Revisiting CT Signs of Unilateral Vocal Fold Paralysis: A Single, Blinded Study.

BACKGROUND AND PURPOSE: Several CT findings are thought to be indicative of vocal cord paralysis; however, these signs have never been validated in a blinded fashion. This study attempts to compare and validate these signs and determine their accuracy in predicting vocal cord paralysis. MATERIALS AND METHODS: A retrospective chart review was performed, and CT scans from patients with known unilateral vocal cord paralysis and known normal vocal cord movement were reviewed by 3 radiologists who were blinded to the status of the patients' laryngeal function. The scans were reviewed and scored for 8 accepted signs of vocal cord paralysis as well as for predicting a final diagnostic conclusion. Statistical analysis using odds ratios for signs and the Fleiss κ for criterion agreement among the radiologists was performed for diagnostic accuracy. RESULTS: The presence of medial displacement of the posterior ipsilateral vocal fold margin and ipsilateral laryngeal ventricular dilation yielded the greatest positive predictive value. Other signs demonstrated high specificity, but interrater discrepancy was greater than expected and diminished the reliability of these signs in predicting vocal cord paralysis. Overall, sensitivity and negative predictive values were low. CONCLUSIONS: Predicting vocal cord paralysis on the basis of CT findings is not as accurate or straightforward in prospectively predicting vocal cord paralysis as implied in prior studies.

Interactive effect of elevated tropospheric ozone and carbon dioxide on radiation utilisation, growth and yield of chickpea (Cicer arietinum L.).

An experiment was conducted in the Free Air Ozone and Carbon dioxide Enrichment (FAOCE) facility to study the impact of elevated O3, CO2 and their interaction on chickpea crop (cv. Pusa-5023) in terms of phenology, biophysical parameters, yield components, radiation interception and use efficiency. The crop was exposed to elevated O3 (EO:60ppb), CO2 (EC:550 ppm) and their combined interactive treatment (ECO: EC+EO) during the entire growing season. Results revealed that the crop's total growth period was shortened by 10, 14 and 17 days under elevated CO2, elevated O3 and the combined treatment, respectively. Compared to ambient condition, the leaf area index (LAI) under elevated CO2 was higher by 4 to 28%, whilst it is reduced by 7.3 to 23.8% under elevated O3. The yield based radiation use efficiency (RUEy) was highest under elevated CO2 (0.48 g MJ-1), followed by combined (0.41 g MJ-1), ambient (0.38 g MJ-1) and elevated O3 (0.32 g MJ-1) treatments. Elevated O3 decreased RUEy by 15.78% over ambient, and the interaction results in a 7.8% higher RUEy. The yield was 31.7% more under elevated CO2 and 21.9% lower in elevated O3 treatment as compared to the ambient. The combined interactive treatment recorded a higher yield as compared to ambient by 9.7%. Harvest index (HI) was lowest under elevated O3 (36.10%), followed by ambient (39.18%), combined (40.81%), and highest was under elevated CO2 (44.18%). Chickpea showed a positive response to elevated CO2 resulting a 5% increase in HI as compared to ambient condition. Our findings quantified the positive and negative impacts of elevated O3, CO2 and their interaction on chickpea and revealed that the negative impacts of elevated O3 can be compensated by elevated CO2 in chickpea. This work promotes the understanding of crop behaviour under elevated O3, CO2 and their interaction, which can be used as valuable inputs for radiation-based crop simulation models to simulate climate change impact on chickpea crop.

Topical Ciclopirox Olamine 1%: Revisiting a Unique Antifungal.

The injudicious use of antifungals, indiscriminate use of corticosteroids for instant relief, persistence of predisposing factors like sweat retention and uncontrolled diabetes, and emerging resistance to antifungals across the globe have rendered the management of an erstwhile simple infection, the superficial cutaneous mycoses highly complicated and tricky. Ciclopirox is an old yet efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Despite its numerous beneficial properties over the majority of other topical antifungals, it remains underutilized.

Radiation interception, extinction coefficient and use efficiency of wheat crop at various irrigation and nitrogen levels in a semi-arid location.

Field experiments were conducted to study the effect of irrigation and nitrogen levels on radiation use efficiency (RUE), radiation extinction coefficient (κ) and temporal variation of leaf area index (LAI) and fraction intercepted photosynthetically active radiation (fIPAR). The LAI of wheat increased with increase in irrigation and nitrogen levels. The fIPAR also followed trend similar to LAI. The LAI and fIPAR showed logarithmic relationship with R2 value of 0.92 and 0.93 for the years 2013-2014 and 2014-2015, respectively. The κ value varied between 0.41 and 0.78 and was significantly affected by nitrogen levels but was not influenced by irrigation levels. The grain and above ground biomass (AGB) yields of wheat were not affected significantly by irrigation levels. However, application of 160 kg N ha-1 (N160) registered higher grain (12-33%) and AGB (22-25%) yeilds as compared to that with application of 40 kg N ha-1 (N40). Similar to AGB, the total intercepted photosynthetically active radiation (TIPAR) was not affected by irrigation levels but N160 treatment registered 9-20% higher TIPAR compared to N40 treatment. The linear relationship between TIPAR and AGB revealed that 83-86% variation in AGB yield of wheat can be explained by TIfIPAR. The RUE of wheat under three irrigations (I3) was 6 and 18% higher (P < 0.05) than the five (I5) and two (I2) irrigation treatments, respectively for the year 2013-2014. However, there was no significant effect of irrigation on RUE of wheat in the year 2014-2015. N160 treatment registered 5-13% higher RUE than the N40 treatment. Thus wheat may be grown with three irrigations (CRI, flowering and grain filling) and 160 kg N ha-1 for higher RUE without significant reduction in AGB of wheat compared to five irrigation levels in semi-arid location of Delhi region.

Targeting KRas-dependent tumour growth, circulating tumour cells and metastasis in vivo by clinically significant miR-193a-3p.

KRas is mutated in a significant number of human cancers and so there is an urgent therapeutic need to target KRas signalling. To target KRas in lung cancers we used a systems approach of integrating a genome-wide miRNA screen with patient-derived phospho-proteomic signatures of the KRas downstream pathway, and identified miR-193a-3p, which directly targets KRas. Unique aspects of miR-193a-3p biology include two functionally independent target sites in the KRas 3'UTR and clinically significant correlation between miR-193a-3p and KRas expression in patients. Rescue experiments with mutated KRas 3'UTR showed very significantly that the anti-tumour effect of miR-193a-3p is via specific direct targeting of KRas and not due to other targets. Ex vivo and in vivo studies utilizing nanoliposome packaged miR-193a-3p demonstrated significant inhibition of tumour growth, circulating tumour cell viability and decreased metastasis. These studies show the broader applicability of using miR-193a-3p as a therapeutic agent to target KRas-mutant cancer.

Climate change impacts on irrigated rice and wheat production in Gomti River basin of India: a case study.

Potential future impacts of climate change on irrigated rice and wheat production and their evapotranspiration and irrigation requirements in the Gomti River basin were assessed by integrating a widely used hydrological model "Soil and Water Assessment Tool (SWAT)" and climate change scenario generated from MIROC (HiRes) global climate model. SWAT model was calibrated and validated using monthly streamflow data of four spatially distributed gauging stations and district wise wheat and rice yields data for the districts located within the basin. Simulation results showed an increase in mean annual rice yield in the range of 5.5-6.7, 16.6-20.2 and 26-33.4 % during 2020s, 2050s and 2080s, respectively. Similarly, mean annual wheat yield is also likely to increase by 13.9-15.4, 23.6-25.6 and 25.2-27.9 % for the same future time periods. Evapotranspiration for both wheat and rice is projected to increase in the range of 3-9.6 and 7.8-16.3 %, respectively. With increase in rainfall during rice growing season, irrigation water allocation for rice is likely to decrease (<5 %) in future periods, but irrigation water allocation for wheat is likely to increase by 17.0-45.3 % in future periods.

Functional proteomics identifies miRNAs to target a p27/Myc/phospho-Rb signature in breast and ovarian cancer.

The myc oncogene is overexpressed in almost half of all breast and ovarian cancers, but attempts at therapeutic interventions against myc have proven to be challenging. Myc regulates multiple biological processes, including the cell cycle, and as such is associated with cell proliferation and tumor progression. We identified a protein signature of high myc, low p27 and high phospho-Rb significantly correlated with poor patient survival in breast and ovarian cancers. Screening of a miRNA library by functional proteomics in multiple cell lines and integration of data from patient tumors revealed a panel of five microRNAs (miRNAs) (miR-124, miR-365, miR-34b*, miR-18a and miR-506) as potential tumor suppressors capable of reversing the p27/myc/phospho-Rb protein signature. Mechanistic studies revealed an RNA-activation function of miR-124 resulting in direct induction of p27 protein levels by binding to and inducing transcription on the p27 promoter region leading to a subsequent G1 arrest. Additionally, in vivo studies utilizing a xenograft model demonstrated that nanoparticle-mediated delivery of miR-124 could reduce tumor growth and sensitize cells to etoposide, suggesting a clinical application of miRNAs as therapeutics to target the functional effect of myc on tumor growth.

Development and evaluation of low cost honey heating-cum-filtration system.

A fully mechanized honey heating-cum-filtration system was designed, developed, fabricated and evaluated for its performance. The system comprised of two sections; the top heating section and the lower filtering section. The developed system was evaluated for its performance at different process conditions (25 kg and 50 kg capacity using processing condition: 50 °C heating temperature and 60 °C heating temperature with 20 and 40 min holding time, respectively) and it was found that the total time required for heating, holding and filtration of honey was 108 and 142 min for 25 kg and 50 kg capacity of machine, respectively, irrespective of the processing conditions. The optimum capacity of the system was found to be 50 kg and it involved an investment of Rs 40,000 for its fabrication. The honey filtered through the developed filtration system was compared with the honey filtered in a high cost honey processing plant and raw honey for its microbial and biochemical (reducing sugars (%), moisture, acidity and pH) quality attributes. It was observed that the process of filtering through the developed unit resulted in reduction of microbes. The microbiological quality of honey filtered through the developed filtration system was better than that of raw honey and commercially processed honey. The treatment conditions found best in context of microbiological counts were 60 °C temperature for 20 min. There was 1.97 fold reductions in the plate count and 2.14 reductions in the fungal count of honey processed through the developed filtration system as compared to the raw honey. No coliforms were found in the processed honey. Honey processed through developed unit witnessed less moisture content, acidity and more reducing sugars as compared to raw honey, whereas its quality was comparable to the commercially processed honey.

Plexiform neurofibroma affecting the upper parietal scalp, with cerebellar hamartoma: role of histopathology, colour Doppler imaging and magnetic resonance imaging.

We report a patient with plexiform neurofibroma, which is pathognomonic for neurofibromatosis type 1 (NF1) affecting the upper parietal region of the scalp. Cerebellar hamartoma was present, a finding that, to our knowledge, has not been reported previously. We highlight the role of histopathology, ultrasonography, colour Doppler imaging and magnetic resonance imaging, in addition to the seven existing criteria, for the diagnosis of NF1.

Optimization of drying process parameters for cauliflower drying.

The different sizes (3, 4 and 5 cm) of hybrid variety of cauliflower (variety no. 71) were dehydrated in thin layer at three temperatures of 55, 60 and 65 °C with velocities of 40, 50 and 60 m/min. Dehydrated samples were analyzed for vitamin C, rehydration ratio and browning. Statistical analysis indicated that drying time was dependent on initial size of cauliflower, drying air temperature and velocity, but rehydration ratio was significantly affected by the combined effect of temperature and airflow velocity. Vitamin C content of the dried cauliflower samples were significantly affected by temperature only and non enzymatic browning was function of temperature, airflow velocity, and combined effect of temperature and airflow velocity. Optimization of the drying process parameters for the given constraints resulted in 60.10(0)C, 59.28 m/min, 3.35 cm. The predicted responses for the optimized combination of process parameters were time, vitamin C content, rehydration ratio, and browning values of 491.22 min (time), 289.86 mg/100 g (Vitamin C), 6.91 ( rehydration ratio), and 0.14 (browning), respectively with the desirability factor of 0.787.

Radioactive bone cement for the treatment of spinal metastases: a dosimetric analysis of simulated clinical scenarios.

Vertebral metastases are a common manifestation of many cancers, potentially leading to vertebral collapse and neurological complications. Conventional treatment often involves percutaneous vertebroplasty/kyphoplasty followed by external beam radiation therapy. As a more convenient alternative, we have introduced radioactive bone cement, i.e. bone cement incorporating a radionuclide. In this study, we used a previously developed Monte Carlo radiation transport modeling method to evaluate dose distributions from phosphorus-32 radioactive cement in simulated clinical scenarios. Isodose curves were generally concentric about the surface of bone cement injected into cadaveric vertebrae, indicating that dose distributions are relatively predictable, thus facilitating treatment planning (cement formulation and dosimetry method are patent pending). Model results indicated that a therapeutic dose could be delivered to tumor/bone within ∼4 mm of the cement surface while maintaining a safe dose to radiosensitive tissue beyond this distance. This therapeutic range should be sufficient to treat target volumes within the vertebral body when tumor ablation or other techniques are used to create a cavity into which the radioactive cement can be injected. With further development, treating spinal metastases with radioactive bone cement may become a clinically useful and convenient alternative to the conventional two-step approach of percutaneous strength restoration followed by radiotherapy.

SU-E-J-102: The Impact of the Number of Subjects for Atlas-Based Automatic Segmentation.

PURPOSE: To determine the impact of atlas size on the performance of atlas-based automatic segmentation (ABAS) in delineation of organs at risk for adaptive radiation therapy. METHODS: A total of 25 patients who had undergone intensity modulated radiation therapy for various head and neck cancers were retrospectively selected for inclusion in a library to be used for ABAS with the MIM VISTA software package (MIM Software, Cleveland OH). Treatment planning computed tomography (CT) scans and subsequent organ at risk (OAR) contours generated as part of the treatment planning process for these patients were added to the library. This library of 25 patients was then successively pruned to generate 5 atlases with 25, 20, 15, 10, and 5 patient subjects respectively. Atlas based segmentation was performed on 10 retrospectively selected treatment planning CT scans to automatically generate right and left parotid glands and brainstem contours. These planning CT scans belonged to a unique set of 10 patient subjects different from the ones used for generating the atlases. One physician (JW), who was blinded to the ABAS results, manually delineated gold-standard contours for the right and left parotid glands and brainstem. Dice similarity coefficients were calculated and analyzed as a function of atlas subject size. RESULTS: For the sites selected in this study, the performance of ABAS was relatively insensitive to atlas size. Furthermore, some patient subjects were repeatedly selected implying that the adoption of a single standard patient for ABAS may be of benefit. CONCLUSIONS: Our preliminary results indicate that the performance of the atlas based segmentation module in MIM VISTA Version 5.2 for the organs studied here may be relatively insensitive to the atlas size.

Juvenile, insulin-dependent diabetes mellitus, type 1-related dermatoses.

Juvenile insulin-dependent diabetes mellitus type 1 (IDDM) is a well-recognized worldwide entity, the significance of which has increased because of its recent upsurging trends, warranting attention on variety of its clinical expressions, in particular, pertaining to skin, an aspect seldom taken cognizance of. Hence an endeavour to recap the related dermatoses, such as limited joint mobility syndrome including sclerodermoid (scleroderma-like) changes, xerosis, necrobiosis lipoidica diabeticorum, granuloma annulare, diabetic foot syndrome, has been made. Complexities relating to the recently explored issues of atopic dermatitis and drug hypersensitivity syndrome have also been covered adequately. In addition, the current concepts of the physiopathology of type 1 diabetes-related dermatoses are briefly recapitulated for clarity.

Immune reconstitution following rabbit antithymocyte globulin.

Depletional induction therapies are routinely used to prevent acute rejection and improve transplant outcome. The effects of depleting agents on T-cell subsets and subsequent T-cell reconstitution are incompletely defined. We used flow cytometry to examine the effects of rabbit antithymocyte globulin (rATG) on the peripheral T-cell repertoire of pediatric and adult renal transplant recipients. We found that while rATG effectively depleted CD45RA+CD27+ naïve and CD45RO+CD27+ central memory CD4+ T cells, it had little effect on CD45RO+CD27- CD4+ effector memory or CD45RA+CD31-, CD45RO+CD27+ and CD45RO+CD27- CD8+ T cell subsets. When we performed a kinetic analysis of CD31+ recent thymic emigrants and CD45RA+/RO+ T cells, we found evidence for both thymopoiesis and homeostatic proliferation contributing to immune reconstitution. We additionally examined the impact of rATG on peripheral CD4+Foxp3+ T cells. We found that in adults, administration of rATG-induced peripheral expansion and new thymic emigration of T cells with a Treg phenotype, while CD4+Foxp3+ T cells of thymic origin predominated in children, providing the first evidence that rATG induces Treg in vivo. Collectively our data indicate that rATG alters the balance of regulatory to memory effector T cells posttransplant, providing an explanation for how it positively impacts transplant outcome.

Evaluation of a radiation transport modeling method for radioactive bone cement.

Spinal metastases are a common and serious manifestation of cancer, and are often treated with vertebroplasty/kyphoplasty followed by external beam radiation therapy (EBRT). As an alternative, we have introduced radioactive bone cement, i.e. bone cement incorporated with a radionuclide. In this study, we present a Monte Carlo radiation transport modeling method to calculate dose distributions within vertebrae containing radioactive cement. Model accuracy was evaluated by comparing model-predicted depth-dose curves to those measured experimentally in eight cadaveric vertebrae using radiochromic film. The high-gradient regions of the depth-dose curves differed by radial distances of 0.3-0.9 mm, an improvement over EBRT dosimetry accuracy. The low-gradient regions differed by 0.033-0.055 Gy/h/mCi, which may be important in situations involving prior spinal cord irradiation. Using a more rigorous evaluation of model accuracy, four models predicted the measured dose distribution within the experimental uncertainty, as represented by the 95% confidence interval of the measured log-linear depth-dose curve. The remaining four models required modification to account for marrow lost from the vertebrae during specimen preparation. However, the accuracy of the modified model results indicated that, when this source of uncertainty is accounted for, this modeling method can be used to predict dose distributions in vertebrae containing radioactive cement.