Comparison of Cardiovascular Response to Lower Body and Whole Body Exercise Among Sedentary Young Adults.

Background Cardiovascular responses to exercise are essential indicators of cardiovascular health and fitness. Understanding how different types of exercise, such as lower-body and whole-body exercises, impact these responses is crucial for designing effective fitness programs and assessing cardiovascular function. Aim This study aimed to compare the cardiovascular response of young adults during lower-body exercise using a bicycle ergometer and whole-body exercise on a treadmill. Methods Thirty-two healthy young adults participated in this study. Each participant completed two exercise sessions on separate days: lower-body exercise on a bicycle ergometer with a fixed cadence of 60 rpm with a breaking resistance of 1.75 kg and whole-body exercise on a treadmill with a speed of 1.7 mph and a 10% grade. Heart rate (HR), systolic blood pressure (BP), and diastolic BP were measured at rest and immediately after a three-minute exercise. Data were analyzed using paired t-tests to compare the cardiovascular responses between the two exercise modalities. Results A total of 17 male and 15 female young adults with a mean age of 20.87±1.43 years participated in the study. The male and female participants had similar ages (p =0.56) and body mass indexes (p = 0.1). There was a higher HR (129.16±2.67 versus 150.87±3.23, p<0.0001) and systolic BP (127.29±2.34 versus 144.9±4.16, p<0.0001) and lower diastolic BP (68.97±2.41 versus 62.97±2.31, p<0.0001) in whole body exercise on treadmill compared to lower body exercise in bicycle ergometer. The effect size was large enough as Cohen's d was 7.33, 5.13, and 2.54 for HR, systolic BP, and diastolic BP, respectively. Conclusion In sedentary young adults, treadmill exercise led to higher HR, systolic BP, and lower diastolic BP than bicycle ergometer exercise. Increased muscle recruitment might result in higher energy expenditure, increasing the HR and systolic BP to deliver oxygen and nutrients to the working muscles. Further research is needed to understand the mechanisms and long-term implications for precise exercise recommendations and better cardiovascular health management.

Feasibility of one-shot dilation access in the pediatric age group.

Objective: To compare sequential fascial dilation (SFD) versus one-shot dilation (OSD) in the pediatric patients undergoing percutaneous nephrolithotomy. Methods: The present study is an observational study. The study subjects were divided into two groups. In group 1, renal dilation was done using the SFD and in group 2, renal dilation was done using the OSD. The amount of time exposed to radiation during access to pelvicalyceal system was estimated. Complications, stone free rates, ancillary procedures for residual stones and hospital stay were compared. Modified Clavien-Dindo classification was used for grading the complications. Results: Radiation exposure and operative time were less in OSD group (95% confidence interval (CI) 3.068 to 14.072, and 2.565 to 12.435, p<0.005). The mean drop of hematocrit was statistically less significant in OSD group (p=0.032). In both groups, complications, stone free rate and hospital stay were statistically insignificant. Conclusions: OSD is feasible in the children with reduced radiation exposure and shorter operative time. The outcome was similar to SFD.

Hybrid fractal acoustic metamaterials for low-frequency sound absorber based on cross mixed micro-perforated panel mounted over the fractals structure cavity.

The proposed work enumerates a hybrid thin, deep-subwavelength (2 cm) acoustic metamaterials acting as a completely new type of sound absorber, showing multiple broadband sound absorption effects. Based on the fractal distribution of Helmholtz resonator (HRs) structures, integrated with careful design and construct hybrid cross micro-perforated panel (CMPP) that demonstrate broad banding approximately one-octave low-frequency sound absorption behavior. To determine the sound absorption coefficient of this novel type of metamaterial, the equivalent impedance model for the fractal cavity and the micro-perforated Maa's model for CMPP are both used. We validate these novel material designs through numerical, theoretical, and experimental data. It is demonstrated that the material design possesses superior sound absorption which is primarily due to the frictional losses of the structure imposed on acoustic wave energy. The peaks of different sound absorption phenomena show tunability by adjusting the geometric parameters of the fractal structures like cavity thickness 't', cross perforation diameter of micro perforated panel, etc. The fractal structures and their perforation panel are optimized dimensionally for maximum broadband sound absorption which is estimated numerically. This new kind of fractals cavity integrated with CMPP acoustic metamaterial has many applications as in multiple functional materials with broad-band absorption behavior etc.

Hepatitis B in hepatocellular carcinoma patients and its correlation with alpha-fetoprotein and liver enzymes.

Background: Hepatocellular carcinoma (HCC) in India ranges from 0.7 to 7.5 for men and 0.2 to 2.2 for women, per 100,000 population per year. The major risk factors for the development of HCC are infection with hepatitis B virus (HBV), hepatitis C virus, and cirrhosis of liver. Alpha-fetoprotein (AFP) and liver enzymes are widely used by clinicians for diagnostic purpose in HCC. Aims and Objective: This study was conducted in HCC patients related to HBV infection and to assess the significance of AFP and liver enzymes in it. Materials and Methods: Blood samples of 68 patients were taken. The samples were analyzed for AFP and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]). Liver enzymes were estimated by auto analyzer OLYMPUS AU400. AFP was analyzed by chemiluminescence immunoassay. Results: The mean values of AFP in serum hepatitis B surface antigen (HBsAg) negative and positive patients ranges from 22745.4 to 23269.3 ng/ml with P = 0.921. The mean value of ALP in HbsAg-negative patients was 418 U/ml, whereas in positive patients, it was 310 U/ml. Both the groups did not show any significant changes in AFP levels. The ALP showed slight rise in negative group. The other parameters did not show significant rise in all patients. Conclusion: These values suggest that there was no significant influence of viral etiology on AFP and liver enzymes level in HCC patients.

Crossing Vessel in Pelvi Ureteric Junction Obstruction: A Histopathological Analysis.

OBJECTIVE: The aim of the study is to identify whether crossing vessel is a cause or an associated finding in Pelvi Ureteric Junction Obstruction. MATERIAL AND METHODS: This is a prospective study of a total of 128 patients who underwent laparoscopic pyeloplasty from January 2016 to June 2020. All patients who underwent laparoscopic pyeloplasty and pelvi ureteric junction segments were sent for histopathological examination. The presence of crossing vessels is documented intraoperative and patients were divided into two groups, group 1 having pelvi ureteric junction obstruction with crossing vessel, and group 2, pelvi ureteric junction obstruction without crossing vessels. Histopathological examination findings of pelvi ureteric junction segment including inflammation, fibrosis, muscle hypertrophy, muscle disarray, and synaptophysin were recorded. Unpaired Student t-test was used for comparing differences between continuous normally distributed data from 2 samples and non-parametric tests were applied for continuous data. RESULTS: Of the total 128 patients, crossing vessels were identified in 42 (32.8%), and 86 (67.2%) were without crossing vessels. The demographic profile of patients between the 2 groups was comparable. On histopathological examination, moderate-to-severe chronic inflammation was seen in 23.8% and 44.2% (P > .05) in group 1 and group 2, respectively; fibrosis and muscular hypertrophy were higher in group 2 but statistically insignificant (P > .05), and muscle disarray was higher in group 1 but statistically insignificant (P > .05). Synaptophysin was positive in 4.8% and 4.7% in group 1 and group 2, respectively. CONCLUSION: The differences in histopathological examination between the 2 groups were not statistically significant. However, in patients with crossing vessels, there was a higher degree of inflammation, which may lead to early pelvi ureteric junction obstruction.

To evaluate the minimum number of renal scans required to follow pediatric patient postpyeloplasty.

The aim of the study is to evaluate the minimum number of renal scans required to follow pediatric patients postpyeloplasty. We prospectively reviewed the renal scans of 145 children with unilateral pelvi-ureteric junction obstruction who underwent dismembered pyeloplasty. Patients were then divided into four groups based on preoperative split renal function. All patients were followed with renal scan and ultrasound for minimum of 4 years. Renal scan and ultrasound were done after stent removal at 3, 6, and 12 months and then yearly after surgery. Drainage pattern (T1/2) was seen in all groups, except in patients where there was no comment on drainage pattern. Statistical analysis was performed using the Friedman ANOVA and Wilcoxon signed-ranks test as a post hoc test with Bonferroni correction and Kruskal-Wallis test with Mann-Whitney U-test as a post hoc test with Bonferroni correction. On comparison of the pattern of drainage with time in Groups 1-4, it was found that there was no significant difference with time in Group 1. Then, further, using Wilcoxon signed-rank test as post hoc test for Friedman ANOVA, Group 2 showed statistically significant difference in drainage pattern in scans between 6 months and 1 year, Group 3 showed statistically significant difference in drainage pattern in scans between 3 months and 1 year, and Group 4 showed statistically significant difference in drainage pattern in scans done between 3 and 6 months (P < 0.05). Minimum of three renal scans were required for paediatric patients post pyeloplasty at 3 months, 6 months and 1 year in the follow up period.

Urodynamic Changes after Valve Fulguration Alone and Valve Fulguration with Bladder Neck Incision.

AIMS: The aim of this study is to compare urodynamic changes after valve fulguration alone and valve fulguration with bladder neck incision (BNI). SETTINGS AND DESIGN: A total of 81 patients with posterior urethral valve were treated at our center from July 2010 to July 2016. Patients were randomized into two groups using simple randomization. Forty patients underwent BNI in addition to valve fulguration (Group I), and the remaining 41 patients underwent conventional transurethral valve fulguration (Group II). SUBJECTS AND METHODS: The exclusion criteria for both the groups were the presence of simultaneous urogenital anomalies, any neurological condition, history of any urethral manipulation, and urinary diversion. Urodynamic changes were compared in both groups postoperatively. All patients were evaluated throughout their follow-up, according to the following protocol: (a) Voiding cystourethrography at 6 weeks after surgery; (b) Renal function test and urine culture at 6 weeks and then 3 monthly; (c) Ultrasound kidney, ureter, and bladder region and urodynamics at 3 and 6 months after surgery and then yearly. Median follow-up period for Group I was 27.5 months (13-72 months) and 14 months (14.5-72 months) for Group II. STATISTICAL ANALYSIS USED: Statistical analysis was done using the Student's t-test for parametric data and Chi-square test for categorical variable. P ≤ 0.05 was considered as statistically significant. RESULTS: The mean age was 7.26 years in Group I and 7.66 years in Group II at the end of follow-up. There was no statistically significant difference found regarding detrusor overactivity (P = 0.68), compliance (P = 0.052), end-filling pressure (P = 0.08), and max Pdet at Qmax (P = 0.08) in the both groups. However, there was a statistically significant difference regarding improvement of peak flow (P = 0.038) and postvoid residue (PVR) (P = 0.045) in Group I in comparison to Group II. CONCLUSIONS: Valve ablation with BNI gives statistically significant better urodynamics in voiding phase regarding flow and lesser PVR in comparison to valve ablation.

Follow-up imaging after pediatric pyeloplasty.

INTRODUCTION: The duration, methods and frequency of radiographic follow-up after pediatric pyeloplasty is not well-defined. We prospectively evaluated a cohort of children undergoing pyeloplasty to determine the method for follow-up. METHODS: Between 2000 and 2008, children undergoing pyeloplasty for unilateral ureteropelvic junction obstruction were evaluated for this study. All patients were evaluated preoperatively with protocol ultrasound (USG) and diuretic renal scan (RS). On the basis of preoperative split renal function (SRF), these patients were divided into four groups - Group I: SRF > 40%, Group II: SRF 30-39%, Group III: SRF 20-29%, and Group IV: SRF 10-19%. In follow-up, USG and RS were done at 3 months and repeated at 6 months, 1 year, and then yearly after surgery for a minimum period of 5 years. Improvement, stability, or worsening of hydronephrosis was based on the changes in anteroposterior (AP) diameter of pelvis and caliectasis on USG. Absolute increase in split renal function (SRF) >5% was considered significant. Failure was defined as increase in AP diameter of pelvis and decrease in cortical thickness on 3 consecutive USG, t½ >20 min with obstructive drainage on RS and/or symptomatic patient. RESULTS: 145 children were included in the study. Their mean age was 3.26 years and mean follow-up was 7.5 years. Pre- and post-operative SRF remain unchanged within 5% range in 35 of 41 patients (85%) in Group I. While 9 of 20 patients (45%) in Group II, 23 of 50 patients (46%) in Group III, and 14 of 34 patients (41%) in Group IV exhibited changes >5% after surgery. 5 patients failed, 2 in Group III, and 3 in Group IV. None of the patients deteriorated in Group I and II. CONCLUSION: After pyeloplasty in children with a baseline split GFR >30%, if a diuretic renogram and USG performed 3 months postoperatively shows nonobstructive drainage with t½ <20 min and decreased hydronephrosis, no further follow-up is required.

Unusual presentation of tuberculosis in the form of a bilateral renal pseudotumor.

Genitourinary tuberculosis (TB) is a common form of extrapulmonary tuberculosis. The kidneys are usually affected by hematogenous seeding at the time of primary pulmonary infection. Genitourinary TB has non-specific clinical presentations and variable radiographic appearances. We are reporting a case of genitourinary TB presenting as bilateral renal mass. The patient underwent computed tomography-guided kidney biopsy that showed a granulomatous lesion. Then, the patient was put on anti-tuberculous treatment with a good response. We feel that patients having multiple bilateral kidney lesions should undergo biopsy to determine the nature of the lesion before any surgical intervention.

Prospective randomized study to evaluate the feasibility and outcome of transmesocolic laparoscopic pyeloplasty and compare it with retrocolic laparoscopic pyeloplasty in pediatric and adolescent patients.

OBJECTIVE: This prospective randomized study was designed to evaluate the feasibility and outcome of transmesocolic laparoscopic pyeloplasty (TMP) and compare it with retrocolic laparoscopic pyeloplasty (RLP) in pediatric and adolescent patients. MATERIALS AND METHODS: Between September 2006 to May 2012, data of pediatric and adolescent patients undergoing laparoscopic pyeloplasty were recorded in a prospective manner. Data included age, pelvic volume, presence of stones, aberrant vessels, operative time, analgesics requirement and time to accept oral feeds and drain removal. Patients with left side pelviureteric junction obstruction with any size of pelvic volume, with or without renal stones and aberrant vessels were included in the study. Patients were assigned into two groups by simple randomization technique. A total of 38 TMP and 41 left sided RLP were performed. Median follow-up period for transmesocolic group was 12.5 months (9.5-62 months) and 14 months (8-66 months) for retro colic group. Outcome for this study was adequate drainage on renal scan, improvement in symptom and or resolution of hydronephrosis on ultrasound. Statistical analysis was performed using the Mann-Whitney test. RESULTS: The mean patient age was 8.73 years in RLP and 7.73 years in TMP. In RLP group the mean operative time was 75.84 min (time from port insertion to pyeloplasty) and 135.4 min (total operative time) while it was 44.82 min and 104.82 min respectively in TMP group. Compared with classic RLP, TMP cases showed a significant reduction in operative time. CONCLUSIONS: The transmesocolic approach for left sided pyeloplasty enables a shorter operative time even in the presence of large pelvis, aberrant vessel and stones without increasing morbidity in comparison to RLP approach.

Congenital anterior urethral diverticulum.

Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair.

Cytohistomorphologic features of malignant fibrous histiocytoma of the breast: a case report.

BACKGROUND: Malignant mesenchymal tumors constitute < 1% of all malignant neoplasms of the breast. These include pure primary sarcoma of the breast, metastatic sarcoma and sarcomatous patterns in metaplastic carcinomas. On fine needle aspiration cytology (FNAC), the cellular features can suggest the diagnosis of sarcoma of the breast, although the potential exists for confusion with very poorly differentiated carcinoma. CASE: A case of recurrent primary malignant fibrous histiocytoma (MFH) occurred in the breast in a 32-year-old woman. The patient presented with a fungating mass in the right breast. FNAC was suggestive of malignant mesenchymal tumor, most probably MFH. The diagnosis was confirmed on biopsy. CONCLUSION: Malignant fibrous histiocytoma of the breast is a rare entity, and a complete clinicopathologic correlation with immunohistochemical profile is essential to arrive at a correct diagnosis and guide appropriate management of the patient.