Breast Cancer in Younger and Older Women: A Comparison of Clinicopathological Traits.

Breast cancer stands as the prevailing invasive cancer globally, bearing high mortality rates among women. Existing evidence indicates diminished survival rates in younger patients. Consequently, this study endeavors to assess and contrast the pathological features of breast cancer in women under 40 years of age with their older counterparts. Conducted as a cross-sectional analysis, this study encompasses 560 patients diagnosed with breast cancer, seeking treatment at Mymensingh Medical College Hospital (MMCH), Community Based Medical College Bangladesh (CBMCB) and several private hospitals in Mymensingh. The gathered data incorporates information such as age, residential area, occupation, tumor histopathology, TNM classification, staging and status of hormone receptor. The patients' mean age (standard deviation) was 49.7±11.9 years, with 20.5% below 40, most were from rural areas and were housewives. Ductal carcinoma prevailed as the most common histopathologic type (87.67%). However, younger patients exhibited a higher prevalence of lobular and other rare carcinomas compared to their older counterparts (p=0.04). Additionally, the younger group demonstrated larger tumor sizes (p=0.01), lymphatic node involvement (p=0.04) and advanced staging (p=0.004). Notably, younger age showed more negativity for estrogen and/or progesterone receptors. The results suggested that women under 40 years old exhibit more aggressive tumor characteristics and a more severe form of breast cancer compared to their older counterparts.

Labile assembly of a tardigrade protein induces biostasis.

Tardigrades are microscopic animals that survive desiccation by inducing biostasis. To survive drying tardigrades rely on intrinsically disordered CAHS proteins, which also function to prevent perturbations induced by drying in vitro and in heterologous systems. CAHS proteins have been shown to form gels both in vitro and in vivo, which has been speculated to be linked to their protective capacity. However, the sequence features and mechanisms underlying gel formation and the necessity of gelation for protection have not been demonstrated. Here we report a mechanism of fibrillization and gelation for CAHS D similar to that of intermediate filament assembly. We show that in vitro, gelation restricts molecular motion, immobilizing and protecting labile material from the harmful effects of drying. In vivo, we observe that CAHS D forms fibrillar networks during osmotic stress. Fibrillar networking of CAHS D improves survival of osmotically shocked cells. We observe two emergent properties associated with fibrillization; (i) prevention of cell volume change and (ii) reduction of metabolic activity during osmotic shock. We find that there is no significant correlation between maintenance of cell volume and survival, while there is a significant correlation between reduced metabolism and survival. Importantly, CAHS D's fibrillar network formation is reversible and metabolic rates return to control levels after CAHS fibers are resolved. This work provides insights into how tardigrades induce reversible biostasis through the self-assembly of labile CAHS gels.

Mental Health Assessment of Health Care Providers of Bangladesh during Covid-19 Pandemic: A Cross-Sectional Web-Based Study.

SARS COV 2 raised immense agony to everyone. As health care workers remains direct contact with patients, they are vulnerable to mental health disorder. The study was done to identify mental health status of health care providers of Bangladesh. It was a cross sectional web based survey among health care providers of bangladesh. A structured web based questionnaire was prepared both in Bangla and English version for better understanding. Total 2594 health care workers responded to online survey. Male were 1303(50.2%) and female were 1291(49.8%). Occupational demography shows 98.5% were physicians. Mean value of patient health questionnaire 9 (PHQ9) and generalized anxiety disorder (GAD) were 8.43±6.082 and 8.27±5.234 respectively among healthcare providers. To overcome anxiety and depression, 93.4% of HCW didn't receive any psychological material and 85.6% HCW didn't find physiological resources even through media. Despite many lacking, healthcare workers were resilient in our study.

Regularized cost function in wavefront shaping for advancing the contrast of structured light.

The cost function in the iterative optimization algorithms is one of the sensitive optimization controllers that plays a crucial role in feedback based wavefront shaping for constructing well-resolved complex structured light through scattering media. There has been a trade-off between resolution and the contrast enhancement of the structured light in wavefront shaping. We have developed an ℓ 2-norm based quadratic cost function (L2QN) and proposed a regularized cost function (RCF) for advancing the contrast and maintaining the high resolution of structured light. Both the simulations and experiments have been performed, and it has been found that the proposed RCF significantly advances the contrast and structural uniformity for focusing light through scattering media as well as for diffused reflection mode. The potential applications of the method demonstrated in this study can be extended into holographic displays, structured light illumination microscopy, photo-lithography, photothermal treatments, dosimetry, laser materials processing, and energy control inside and outside an incubation system.

Formation of multiple complex light structures simultaneously in 3D volume using a single binary phase mask.

Complex structure formation inside or through turbid media is a challenging task due to refractive index inhomogeneity, random light scattering, and speckle noise formation. In this article, we have coupled the data regression model in the R-squared metric and used its advantages as a fitness function in the genetic algorithm to advance the resolution and structural uniformity. As a compatible system with the binary genetic algorithm, we have presented a cost-effective iterative wavefront shaping system-design with binary phase modulation using an affordable ferroelectric liquid crystal (FLC) based binary-phase spatial light modulator (SLM). R-squared metric in the genetic algorithm is analyzed to optimize the binary phase mask, and the prototype system based on iterative binary phase modulation has been validated with a 120-grit ground glass diffuser and fresh chicken tissues of thickness 307 [Formula: see text] and 812 [Formula: see text]. The detailed results show that the proposed cost-effective wavefront shaping system with data regression model assisted R-squared fitness function can construct high-resolution multiple complex hetero-structures simultaneously in 3D volume using an optimized single phase-mask.

1†Retreatment for reactivation of ROP following initial anti-VEGF injections. A 5-year retrospective study.

To present the retreatment rates and the characteristics of ROP reactivation, as well as the differences between bevacizumab and ranibizumab injections in premature babies treated in our department over the past 5 years.A retrospective analysis of babies with treated ROP was performed. 89 babies who required treatment from 2017 to 2022 were examined. We studied the severity of their disease with regards to their gestational age, treatment time and type and the need of further treatment. We also focused on the comparison of anti-VEGF agents for ROP.22 out of 89 babies (14 boys and 8 girls) with aggressive posterior retinopathy of prematurity (APROP) and mean gestational age of 25+3w received initially anti-VEGF injections. 16 of those (11 boys and 5 girls) required retreatment with diode laser. 9 out of these 16 babies were treated with ranibizumab (Lucentis) and 7 with bevacizumab (Avastin). It is also of note that only 2 out of 67 babies who initially received laser treatment needed a complementary laser session.The majority of babies with aggressive ROP who receive anti-VEGF agents will most probably require further laser treatment. At an equal level of retinal damage, it seems that their response to ranibizumab and bevacizumab is similar.

Comparison of Serum Zinc in Children of Wilson Disease and Non-Wilsonian Volunteers in Bangladesh.

Wilson disease (WD) is an autosomal recessive disorder of copper metabolism with diverse clinical manifestations. Zinc (Zn) has been used for treatment of WD. Recent studies showed low serum zinc level in patients suffering from WD than the normal. This cross-sectional analytical study has been designed to compare the serum zinc level between paediatric patients suffering from WD but yet not started treatment and children who have normal ALT level. This study was carried out at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from July 2018 to June 2019. Total 51 children were included in this study. Among them 27 were diagnosed case of WD aged between three to eighteen years and 24 children of same ages who were suffering from other than liver disease having normal ALT were included as volunteers. The patients of WD were divided into four groups according to their presentation as acute hepatitis, chronic liver disease (CLD), acute liver failure & neuropsychiatric manifestation. Informed written consent was obtained from all patients and volunteers for participation in this study. Along with other physical findings and laboratory investigations 3 ml of venous blood were collected for estimation of serum zinc level. After estimation of serum zinc level results were analyzed statistically. The difference in serum zinc levels were compared between the groups. Serum zinc level was significantly lower in Wilson disease patients (43.8±19.7µg/dl; range: 13-83) compared to volunteers group (67.8±11.8µg/dl; range: 47-97) p<0.001. Among the diseased group, serum zinc level were significantly lower in 18 CLD (38.4±17.4µg/dl) and in 4 acute liver failure (33.1±3.7µg/dl) compared to 4 acute hepatitis (71.8±4.3µg/dl) (p=0.001) and (p<0.001) respectively. Mean serum zinc level was low in 4 Wilsonian acute liver failure (33.1±3.7µg/dl), which was significant compared to those (23) who presented as Wilson disease non acute liver failure (45.7±20.8µg/dl) (p=0.013). Serum zinc level was significantly lower in Wilson disease children compared to the volunteers. Zinc level was also found significantly low in Wilson disease presented as CLD and acute liver failure in comparison to Wilson disease presented as acute hepatitis.

Haematohidrosis: A Case Series of Five Patients.

Haematohidrosisis manifested by sweating mixed with blood. It is a rare disease and there are scarce literature regarding case report. We are describing five cases of haematohidrosis in different age group here in this case series. In case 1- a 20 year old woman was admitted with history of recurrent haemorrhage from various sites without any trauma or anticoagulant or antipletlet medication. There was no evidence of local trauma. Physical examination was unremarkable. Her blood workup came out insignificant. In case 2- a 10 year old boy was admitted with epistaxis, conjunctival bleeding, haematuria and per rectal bleeding without any history of injury. He had no history of medicine which would cause bleeding. Physical examination and laboratory profile were insignificant. In case 3- a 15 year old boy presented with recurrent haematuria and conjunctival haemorrhage without any trauma. No history of medication that would cause the bleeding. His systemic examination and laboratory profile was unremarkable. In case 4- a 25 year old woman presented with bleeding from ear, nose and eyes without any local trauma. She was not on any medication that would cause bleeding. Her systemic inquiry and laboratory profile was unremarkable. In case 5- a 20 year old woman presented with bleeding from eyes, ears and umbilicus. There was no evidence of self-inflicted injury. She had features of anxiety disorder. Other systemic examination and laboratory profile was unremarkable. All the cases were labelled as haematohidrosis and treated with propranolol with successful outcome. We report this case series to build up awareness and disseminate clinical knowledge.

The Sheen Paajanen grOin Recommended Treatment 'SPoRT' score for groin pain.

INTRODUCTION: Evaluating groin pain still evades many clinicians at times as they have difficulty determining the cause of pain when no true hernia exists. This study's aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption. MATERIAL & METHODS: A retrospective analysis of all patients from 2018 to 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1-year follow-up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from - 2 to + 2 based on the defined findings listed. A maximum total of four points scored for each assessment was used. Sensitivity and specificity analysis was conducted for each potential score cut off point. RESULTS: A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The median SPoRT score for the surgery group was 2.0 (1.0, 3.0), and - 1.0 (- 3.0, 0.0) in the physiotherapy group which was a significant difference (p < 0.001). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI 75.7%-98.1%), a specificity of 89.2% (95% CI 82.8%-93.8%) and an area under the curve (AUC) of 0.936 (95% CI 0.874-0.997). DISCUSSION: SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery. Further validation of the score is necessary.

Health Related Quality of Life in Patients with Pulmonary Tuberculosis.

Tuberculosis (TB) is one of the major public health issues in many developing nations especially in Bangladesh. Though most focus is being directed towards mortality and incidence rate, the changes in morbidity and other health status parameters are not been well considered. The aim of the study was a comprehensive assessment of patients with pulmonary tuberculosis by measuring patient's quality of life which may lead to better outcome in patients' health, infection surveillance and prevention programs. This prospective study was conducted in the department of Respiratory and Internal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2015 to March 2017. The quality of life scores of 61 smear positive pulmonary tuberculosis cases were measured by validated Bangla version of SF-36 questionnaire before or at the starting of treatment, after the initial phase and at the end of treatment. Then the score was compared with those of 75 healthy matched controls. The changes of the quality of life with the stage of treatment and with socio-demographic variables were assessed. Before treatment, all domains of HRQoL of the pulmonary TB patients were significantly lower than those of the control group (p<0.001). At the end of six-month treatment period, HRQoL of the pulmonary TB patient had significantly increased compared to before treatment (p<0.001). There was no significant difference of scores after six months of treatment with that of control (p>0.05). The lowest score in tuberculosis patients was related to general health perception and vitality. Patients with low socio economic status, low educational level, prolonged disease duration and increased number of symptoms had lower HRQoL scores.

Paroxysmal Nocturnal Hemoglobinuria in Systemic Lupus Erythematosus: A Rare Manifestation.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare disorder of hematopoietic stem cells. The occurrence of PNH in a patient with systemic lupus erythematosus (SLE) is even rarer. One such presentation was seen in a 19 years old woman who presented with fever, multiple joint pain, photosensitivity, oral ulcer, hair loss and was diagnosed as a case of SLE and was admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 7th February 2019. Subsequently she developed progressive anaemia and passing of dark colored urine. Flow cytometry analysis showed PNH clone within red cells. We report this case so that clinicians are aware about this association between PNH and SLE. Informed written consent was obtained from the patient for the publication of this case report, the copy of which is available with the authors.

Prevalence and molecular characterization of extended-spectrum ß-lactamase (ESBL) producing Escherichia coli isolated from dogs suffering from diarrhea in and around Kolkata.

Background: Dogs are the favorite companion animals among humans. The close interaction between dogs and people increases the risk of antibiotic resistance spreading. Surveillance for antimicrobial resistance and the identification of ESBL-producing Escherichia coli as an indicator bacterium is an important tool for managing antimicrobial drug therapy. Aims: The present study targeted to identify and characterize ESBL-producing E. coli among dogs suffering from diarrhea in and around Kolkata. Methods: Isolation and identification of E. coli from dogs suffering from diarrhea (n=70) along with screening for the production of both ESBL and AmpC. The isolates were further characterized through antimicrobial resistance profiling, resistance genes (bla CTX-M, bla TEM, and bla SHV) screening, and phylogenetic group study. Results: Among the 70 isolates, 21 (30%) were confirmed ESBL producers. An antibiogram typing of ESBL-producing E. coli revealed that the majority of them were resistant to norfloxacin (85.7%) followed by tetracycline (61.90%), doxycycline (57.14%), piperacillin/tazobactam (52.38%), cotrimoxazole (47.62%), gentamicin (42.62%), amikacin (23.81%), and chloramphenicol (19.05%). Major resistance genes included bla CTX-M (100%), bla TEM (28.57%), and bla SHV (9.50%). The predominant phylogenetic groups were phylogroup A (76%) followed by phylogroup D (24%). Conclusion: The current investigation reported a high prevalence of both ESBL and AmpC ß-lactamase (AmpC) producing E. coli, co-resistance to a distinct group of antibiotics, and co-existence of different ESBL genes in dogs. Our findings highlight the importance of diagnostic antimicrobial susceptibility testing for proper antimicrobial therapy and to prevent antimicrobial resistance from spreading to humans from dogs in Kolkata and the surrounding area.

Immunophenotypic Characterization and Ploidy Analysis of Neoplastic Plasma Cells by Multiparametric Flow Cytometry.

Flow cytometric (FCM) immunophenotyping is an important tool for generating diagnostic and prognostic information in plasma cell dyscrasias. This study aimed to evaluate the immunophenotype and ploidy status of plasma cells (PCs) in patients of myeloma and its correlation with other laboratory parameters. Bone marrow of 70 newly diagnosed cases of myeloma were subjected to FCM using a panel of antibodies; CD138, CD38, CD19, CD45, CD28, CD81, CD56, CD200, and CD229. FxCycle Violet (FCV) dye was used for the ploidy analysis of clonal PCs. Median age was 60 years with M:F ratio of 3.2:1. A positive correlation was noted between the morphological and FCM-based PC enumeration (r = 0.4, p = 0.001). Aberrant expression of CD56, CD200, CD28, CD117, CD81 and CD19 and was observed in 88.5%, 77%, 29%, 37%, 23% and 17% cases respectively. Two aberrant antigens were noted in all cases. CD81 + cases had a relatively higher quantity of monoclonal-protein (> 1 g/dl, p < 0.05) and renal insufficiency (Cr > 2 mg/dl, p < 0.05) as compared to the CD81- cases. CD229 was expressed in all the cases, with a median MFI in PCs significantly higher than other hematopoietic elements. Hyperdiploid PCs (median DI-1.59, range, 1.16-2.6) were noted in 80% cases (n = 48), diploid/ near-hyperdiploid PCs in 8% (n = 5) cases and hypodiploidy in 3% (n = 1) cases. Bright CD56/CD200 and CD45- can identify abnormal PC in the majority of the cases. CD81 appears to correlate with disease burden and might be useful as a prognostic marker. CD229 is a reliable gating marker for plasma cells. Ploidy analysis may be incorporated in routine workup to guide in the identification of patients with poor prognosis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-021-01477-y.

Impact of plasma glucose and duration of type 2 diabetes mellitus on SYNTAX Score II in patients suffering from non ST-elevation myocardial infarction.

Aim    The objective was to assess the correlation of fasting plasma glucose (FPG), HbA1c, and the duration of type 2 diabetes mellitus (T2DM) with SYNTAX score (SS) II in patients with non-ST elevation myocardial infarction (NSTEMI).Material and methods    FPG and HbA1C were measured in 398 patients presenting with NSTEMI at admission. SS II was calculated using an online calculator. Patients were stratified according to SS II (≤21.5, 21.5-30.6, and ≥30.6), defined as SS II low, mid, and high, respectively.Results    37.7 % of subjects were diabetic. Correlations of FPG (R=0.402, R2=0.162, p<0.001) and HbA1c (R=0.359, R2=0.129, p<0.001) with SS II were weak in the overall population. Duration of T2DM showed very strong correlation with SS II (R=0.827, R2=0.347). For the prediction of high SS II in the study population, FPG≥98.5 mg / dl demonstrated a sensitivity of 58 % and a specificity of 60 %, and HbA1c ≥6.05 demonstrated a sensitivity of 63 % and a specificity of 69 %. Duration of T2DM (adjusted odds ratio (OR): 1.182; 95 % confidence interval (CI): 1.185-2.773) and FPG (OR: 0.987; 95 % CI: 0.976-0.9959) were significantly associated with high SS II after controlling for other risk factors. Duration of T2DM (Beta=0.439) contributed strongly to variance of SS II, whereas HbA1c (Beta=0.063) contributed weakly.Conclusion    Duration of T2DM is a very important risk factor for severity of coronary artery disease.

Measurement of Bone Mineral Density in the Transfusion Dependent Thalassemic Patients.

Low bone mineral density represents as a major cause of morbidity in thalassemic patient. The mechanism depends upon several factors. Transfusion dependent iron over load cause decrease secretion of growth hormone, insulin, thyroid hormone, parathyroid hormone, sex hormone and vitamin D from different endocrine organs which ultimately causes impairment of adequate bone mass achievement. Other causes of low bone mass are iron chelating agent and bony expansion due to increase erythropoiesis. To find out the frequency of low bone mineral density in thalassemia patients who are transfusion dependent. This study was designed as a cross sectional observational study, which was analyzed in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka and National Institution of Nuclear Medicine and Allied Sciences (NINMAS), Bangladesh Atomic Energy Commission (BAEC) from September 2017 to August 2018. It had been performed over total 72 (Age ≥06 years to ≤40 years) thalassaemic patients who are transfusion dependent. Presence of bone diseases was detected by Bone mineral density (BMD). Seventy-two (72) patients with transfusion dependent thalassaemia, aged 6 to 39 years were enrolled. Mean age of patients was 20.9±7.2 years. Among them, 57(79.2%) patients were detected as a normal bone mineral density and fifteen (20.8%) patients were detected as a low bone mineral density in the left femoral neck. In transfusion dependent thalassaemic patient, Low bone mass was significantly associated with low BMI, total number of blood transfusion and serum ferritin level remarkably. This survey has established a new path for early detection of low bone mass and helped in prevention of bone loss and its sequel by starting early treatment in these groups of patients.

Finding gaps in routine TB surveillance activities in Bangladesh.

BACKGROUND: TB was the leading cause of death from a single infectious pathogen globally between 2014 and 2019. Fine-scale estimates of TB prevalence and case notifications can be combined to guide priority-setting for strengthening routine surveillance activities in high-burden countries. We produce policy-relevant estimates of the TB epidemic at the second administrative unit in Bangladesh.METHODS: We used a Bayesian spatial framework and the cross-sectional National TB Prevalence Survey from 2015-2016 in Bangladesh to estimate prevalence by district. We used case notifications to calculate prevalence-to-notification ratio, a key metric of under-diagnosis and under-reporting.RESULTS: TB prevalence rates were highest in the north-eastern districts and ranged from 160 cases per 100,000 (95% uncertainty interval [UI] 80-310) in Jashore to 840 (UI 690-1020) in Sunamganj. Despite moderate prevalence rates, the Rajshahi and Dhaka Divisions presented the highest prevalence-to-notification ratios due to low case notifications. Resolving subnational disparities in case detection could lead to 26,500 additional TB cases (UI 8,500-79,400) notified every year.CONCLUSION: This study is the first to produce and map subnational estimates of TB prevalence and prevalence-to-notification ratios, which are essential to target prevention and treatment efforts in high-burden settings. Reaching TB cases currently missing from care will be key to ending the TB epidemic.

Routine Exposure Versus Non-Exposure of Recurrent Laryngeal Nerve during Thyroid Surgery: Our Experience of 300 Cases.

The technique of thyroidectomy has been in evolution for many years. It is a basic rule of surgery that an important structure of a human body must be recognized certainly during the surgical procedure in order to prevent its damage. The purpose of this study was to evaluate our routine identification and without identification of recurrent laryngeal nerve during thyroidectomy aiming to lessen the inadvertent injury of the recurrent laryngeal nerve. This retrospective clinical controlled study was performed in the Department of ENT and Head-Neck Surgery, BIRDEM General Hospital and the Department of General Surgery, BIRDEM General Hospital, Dhaka, Bangladesh from January 2014 to December 2018. Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cords were included in this study. Patients were excluded like containing hoarseness voice, abnormal movements of vocal cord. The total number of patients was 300 and these patients were randomly divided into two groups of 150 each using random number tables. In Group A the recurrent laryngeal nerves were identified by exposing the inferior thyroid artery and markedly seen in its entire course. Where as, in Group B, nerves were not identified during the operation. Immediate post operative direct laryngoscopy was performed by a surgeon with the help of an Anesthesiologist for the assessment of vocal cords. Patients with either persistent hoarseness of voice or not were followed up with indirect laryngoscopy or fiber optic laryngoscopy (FOL) at three and six months. In Group A, out of 150 patients, 6(4%) patients developed transient unilateral paralysis, resulting in slight hoarseness of voice postoperatively. The voice improved within 6 weeks. While 2(1.3%) patients developed permanent unilateral paralysis of recurrent laryngeal nerve. The voice and cord movement did not return to normal even after 6 months in one case while other one improved within the period of 6 months. In Group B, out of 150 patients, 14(9.3%) patients developed transient paralysis. Out of 14 transient paralysis 11 were unilateral and 3 were bilateral nerve paralysis. The voice was improved within 6 months in all of unilateral and bilateral transient paralyzed cases. While 6(4%) patients developed permanent paralysis of recurrent laryngeal nerve. Out of 6 permanent paralysis 2 cases were of bilateral recurrent laryngeal nerve paralysis required immediate tracheostomy. Rest 4 cases of unilateral permanent nerve paralysis, hoarseness of voice occurred but improved in 2 cases during the period varying from 2 to 6 months while in other 2 cases, it persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in Group A as compared to Group B. This difference remained statistically significant (p=0.046) between the two groups in terms of type of thyroid diseases, type of surgeries and number of surgeries. For essentially eliminating the risk of nerve injury during surgery, recurrent laryngeal nerve should be exposed and identified routinely in its entire course.

Sonocatalytic recovery of ceria from graphite and inhibition of graphite erosion by ionic liquid based platinum nanocatalyst.

Use of ultrasound as an intensified non-destructive decontamination technique for processing graphite limits its reusability beyond a few number of decontamination cycles due to the exfoliation of graphite due to cavitation effects. The current work establishes that the use of platinum nanoparticles in the leachant reduces the erosion of graphite substrate due to cavitation. It presents an improved way of sonochemical recovery of ceria using a mixture of nitric acid, formic acid and hydrazinium nitrate in the presence of platinum nanoparticles and ionic liquid. The platinum nanoparticles catalyst in ionic liquid prevented the generation of the carbon residue due to the combined effect of denitration and reduced sonication. The presence of the catalyst showed a fivefold increase in dissolution kinetics of ceria as well as absence of graphite erosion, facilitating better chances of graphite recycling than the decontamination without the catalyst. The catalytic approach offers a better recycle strategy for graphite with reduced exfoliation and NOx generation due to denitration, making it a more sustainable decontamination process. Since ceria is used as a surrogate for plutonium oxide, the results can be extended to decontaminate such deposits clearly establishing the utility of the presented results in the nuclear industry.