Doppler Assessment of Hepatic Venous Waves for Evaluation of Large Varices in Cirrhotic Patient.

This cross sectional study was conducted to evaluate the role of doppler ultrasonography of hepatic venous waves for evaluation of large varices in cirrhotic patients from July 2013 to June 2015 in Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Patients getting admitted in the ward with a diagnosis of cirrhosis were enrolled in the study and purposive sampling technique was adopted. The sample size was 43. Data were collected by face to face interview and some data were gathered by records review and analyzed with the help of SPSS windows version - 12 software programs. Statistical significance was set at P<0.05 and confidence interval set at 95%. The research protocol was approved by the local ethical committee. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. If the gold standard is not available, other possible diagnostic steps would be Doppler ultrasonography of the blood circulation (not endoscopic ultrasonography). Although and it can certainly demonstrate the presence of varices. In 60.47% of patient's monophasic wave pattern was seen and in 39.53% of cases biphasic & triphasic wave pattern were detected. Endoscopic examination was performed in all selected patients. In this study, 67.44% is large varices, 32.66% is small varices. Chi Square test was done for hypothesis testing and it was found significant (<0.05) and it indicates monophasic wave in Doppler USG signifies large varices. This test was also done to find out whether any significant difference of hepatic venous waveform in between male and female but it was not significant (>0.05). Diagnostic performance of USG for evaluation of varices showed, Sensitivity: 86.2%, Specificity: 92.85%, PPV: 96%, NPV: 76.47%, Accuracy 88%. Correlation co-efficient was 0.0064 which indicates moderately positive correlation in between monophasic hepatic venous waveform pattern by Doppler USG and large varices in oesophagogastroduodenoscopic findings Normal hepatic wave form shows triphasic pattern. Loss of this pattern in cirrhosis is mainly due to loss of compliance of liver. In conclusion, the loss of triphasic pattern of hepatic wave form is highly sensitive in predicting the presence of large varices in cirrhotic patients and this doppler parameter may be used as a non-invasive test for cirrhotic patients, who wish to avoid upper GI endoscopy. Further studies using a combination of various doppler parameters are needed to create indices with a better predictive value.

Biological treatment of produced water in a sequencing batch reactor by a consortium of isolated halophilic microorganisms.

Produced water or oilfield wastewater is the largest volume ofa waste stream associated with oil and gas production. The aim of this study was to investigate the biological pretreatment of synthetic and real produced water in a sequencing batch reactor (SBR) to remove hydrocarbon compounds. The SBR was inoculated with isolated tropical halophilic microorganisms capable of degrading crude oil. A total sequence of 24 h (60 min filling phase; 21 h aeration; 60 min settling and 60 min decant phase) was employed and studied. Synthetic produced water was treated with various organic loading rates (OLR) (0.9 kg COD m(-3) d(-1), 1.8 kg COD m(-3) d(-1) and 3.6 kg COD m(-3) d(-1)) and different total dissolved solids (TDS) concentration (35,000 mg L(-1), 100,000 mg L(-1), 150,000 mg L(-1), 200,000 mg L(-1) and 250,000 mg L(-1)). It was found that with an OLR of 0.9 kg COD m(-3) d(-1) and 1.8 kg COD m(-3) d(-1), average oil and grease (O&G) concentrations in the effluent were 7 mg L(-1) and 12 mg L(-1), respectively. At TDS concentration of 35,000 mg L(-1) and at an OLR of 1.8 kg COD m(-3)d(-1), COD and O&G removal efficiencies were more than 90%. However, with increase in salt content to 250,000 mg L(-1), COD and O&G removal efficiencies decreased to 74% and 63%, respectively. The results of biological treatment of real produced water showed that the removal rates of the main pollutants of wastewater, such as COD, TOC and O&G, were above 81%, 83%, and 85%, respectively.

A validation of dynamic causal modelling for 7T fMRI.

BACKGROUND: There is growing interest in ultra-high field magnetic resonance imaging (MRI) in cognitive and clinical neuroscience studies. However, the benefits offered by higher field strength have not been evaluated in terms of effective connectivity and dynamic causal modelling (DCM). NEW METHOD: In this study, we address the validity of DCM for 7T functional MRI data at two levels. First, we evaluate the predictive validity of DCM estimates based upon 3T and 7T in terms of reproducibility. Second, we assess improvements in the efficiency of DCM estimates at 7T, in terms of the entropy of the posterior distribution over model parameters (i.e., information gain). RESULTS: Using empirical data recorded during fist-closing movements with 3T and 7T fMRI, we found a high reproducibility of average connectivity and condition-specific changes in connectivity - as quantified by the intra-class correlation coefficient (ICC = 0.862 and 0.936, respectively). Furthermore, we found that the posterior entropy of 7T parameter estimates was substantially less than that of 3T parameter estimates; suggesting the 7T data are more informative - and furnish more efficient estimates. COMPARED WITH EXISTING METHODS: In the framework of DCM, we treated field-dependent parameters for the BOLD signal model as free parameters, to accommodate fMRI data at 3T and 7T. In addition, we made the resting blood volume fraction a free parameter, because different brain regions can differ in their vascularization. CONCLUSIONS: In this paper, we showed DCM enables one to infer changes in effective connectivity from 7T data reliably and efficiently.

InFlo: a novel systems biology framework identifies cAMP-CREB1 axis as a key modulator of platinum resistance in ovarian cancer.

Characterizing the complex interplay of cellular processes in cancer would enable the discovery of key mechanisms underlying its development and progression. Published approaches to decipher driver mechanisms do not explicitly model tissue-specific changes in pathway networks and the regulatory disruptions related to genomic aberrations in cancers. We therefore developed InFlo, a novel systems biology approach for characterizing complex biological processes using a unique multidimensional framework integrating transcriptomic, genomic and/or epigenomic profiles for any given cancer sample. We show that InFlo robustly characterizes tissue-specific differences in activities of signalling networks on a genome scale using unique probabilistic models of molecular interactions on a per-sample basis. Using large-scale multi-omics cancer datasets, we show that InFlo exhibits higher sensitivity and specificity in detecting pathway networks associated with specific disease states when compared to published pathway network modelling approaches. Furthermore, InFlo's ability to infer the activity of unmeasured signalling network components was also validated using orthogonal gene expression signatures. We then evaluated multi-omics profiles of primary high-grade serous ovarian cancer tumours (N=357) to delineate mechanisms underlying resistance to frontline platinum-based chemotherapy. InFlo was the only algorithm to identify hyperactivation of the cAMP-CREB1 axis as a key mechanism associated with resistance to platinum-based therapy, a finding that we subsequently experimentally validated. We confirmed that inhibition of CREB1 phosphorylation potently sensitized resistant cells to platinum therapy and was effective in killing ovarian cancer stem cells that contribute to both platinum-resistance and tumour recurrence. Thus, we propose InFlo to be a scalable and widely applicable and robust integrative network modelling framework for the discovery of evidence-based biomarkers and therapeutic targets.

Detection of Ovarian Tumor by Color Doppler Ultrasonography and CA-125.

Ovarian cancer is the most frequent cause of death from all gynaecological malignancies because of its insidious onset, vague symptoms and late presentation. This cross-sectional study was carried out on purposively selected 43 patients with suspected ovarian tumor in the Department of Radiology and Imaging in collaboration with the Department of Gynaecology and Obstetrics and Department of Pathology, Mymensingh Medical College Hospital, Bangladesh from January 2015 to December 2016 to assess the diagnostic performance of color Doppler ultrasonography and CA-125 in a combination described as Novel Index in detection of ovarian tumor. Highest number of patients of ovarian tumor 10(23.26%) were in age group 35 to 44 years and 45 to 54 years with a mean of 37.72±15.65 years with a range of 8-70 years. Histopathology findings revealed 19(44.18%) benign tumors and 24(55.82%) malignant tumors. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Resistance Index (RI) in diagnosis of ovarian tumor were 91.67%, 89.47%, 91.67%, 89.47% and 90.69% respectively. Sensitivity, specificity, PPV, NPV and accuracy of serum CA-125 were 83.33%, 89.47%, 90.90%, 80.95% and 86.04% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Novel index were 95.83%, 89.47%, 92.00%, 94.44% and 93.02% respectively. Novel index showed better diagnostic performance. Based on the current study it is concluded that the combination of color Doppler ultrasonography and serum CA-125 can be useful for diagnosis of ovarian tumor.

Use of fungi to improve bioconversion of activated sludge.

The present study was designed to evaluate the potential of microbial adaptation and its affinity to biodegradation as well as bioconversion of soluble/insoluble (organic) substances of domestic wastewater treatment plant (DWTP) sludge (activated domestic sludge) under natural/non-sterilized conditions. The two filamentous fungi, Penicillium corylophilum (WWZP1003) and Aspergillus niger (SCahmA103) were used to achieve the objectives. It was observed that P. corylophilum (WWZP1003) was the better strain compared to A. niger (SCahmA103) for the bioconversion of domestic activated sludge through adaptation. The visual observation in plate culture showed that about 95-98% of cultured microbes (P. corylophilum and A. niger) dominated in treated sludge after 2 days of treatment. In this study, it was also found that the P. corylophilum was capable of removing 94.40% of COD and 98.95% of turbidity of filtrate with minimum dose of inoculum of 10% v/v in DWTP sludge (1% w/w). The pH level was lower (acidic condition) in the fungal treatment and maximum reduction of COD and turbidity was observed (at lower pH). The results for specific resistance to filtration (SRF) showed that the fungi played a great role in enhancing the dewaterability and filterability. In particular, the strain Penicillium had a more significant capability (than A. niger) of reducing 93.20% of SRF compared to the uninoculated sample. Effective results were observed by using fungal inoculum after 2 days of treatment. The developed LSB process is a new biotechnological approach for sludge management strategy.

Concha bullosa in chronic sinusitis.

Sinusitis is an important cause of morbidity and one of the major sources of income loss. Anatomical variations of the nose have been reported to predispose to sinusitis. These variations include concha bullosa, nasal septal deviation and oversized bulla. The aim of this study was to determine the proportion and the distribution of concha bullosa in patients with chronic sinusitis and to determine the relationship between concha bullosa and age, sex, ethnicity. A cross-sectional study was conducted at the Department of Ear, Nose and Throat in Kuala Lumpur Hospital (HKL). Data was collected retrospectively using a pretested proforma. All patients who underwent Sino nasal surgery between January 1999 and December 2000 and whose preoperative CT scans were available were included in the study. The CT scans were reviewed. Analysis was carried out using Statistical Package for Social Sciences. Out of 146 patients who underwent sinonasal surgery between January 1999 and December 2000, 101 (69.2% preoperative CT scans of these patients were available and these were reviewed. The proportion of patients with concha bullosa was 49.5%. The results showed that there was significant relationship between presence of concha bullosa and age and sex. The overall mean age of patient with concha bullosa was 35.7 years (95% CI 12.1-39.3) and ranged from 11-years to 56-years. The mean age of respondents with concha bullosa was significantly lower than patients without concha bullosa 41.98 (95% CI 37.6-46.3; t-test = 2.221; df=99; p < 0.05). Concha bullosa was significantly more in females (66.0%) compared to males (chi2 = 4.465, df=1, p < 0.05). There was no significant relationship between presence of concha bullosa and ethnicity.

Enhanced settleability and dewaterability of fungal treated domestic wastewater sludge by liquid state bioconversion process.

A study was conducted to evaluate the settleability and dewaterability of fungal treated and untreated sludge using liquid state bioconversion process. The fungal mixed culture of Aspergillus niger and Penicillium corylophilum was used for fungal pretreatment of wastewater sludge. The fungal strains immobilized/entrapped on sludge particles with the formation of pellets and enhanced the separation process. The results presented in this study showed that the sludge particles (pellets) size of 2-5mm of diameter were formed with the microbial treatment of sludge after 2 days of fermentation that contained maximum 33.7% of total particles with 3-3.5mm of diameter. The settling rate (measured as total suspended solids (TSS) concentration, 130 mg/l) was faster in treated sludge than untreated sludge (TSS concentration, 440 mg/l) after 1 min of settling time. In 1 min of settling operation, 86.45% of TSS was settled in treated sludge while 4.35% of TSS settled in raw sludge. Lower turbidity was observed in treated sludge as compared to untreated sludge. The results to specific resistance to filtration (SRF) revealed that the fungal inoculum had significant potentiality to reduce SRF by 99.8% and 98.7% for 1% w/w and 4% w/w of TSS sludge, respectively. The optimum fermentation period recorded was 3 days for 1% w/w sludge and 6 days for 4% w/w sludge, respectively, for dewaterability test.

Biosolids accumulation and biodegradation of domestic wastewater treatment plant sludge by developed liquid state bioconversion process using a batch fermenter.

The biosolids accumulation and biodegradation of domestic wastewater treatment plant (DWTP) sludge by filamentous fungi have been investigated in a batch fermenter. The filamentous fungi Aspergillus niger and Penicillium corylophilum isolated from wastewater and DWTP sludge was used to evaluate the treatment performance. The optimized mixed inoculum (A. niger and P. corylophilum) and developed process conditions (co-substrate and its concentration, temperature, initial pH, inoculum size, and aeration and agitation rate) were incorporated to accelerate the DWTP sludge treatment process. The results showed that microbial treatment of higher strength of DWTP sludge (4% w/w of TSS) was highly influenced by the liquid state bioconversion (LSB) process. In developed bioconversion processes, 93.8 g/kg of biosolids was enriched with fungal biomass protein of 30 g/kg. Enrichment of nutrients such as nitrogen (N), phosphorous (P), potassium (K) in biosolids was recorded in 6.2% (w/w), 3.1% (w/w) and 0.15% (w/w) from its initial values of 4.8% (w/w), 2.0% (w/w) and 0.08% (w/w) respectively after 10 days of fungal treatment. The biodegradation results revealed that 98.8% of TSS, 98.2% of TDS, 97.3% of turbidity, 80.2% of soluble protein, 98.8% of reducing sugar and 92.7% of COD in treated DWTP sludge supernatant were removed after 8 days of microbial treatment. The specific resistance to filtration (SRF) in treated sludge (1.4x10(12) m/kg) was decreased tremendously by the microbial treatment of DWTP sludge after 6 days of fermentation compared to untreated sample (85x10(12) m/kg).

Skin prick test reactivity to foods in adult Malaysians with rhinitis.

The aim of the study was to determine the incidence of food and house dust mite (HDM) allergy in patients with nasal congestion and rhinorrhea attending the Otorhinolaryngology Clinic, National University of Malaysia, Kuala Lumpur. This was a prospective matched, controlled study of patients skin prick tested with commercial food and common aeroallergens. The participants were 148 Malaysian adults with symptoms of nasal congestion and rhinorrhea and 113 adult Malaysian control subjects without rhinitis symptoms. The skin prick test (SPT) was used to evaluate 11 foods common to the Malaysian diet and 3 HDM inhalants. Forty-eight percent of the patients with rhinitis had positive SPT results to foods, compared with 4.4% of control subjects (P < 0.05). The most commonly implicated foods were shrimp (48%) and rice (30%), which are common in the Malaysian diet. Seventy-two percent of rhinitis patients had positive SPT results to HDM, compared with 22.2% of control subjects (P < 0.05). Patients with rhinitis also had significantly more gastrointestinal problems than control subjects (P < 0.05). The incidences of HDM and food allergy are significantly greater in Malaysian adults with rhinitis symptoms than in control subjects without rhinitis. The effect of avoidance or immunotherapy awaits further study.

A potential resource for bioconversion of domestic wastewater sludge.

Twenty seven filamentous fungal strains representing five genera; Aspergillus, Penicillium, Trichoderma, Myriodontium and Pleurotus were isolated from four sources; domestic wastewater sludge cake (SC) from IWK (Indah Water Konsortium) wastewater treatment plant, palm oil mill effluent compost from Sri Ulu palm Oil Processing Mill, compost of plant debris, and fungal fruiting bodies from a rotten wood stump. Thirty-three strains/isolates were tested for their ability to convert domestic wastewater sludge into compost by assessing biomass production and growth rate on sludge enriched media. The strains/isolates Aspergillus niger, SS-T2008, WW-P1003 and RW-P1 512 produced the highest dry biomass at higher sludge supplemented culture media from their respective group (Aspergillus, Trichoderma, Penicillium and Basidiomycetes, respectively). This implied these strains are better adapted for growth at higher sludge rich substances, and subsequently may be efficient in bioconversion/biodegradation of sludge. The fungi isolated from ecological closely related sources were more amendable to adaptation in a sludge rich culture media.

Management of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head continues to pose a therapeutic challenge to orthopedic surgeons. This pathologic process results from the death of living components of bone from mechanical and biologic factors. Diagnosis, clinical symptoms, and classification systems are discussed. Several treatment regimens and their controversies are explored in this article.

Rhabdomyosarcoma of the middle ear and mastoid in children.

Three cases of embryonal rhabdomyosarcoma in the middle ear and mastoid in children are presented. Diagnosis was confirmed by histopathology. A multidisciplinary approach employing surgery, chemotherapy and radiation therapy is the method of choice in the management of this rare and highly lethal condition.

A prospective evaluation of foreign bodies presenting to the Ear, Nose and Throat Clinic, Hospital Kuala Lumpur.

The results of a prospective study of 94 patients with history of ear, nose or aerodigestive tract foreign bodies were analysed. Sixty six to 94% of patients presented within 24 hours to a primary care doctor, 80 to 94% was referred to the ENT Department within 24 hours and 89 to 93% of patients had their foreign bodies removed within 24 hours. Overall, 58% of aural foreign bodies, 67% nasal foreign bodies and 94% of aerodigestive tract foreign bodies were removed within 48 hours of insertion. As a result of the prompt removal of foreign bodies in the majority of patients, no significant complications occurred. Foreign bodies in the aerodigestive tract tend to present earlier and more promptly removed compared with ear and nose foreign bodies. There was a significantly higher proportion of foreign body in the right ear and nostril compared to the left.

Evaluation of fungal potentiality for bioconversion of domestic wastewater sludge.

This study was undertaken to screen the filamentous fungi isolated from its relevant habitats(wastewater, sewage sludge and sludge cake) for the bioconversion of domestic wastewater sludge. A total of 35 fungal strains were tested against wastewater sludge (total suspended solids, TSS 1%-5% w/w) to evaluate its potentiality for enhancing the biodegradability and dewaterability using liquid state bioconversion(LSB) process. The strains were divided into five groups i.e. Penicillium, Aspergillus, Trichoderma, Basidiomycete and Miscellaneous, respectively. The strains WWZP1003, SCahmA103, SCahmT105 and PC-9 among their respective groups of Penicillium, Aspergillus, Trichoderma and Basidiomycete played potential roles in terms of separation (formation of pellets/flocs/filaments), biodegradation(removal of COD) and filtration (filterability) of treated domestic wastewater sludge. The Miscellaneous group was not considered due to its unsatisfactory results as compared to the other groups. The pH value was also influenced by the microbial treatment during fermentation process. The filterability of treated sludge was improved by fungal treatment, and lowest filtration time was recorded for the strain WWZP1003 and SCahmA103 of Penicillium and Aspergillus groups respectively compared with other strains.

Assessment of sewage sludge bioremediation at different hydraulic retention times using mixed fungal inoculation by liquid-state bioconversion.

Sustainable, environmental friendly, and safe disposal of sewage treatment plant (STP) sludge is a global expectation. Bioremediation performance was examined at different hydraulic retention times (HRT) in 3-10 days and organic loading rates (OLR) at 0.66-7.81 g chemical oxygen demand (COD) per liter per day, with mixed filamentous fungal (Aspergillus niger and Penicillium corylophilum) inoculation by liquid-state bioconversion (LSB) technique as a continuous process in large-scale bioreactor. Encouraging results were monitored in treated sludge by LSB continuous process. The highest removal of total suspended solid (TSS), turbidity, and COD were achieved at 98, 99, and 93%, respectively, at 10 days HRT compared to control. The minimum volatile suspended solid/suspended solid implies the quality of water, which was recorded 0.59 at 10 days and 0.72 at 3 days of HRT. In treated supernatant with 88% protein removal at 10 days of HRT indicates a higher magnitude of purification of treated sludge. The specific resistance to filtration (SRF) quantifies the performance of dewaterability; it was recorded minimum 0.049 × 10(12) m kg(-1) at 10 days of HRT, which was equivalent to 97% decrease of SRF. The lower OLR and higher HRT directly influenced the bioremediation and dewaterability of STP sludge in LSB process. The obtained findings imply encouraging message in continuing treatment of STP sludge, i.e., bioremediation of wastewater for environmental friendly disposal in near future.

Modeling of crude oil biodegradation using two phase partitioning bioreactor.

In this work, crude oil biodegradation has been optimized in a solid-liquid two phase partitioning bioreactor (TPPB) by applying a response surface methodology based d-optimal design. Three key factors including phase ratio, substrate concentration in solid organic phase, and sodium chloride concentration in aqueous phase were taken as independent variables, while the efficiency of the biodegradation of absorbed crude oil on polymer beads was considered to be the dependent variable. Commercial thermoplastic polyurethane (Desmopan®) was used as the solid phase in the TPPB. The designed experiments were carried out batch wise using a mixed acclimatized bacterial consortium. Optimum combinations of key factors with a statistically significant cubic model were used to maximize biodegradation in the TPPB. The validity of the model was successfully verified by the good agreement between the model-predicted and experimental results. When applying the optimum parameters, gas chromatography-mass spectrometry showed a significant reduction in n-alkanes and low molecular weight polycyclic aromatic hydrocarbons. This consequently highlights the practical applicability of TPPB in crude oil biodegradation.

Penile Preservation for Male Urethral Cancer.

Tumors of the male urethra are rare, comprising <1% of urologic malignancies. This is a report of a 44-year-old man presented with a 4-month history of gross initial hematuria and dysuria. After examining the patient, we found a firm mass extending 1 cm within the proximal bulbar urethra and a pathologic report of moderately differentiated squamous cell carcinoma. He underwent excision of the involved urethra followed by end-to-end bulbar urethroplasty. External beam radiation was performed at the dose of 6000 Rad, in 33 courses. The patient was followed by surveillance protocol and, no evidence of urethral or bladder tumor was found in the 2-year follow-up with bi-annual cystoscopic examination.

Modeling of membrane bioreactor treating hypersaline oily wastewater by artificial neural network.

A membrane sequencing batch reactor (MSBR) treating hypersaline oily wastewater was modeled by artificial neural network (ANN). The MSBR operated at different total dissolved solids (TDSs) (35,000; 50,000; 100,000; 150,000; 200,000; 250,000mg/L), various organic loading rates (OLRs) (0.281, 0.563, 1.124, 2.248, and 3.372kg COD/(m(3)day)) and cyclic time (12, 24, and 48h). A feed-forward neural network trained by batch back propagation algorithm was employed to model the MSBR. A set of 193 operational data from the wastewater treatment with the MSBR was used to train the network. The training, validating and testing procedures for the effluent COD, total organic carbon (TOC) and oil and grease (O&G) concentrations were successful and a good correlation was observed between the measured and predicted values. The results showed that at OLR of 2.44kg COD/(m(3)day), TDS of 78,000mg/L and reaction time (RT) of 40h, the average removal rate of COD was 98%. In these conditions, the average effluent COD concentration was less than 100mg/L and met the discharge limits.