.

Is simple nephrectomy the right nomenclature? - Comparing simple and radical nephrectomy to find the answer.

Introduction: The word "simple" means "easily done" or "presenting no difficulty." Hence, the "Simple Nephrectomy" (SN) operation should be "easy to perform." However, in clinical practice, we have noticed that SN can be equally or more challenging surgery than radical nephrectomy (RN). This study assesses the need to modify the terminology of simple nephrectomy and identify the level of difficulty between SN and RN by comparing various intraoperative and postoperative factors. Methods: Patients undergoing open SN for benign renal disease (Group A) and RN for T1/2 renal tumors (Group B) were included in the study. Two groups were compared for operative time, estimated blood loss, postoperative complications, blood transfusion rate, and length of hospital stay. Results: A total of 114 patients were analyzed (82 in Group A and 32 in Group B). Mean age of the patients was higher in Group B (41.2 vs 53.6 years, P < 0.01). Mean operative time (136.8 vs 125.5 min, P = 0.08), incidence of postoperative complications (32.9% vs 25%, P = 0.50), length of hospital stay (7.2 vs 6.5 days, P = 0.09), estimated blood loss more than 500 ml (13.4% vs 9.3%, P = 0.75), and requirement of blood transfusion (10.9% vs 6.2%, P = 0.72) were higher in group A. Conclusion: The application of correct terminology is important to understand the subject and to convey the information. Simple nephrectomy is not an appropriate term as it is equally challenging to perform than its radical counterpart.

Microplastic pollution in fragile coastal ecosystems with special reference to the X-Press Pearl maritime disaster, southeast coast of India.

Microplastics (MPs) are a global environmental concern and pose a serious threat to marine ecosystems. This study aimed to determine the abundance and distribution of MPs in beach sediments (12 beaches), marine biota (6 beaches) and the influence of microbes on MPs degradation in eco-sensitive Palk Bay and Gulf of Mannar coast. The mean MP abundance 65.4 ± 39.8 particles/m2 in beach sediments; 0.19 ± 1.3 particles/individual fish and 0.22 ± 0.11 particles g-1 wet weight in barnacles. Polyethylene fragments (33.4%) and fibres (48%) were the most abundant MPs identified in sediments and finfish, respectively. Histopathological examination of fish has revealed health consequences such as respiratory system damage, epithelial degradation and enterocyte vacuolization. In addition, eight bacterial and seventeen fungal strains were isolated from the beached MPs. The results also indicated weathering of MPs due to microbial interactions. Model simulations helped in tracking the fate and transboundary landfall of spilled MPs across the Indian Ocean coastline after the X-Press Pearl disaster. Due to regional circulations induced by the monsoonal wind fields, a potential dispersal of pellets has occurred along the coast of Sri Lanka, but no landfall and ecological damage are predicted along the coast of India.

Global popularization of CuNiO2 and their rGO nanocomposite loveabled to the photocatalytic properties of methylene blue.

New advancements of photocatalytic activity with higher efficiency, low price are most important, which is challenging in industrialized and many fields. We have introduced CuNiO2 and CuNiO2/rGO nanocomposite was generally prepared by the hydrothermal treatment and tested to the photocatalytic studies. Photocatalytic measurements of CuNiO2 with different weight percentages CuNiO2/rGO (25/75), (50/50), and (75/25) are achieved to the efficiency under visible light, in this case, CuNiO2/rGO (50/50) composite have the highest performance is scrutinized. This was obeyed for a synergistic effect between CuNiO2 nanoparticles and rGO composites. Furthermore, the CuNiO2, CuNiO2/rGO (25/75), (50/50), and (75/25) nanocomposite were tested by several analyses like XRD, FT-IR, DRS UV Visible spectroscopy, Raman spectroscopy, and FESEM & HRTEM investigations. In this regard all measurements are very clear and satisfied; therefore we are encouraged for future developing environmental applications.

Enhanced Photocatalytic Performance of Sn6SiO8 Nanoparticles and Their Reduced Graphene Oxide (rGO) Nanocomposite.

Photocatalysts provide excellent potential for the full removal of organic chemical pollutants as an environmentally friendly technology. It has been noted that under UV-visible light irradiation, nanostructured semiconductor metal oxides photocatalysts can degrade different organic pollutants. The Sn6SiO8/rGO nanocomposite was synthesized by a hydrothermal method. The Sn6SiO8 nanoparticles hexagonal phase was confirmed by XRD and functional groups were analyzed by FT-IR spectroscopy. The bandgap of Sn6SiO8 nanoparticles (NPs) and Sn6SiO8/GO composites were found to be 2.7 eV and 2.5 eV, respectively. SEM images of samples showed that the flakes like morphology. This Sn6SiO8/rGO nanocomposite was testing for photocatalytic dye degradation of MG under visible light illumination and excellent response for the catalysts. The enhancement of photocatalytic performance was mainly attributed to the increased light absorption, charge separation efficiency and specific surface area, proved by UV-vis DRS. Further, the radical trapping experiments revealed that holes (h+) and superoxide radicals (·O-2) were the main active species for the degradation of MG, and a possible photocatalytic mechanism was discussed.

Visible-Light Driven Effective Photocatalytic Degradation of Methylene Blue Dye Using Perforated Curly Zn0.1Ni0.9O Nanosheets.

Herein, we report the facile synthesis, characterization and visible-light-driven photocatalytic degradation of perforated curly Zn0.1Ni0.9O nanosheets synthesized by hydrothermal process. The X-ray diffraction (XRD) and scanning electron microscopy (SEM) studies confirmed the cubic phase crystalline structure and growth of high density perforated curly Zn0.1Ni0.9O nanosheets, respectively. As a photocatalyst, using methylene blue (MB) as model pollutant, the synthesized nanosheets demonstrated a high degradation efficiency of ~76% in 60 min under visible light irradiation. The observed results suggest that the synthesized Zn0.1Ni0.9O nanosheets are attractive photocatalysts for the degradation of toxic organic waste in the water under visible light.

Synchronous detection of cadmium and lead in honey, cocos nucifera and egg white samples using multiwalled carbon nanotube/hyaluronic acid/amino acids nanocomposites.

Electrochemical Synchronous detection of cadmium (Cd(II)) and lead (Pb(II)) was obtained by acid treated multiwalled carbon nanotube (A-MWCNT) functionalized with hyaluronic acid (Hyalu) and this mixture was separately further modified with l-cysteine (l-Cys) and l-serine (l-Ser). Under the optimized circumstance best voltammetric responses were produced by A-MWCNT/Hyalu/l-Cys and A-MWCNT/Hyalu/l-Ser modified electrodes. The peak current was linearly dependent on the Cd(II) and Pb(II) concentrations in the range from 0.4 to 4 µg L-1. The sensitivities were calculated as 0.7 µA/nM (Cd(II)) and 3.5 µA/nM (Pb(II)) for A-MWCNT/Hyalu/l-Cys/GCE and 0.6 µA/nM (Cd(II)) and 2.6 µA/nM (Pb(II)) for A-MWCNT/Hyalu/l-Ser/GCE. From the calibration plot LODs were calculated to be 0.032 µg L-1 (Cd(II)) and 0.015 µg L-1 (Pb(II)) for A-MWCNT/Hyalu/l-Cys/GCE and 0.057 µg L-1 (Cd(II)) and 0.034 µg L-1 (Pb(II)) for A-MWCNT/Hyalu/l-Ser/GCE. Moreover, the proposed electrodes were subjected to the real sample application in honey, cocos nucifera and egg white.

Binary Mixture of Lanthanide Metal Doped ZnO Nanorod: f-MWCNT Nanocomposite for Simultaneous and Selective Determination of Vitamins B² and B6.

An electrochemical sensor using lanthanide element Gadolinium doped Zinc oxide and functionalized Multiwalled Carbon Nanotube (Gd-ZnO:f-MWCNT) fabricated electrode was presented for the simultaneous determination of vitamins (Riboflavin (VB2) and Pyridoxine (VB6)). The nanocomposite was characterized by FESEM, EDS, XRD and FTIR techniques. The CV, EIS and DPV techniques were used to evaluate the electrochemical properties of the nanocomposite. Under optimum conditions, the peak current of VB2 and VB6 are linearly proportional to its concentration in the range from 0.05 to 10 µM and the estimated detection limits were 0.009 and 0.001 µM for VB2 and VB6 respectively. The sensitivities calculated were 0.94 µA nM-1 cm-2 (VB2) and 1.43 µA nM-1 cm-2 (VB6). In addition, the proposed electrode was exhibited high selectivity, reproducibility, as well as long-term stability for the determination of vitamins. Finally, the vitamins contained in pharmaceutical formulation and commercial orange juice has been determined by the proposed sensor and the obtained results were validated with HPLC.

Bilateral retrograde pyelography leading to anuria.

Retrograde pyelography (RGP) is done to evaluate the collecting system when intravenous contrast studies are contraindicated due to renal insufficiency or prior adverse reactions. We report a patient who developed acute renal shutdown following bilateral RGP in the same sitting done for evaluation of positive malignant cytology of urine. A 65-year-old man on treatment for left stroke and hypertension, with a baseline serum creatinine of 1.9 mg/dl presented with painless haematuria for 2 months. Plain computed tomogram revealed a small papillary growth on the posterior wall of the urinary bladder. Transurethral resection revealed inflammatory atypia. As the patient continued to have haematuria, he was taken up for bilateral ureteric washings for cytology and bilateral RGP. A 5-Fr universal ureteral catheter was used to cannulate the ureters, urine was aspirated for cytology and 6 ml of 76% meglumine diatrizoate (1:2) was injected, and sufficient opacification with no abnormality or pyelosinus/venous or lymphatic reflux was noted. In the immediate postoperative period, he developed anuria and the serum creatinine rose to 3.6 mg/dl on postoperative day 1 and to 7.5 mg/dl on day 5. He needed three sessions of haemodialysis. Ultrasonography showed no hydroureteronephrosis. Urine output improved and his serum creatinine stabilized at the preoperative level of 1.8 mg/dl. The patient is doing well with stable renal function at 12 months. Although RGP is useful, it needs to be done with caution if a bilateral procedure is contemplated. This entity is seldom reported, and routine double-J stenting following unilateral/bilateral RGP also needs evaluation.

Finite element analysis of displacement with single and two piece hollow bulb obturator prosthesis.

BACKGROUND: Rehabilitation of hemi-maxillectomy defects is difficult and challenging when there is displacement of obturator prosthesis. The literature lacks data on the displacement of different types of obturators. The intent of the study was to evaluate the differences in displacement between the single and two piece hollow bulb obturator prosthesis in Aramany Class I maxillectomy defect. METHODS: Finite element (FE) model of Aramany Class I maxillectomy defect restored with single and two piece closed bulb obturator was fabricated based on patient computed tomography (CT) scan. Finite element analysis (FEA) with three different load applications was done to measure the displacement of the obturator. Graphical and numerical values of displacement were obtained and the results were tabulated. RESULTS: The results were obtained as displacement colour images and the numerical displacement values. The displacement of two piece obturator was 4.779e-8, 6.372e-8, 7.965e-8 compared to single piece obturator 4.509e-8, 6.012e-8, and 7.5151e-8. There was marginal numerical increase in magnitude of displacement in two piece obturator compared to single piece obturator. CONCLUSION: The study observed no significant difference in displacement between the obturator. The numerical difference in displacement is more in two piece obturator compared to the single piece obturator.

Prostatectomía inmediata versus demorada en pacientes que progresan a una enfermedad de mayor riesgo en vigilancia activa / Immediate versus delayed prostatectomy and the fate of patients who progress to a higher risk disease on active surveillance

Introducción: Se debaten los resultados oncológicos de la prostatectomía radical (PR) en pacientes que progresan en vigilancia activa (VA). Comparamos los resultados de los pacientes elegibles para VA sometidos a PR inmediatamente después del diagnóstico con aquellos que lo hacían después de un retraso o progresión de la enfermedad en VA. Métodos: Entre 2000 y 2014, 961 pacientes fueron elegibles para VA según los criterios de la EAU. Se comparó la PR a los 6 meses del diagnóstico (PRI) o más allá (PRT), PR sin VA (PRTa) y pacientes en VA que progresan a PR (PRTb). Se registró PSA inicial, características clínicas y de biopsia. Los resultados oncológicos incluyeron patología adversa (PA) en la muestra de PR y recurrencia bioquímica (RBQ). Se realizó un análisis de pares emparejados entre los pacientes con PRTb y GS7 sometidos a PR inmediata (GS7PRI). Resultados: PRI, PRT, PRTa y PRTb tuvieron 820 (85%), 141 (15%), 118 (12,24%) y 23 (2,7%) pacientes respectivamente. PRI, PRTa y PRTb se sometieron a PR a una mediana de 3, 9 y 19 meses después del diagnóstico, respectivamente. Las características basales fueron comparables. PRT vs. PRI tuvieron una mediana de tiempo más temprana (31 vs. 43 meses; p < 0,001) y una mayor tasa de progresión a RBQ (7,6 vs. 3,9%; p = 0,045). PRTb mostró RBQ más alta (19 frente a 5%; p = 0,021) con una mediana de tiempo más temprana a RBQ, en comparación con PRI y PRTa (p = 0,038). No hubo diferencias en las tasas de PA y RBQ, pero el tiempo hasta RBQ fue significativamente menor en PRTb (49 frente a 6 meses; p<0,001), en comparación con GS7PRI. Conclusiones: Los pacientes que progresaron en VA tuvieron los peores resultados oncológicos. PR para progresión de GS7 y par coincidente de pacientes con GS7 tuvieron resultados similares. Peores resultados oncológicos en los progresores de VA no pueden explicarse por una mera demora en PR

Introduction: Oncological outcomes of radical prostatectomy (RP) in patients progressing on active surveillance (AS) are debated. We compared outcomes of AS eligible patients undergoing RP immediately after diagnosis with those doing so after delay or disease progression on AS. Methods: Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared. Baseline PSA, clinical and biopsy characteristics were noted. Oncological outcomes included adverse pathology in RP specimen and biochemical recurrence (BCR). Matched pair analysis was done between DRPb and GS7 patients undergoing immediate RP (GS7IRP). Results: IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively. IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively. Baseline characteristics were comparable. DRP vs. IRP had earlier median time (31 vs. 43 months; p < 0.001) and higher rate of progression to BCR (7.6 vs. 3.9%; p = 0.045). DRPb showed higher BCR (19 vs. 5%; p = 0.021) with earlier median time to BCR, compared to IRP and DRPa (p = 0.038). There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months; p < 0.001), compared to GS7IRP. Conclusions: Patients progressing on AS had worst oncological outcomes. RP for GS7 progression and matched pair of GS7 patients had similar outcomes. Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP

3D cloves bud like Gd doped ZnO strewn rGO hybrid for highly selective determination of l-dopa in the presence of carbidopa and ascorbic acid.

An electrochemical sensor using three dimensional (3D) cloves bud like gadolinium doped ZnO nanoflowers strewn reduced graphene oxide (GZO@rGO) modified glassy carbon electrode was proposed for the sensitive and selective detection of l-dopa. The GZO@rGO nanocomposite was synthesized by hydrothermal method and characterized by a variety of analytical and spectroscopy techniques, viz. Field Emission Scanning Electron Microscopy, X-Ray Diffraction, Fourier Transformed Infrared Spectrum and X-ray photoelectron spectroscopy. The electrochemical characterization was evaluated by Cyclic Voltammetry (CV), Electrochemical Impedance Spectroscopy (EIS) and Differential Pulse Voltammetry (DPV). The 3D cloves bud like GZO@rGO hybrid displayed the highest electro-catalytic behaviour for the selective l-dopa detection. Under optimum conditions, the oxidation current response of l-dopa is directly proportional to its concentration ranging from 10 to 100 nM. The sensitivity and limit of detection was calculated as 0.1 µA nM-1 cm-2 and 0.82 nM respectively. Moreover, the proposed electrode offers excellent selectivity, because it can efficiently evade the intervention of carbidopa and ascorbic acid even in the higher concentration. Thus, the reported sensor exhibits accurate determination of l-dopa (in the presence of carbidopa & ascorbic acid) and possesses an excellent real-time application with Mucuna prurita, pharmaceutical and human urine samples.

Resultados oncológicos y características patológicas de la sobrestadificación de cT1 a carcinoma de células renales pT3a en comparación con los tumores pT3a de novo / Oncological outcomes and pathological characteristics of cT1 upstaging to pT3a renal cell carcinoma compared with de novo pT3a tumors

Introducción: La importancia de la sobrestadificación de tumores renales cT1 a pT3a no está clara. Evaluamos la incidencia de la sobrestadificación, identificamos factores predictivos y analizamos los resultados oncológicos de estos pacientes frente a aquellos que no sobrestadificaron. También comparamos los resultados oncológicos de la sobrestadificación de cT1 a pT3a con tumores renales pT3a de novo. Métodos: De una base de datos de 1.021 tumores renales con datos de seguimiento completos disponibles, 517 pacientes tenían cT1. Los pacientes que sobrestadificaron a pT3a se compararon con aquellos que no lo hicieron. Se analizaron los resultados de las características clínicas, perioperatorias, histopatológicas y oncológicas iniciales. Resultados: De 517 pacientes con cT1, 105 (20,3%) sobrestadificaron a pT3a y 412 (79,7%) no lo hicieron. La proporción de pacientes en cada grupo tratados mediante nefrectomía parcial y radical, el tamaño del tumor postoperatorio, la histología, el estado de los márgenes, y la afectación de ganglios linfáticos fueron similares. Entre los que sobrestadificaron, 9 pacientes (8,6%) desarrollaron la primera recurrencia en comparación con solo 3 (0,7%) en aquellos que no sobrestadificaron (p < 0,001). La mediana del tiempo hasta la recurrencia (57 frente a 107 meses; p < 0,001) fue menor en los tumores renales pT3a de novo. Conclusiones: La sobrestadificación patológica de cT1 a pT3a y la necrosis en la histopatología se asociaron con la recurrencia. La edad avanzada, el tabaquismo, la necrosis en la histopatología, la histología de células claras y grados más altos de Fuhrman contribuyeron a la sobrestadificación patológica de los tumores cT1. El CCR pT3a de novo tuvo una supervivencia peor cuando se comparó con los pacientes con cT1 que sobrestadificaron a CCR pT3a

Introduction: The significance of upstaging of cT1 renal tumors to pT3a is not clear. We evaluate the incidence of upstaging, identify predictors and analyze oncological outcomes of these patients versus those who did not upstage. We also compared the oncological outcomes of cT1 upstaging to pT3a with de novo pT3a renal tumors. Methods: From a database of 1021 renal tumors with complete available follow-up data, 517 patients had cT1. Patients upstaging to pT3a were compared to those who did not. Baseline clinical, perioperative, histopathologic features and oncological outcomes were analysed. Results: Out of 517 cT1 patients, 105 (20.3%) upstaged to pT3a and 412 (79.7%) did not. Proportion of patients in each group undergoing partial and radical nephrectomy, postoperative tumor size, histology, margin status and lymph node involvement were similar. Among upstaged, 9 patients (8.6%) developed first recurrence as compared to only 3 (0.7%) in those not upstaging (P < 0.001). The median time to recurrence (57 vs. 107 months; P < 0.001) was lesser in de novo pT3a renal tumors. Conclusions: Pathological upstaging from cT1 to pT3a and necrosis on histopathology were associated with recurrence. Advanced age, smoking, necrosis on histopathology, clear cell histology and higher Fuhrman grades contributed to pathological upstaging of cT1 tumors. De novo pT3a RCC had worse survival when compared to cT1 patients upstaging to pT3a RCC

Immediate versus delayed prostatectomy and the fate of patients who progress to a higher risk disease on active surveillance. / Prostatectomía inmediata versus demorada en pacientes que progresan a una enfermedad de mayor riesgo en vigilancia activa.

INTRODUCTION: Oncological outcomes of radical prostatectomy (RP) in patients progressing on active surveillance (AS) are debated. We compared outcomes of AS eligible patients undergoing RP immediately after diagnosis with those doing so after delay or disease progression on AS. METHODS: Between 2000 and 2014, 961 patients were AS eligible as per EAU criteria. RP within 6 months of diagnosis (IRP) or beyond (DRP), RP without AS (DRPa) and AS patients progressing to RP (DRPb) were compared. Baseline PSA, clinical and biopsy characteristics were noted. Oncological outcomes included adverse pathology in RP specimen and biochemical recurrence (BCR). Matched pair analysis was done between DRPb and GS7 patients undergoing immediate RP (GS7IRP). RESULTS: IRP, DRP, DRPa and DRPb had 820 (85%), 141 (15%), 118 (12.24%) and 23 (2.7%) patients respectively. IRP, DRPa and DRPb underwent RP at a median of 3, 9 and 19 months after diagnosis respectively. Baseline characteristics were comparable. DRP vs. IRP had earlier median time (31 vs. 43 months; p<.001) and higher rate of progression to BCR (7.6 vs. 3.9%;p=.045). DRPb showed higher BCR (19 vs. 5%;p=.021) with earlier median time to BCR, compared to IRP and DRPa (p=.038). There was no difference in adverse pathology and BCR rates, but time to BCR was significantly lesser in DRPb (49 vs. 6 months;p<.001), compared to GS7IRP. CONCLUSIONS: Patients progressing on AS had worst oncological outcomes. RP for GS7 progression and matched pair of GS7 patients had similar outcomes. Worse oncological outcomes in AS progressors cannot be explained by a mere delay in RP.

Oncological outcomes and pathological characteristics of cT1 upstaging to pT3a renal cell carcinoma compared with de novo pT3a tumors. / Resultados oncológicos y características patológicas de la sobrestadificación de cT1 a carcinoma de células renales pT3a en comparación con los tumores pT3a de novo.

INTRODUCTION: The significance of upstaging of cT1 renal tumors to pT3a is not clear. We evaluate the incidence of upstaging, identify predictors and analyze oncological outcomes of these patients versus those who did not upstage. We also compared the oncological outcomes of cT1 upstaging to pT3a with de novo pT3a renal tumors. METHODS: From a database of 1021 renal tumors with complete available follow-up data, 517 patients had cT1. Patients upstaging to pT3a were compared to those who did not. Baseline clinical, perioperative, histopathologic features and oncological outcomes were analysed. RESULTS: Out of 517 cT1 patients, 105 (20.3%) upstaged to pT3a and 412 (79.7%) did not. Proportion of patients in each group undergoing partial and radical nephrectomy, postoperative tumor size, histology, margin status and lymph node involvement were similar. Among upstaged, 9 patients (8.6%) developed first recurrence as compared to only 3 (0.7%) in those not upstaging (P <0.001). The median time to recurrence (57 vs. 107 months; P <0.001) was lesser in de novo pT3a renal tumors. CONCLUSIONS: Pathological upstaging from cT1 to pT3a and necrosis on histopathology were associated with recurrence. Advanced age, smoking, necrosis on histopathology, clear cell histology and higher Fuhrman grades contributed to pathological upstaging of cT1 tumors. De novo pT3a RCC had worse survival when compared to cT1 patients upstaging to pT3a RCC.

Ranolazine: A true pluripotent cardiovascular drug or jack of all trades, master of none?

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Although the majority of patients with CVD are treated with interventional procedures, a substantial number require medical therapy in terms of both prognosis and symptomatic relief. However, commonly used agents such as ß-blockers and calcium channel blockers reduce blood pressure in patients whose resting pressures are often already low. Ranolazine is a promising agent that does not have significant effects on blood pressure or heart rate. Use of this drug has been documented in various cardiovascular conditions, including ischaemic heart disease, heart failure and arrhythmias. This review article aimed to examine current evidence on the use of ranolazine in various cardiovascular conditions in order to determine whether it is a true pluripotent cardiovascular agent or, on the other hand, a "jack of all trades, master of none."

Innominate Vein Stenosis in Association with Ipsilateral Hyperdynamic Brachiobasilic Fistula Causing Ipsilateral Limb and Hemifacial Swelling.

A 34-year-old hypertensive woman with a hyperdynamic, left brachiobasilic dialysis fistula presented with a long history of throbbing in her head and swelling of the left side of the face. Tight stenosis of left brachiocephalic vein was found to be causing retrograde flow into the left jugular vein which normalized after dilatation and stenting with resolution of all the symptoms and patient is asymptomatic for 1 year.

The neuropathological signature of bulbar-onset ALS: A systematic review.

ALS is a multisystem disorder affecting motor and cognitive functions. Bulbar-onset ALS (bALS) may be preferentially associated with cognitive and language impairments, compared with spinal-onset ALS (sALS), stemming from a potentially unique neuropathology. The objective of this systematic review was to compare neuropathology findings reported for bALS and sALS subtypes in studies of cadaveric brains. Using Cochrane guidelines, we reviewed articles in MEDLINE, Embase, and PsycINFO databases using standardized search terms for ALS and neuropathology, from inception until July 16th 2016. 17 studies were accepted for analysis. The analysis revealed that both subtypes presented with involvement in motor and frontotemporal cortices, deep cortical structures, and cerebellum and were characterized by neuronal loss, spongiosis, myelin pallor, and ubiquitin+ and TDP43+ inclusion bodies. Changes in Broca and Wernicke areas - regions associated with speech and language processing - were noted exclusively in bALS. Further, some bALS cases presented with atypical pathology such as neurofibrillary tangles and basophilic inclusions, which were not found in sALS cases. Given the limited number of studies, all with methodological biases, further work is required to better understand neuropathology of ALS subtypes.

Laparoendoscopic single site surgery for extravesical repair of vesicovaginal fistula using conventional instruments: Our initial experience.

OBJECTIVE: Vesicovaginal fistula (VVF) is a major complication with psychosocial ramifications. In literature, few VVF cases have been managed by laparoendoscopic single site surgery (LESS) and for the 1(st) time we report VVF repair by LESS using conventional laparoscopic instruments. We present our initial experience and to assess its feasibility, safety and outcome. PATIENTS AND METHODS: From March 2012 to September 2015, LESS VVF repair was done for ten patients aged between 30 and 65 (45.6 ± 10.15) years, who presented with supratrigonal VVF. LESS was performed by modified O'Conor technique using regular trocars with conventional instruments. Data were collected regarding feasibility, intra- or post-operative pain, analgesic requirement, complication, and recovery. RESULTS: All 10 cases were completed successfully, without conversion to a standard laparoscopic or open approach. The mean operative time was 182.5 ± 32.25 (150-250) min. The mean blood loss was 100 mL. The respective mean visual analog score for pain on day 1, 2, and 3 was 9.2 ± 1, 5 ± 1, and 1.4 ± 2.3. The analgesic requirement in the form of intravenous tramadol on days 1, 2, and 3 was 160 ± 51.6, 80 ± 63.2, and 30 ± 48.3, mgs respectively. No major intra- or post-operative complications were observed. The mean hospital stay was 2.6 ± 0.7 (2-4) days. CONCLUSION: In select patients, LESS extravesical repair of VVF using conventional laparoscopic instruments is safe, feasible with all the advantages of single port surgery at no added cost. Additional experience and comparative studies with conventional laparoscopy are warranted.