Diagnostic accuracy of the risk of malignancy index 1 compared to the more recent IOTA ADNEX model in discriminating benign from malignant adnexal masses: a multi-centric study

Background: Identification of the nature of an adnexal mass can ensure optimum management. Single parameters as well as diagnostic models using a combination of several parameters are in use. The International Ovarian Tumor Analysis (IOTA) consortium has developed and published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, which differentiates between benign and malignant masses. Authors conducted this study with the aim of finding a cut off value for this model in the study population and comparing the diagnostic accuracy of this model to that of the risk of malignancy (RMI).Methods: Women with adnexal masses admitted to the 3 medical college affiliated hospitals for surgical management were included in this study. Appropriate investigations were done to calculate the RMI-I and ADNEX score for each participant. A cut off score for the ADNEX model was determined and diagnostic accuracy tests were done for comparison.Results: At a cut-off of 29 for the ADNEX model and 200 for RMI model the sensitivity was 75% and 77.8, specificity 100% and 80.6%; Positive Predictive Value (PPV) 100%and 60%; Negative Predictive Value (NPV) 91% and 90.6%; Positive Likelihood ratio of infinity and 4 and a negative Likelihood Ratio of 2.8 and 2.5 respectively.Conclusions: The ADNEX model rates higher than the RMI in almost all tests of diagnostic accuracy and can be used for triaging, framing a referral policy and prioritizing surgery.

Adjacent Disc Stress Following Floating Lumbar Spine Fusion: A Finite Element Study

STUDY DESIGN: Experimental study. PURPOSE: The study aimed to develop a finite element (FE) model to determine the stress on the discs adjacent to the fused segment following different types of floating lumbar spinal fusions. OVERVIEW OF LITERATURE: The quantification of the adjacent disc stress following different types of floating lumbar fusions has not been reported. The magnitude of the stress on the discs above and below the floating fusion remains unknown. METHODS: A computer-aided engineering-based approach using implicit FE analysis was employed to assess the stress on the lumbar discs above and below the floating fusion segment (L4–L5) following anterior and posterior lumbar spine fusions at one, two, and three levels (with and without instrumentation). RESULTS: Both discs suprajacent and infrajacent to the floating fusion experienced increased stress, but the suprajacent disc experienced relatively high stress level. Instrumentation increased the stress on the discs suprajacent and infrajacent to the floating fusion, but the magnitude of stress on the suprajacent disc remained relatively high. CONCLUSIONS: The FE model was employed under similar loading and boundary conditions to provide quantitative data, which will be useful for clinicians to understand the probable long-term effects of floating fusions.

Lateralization of Tibial Plateau Reference Point Improves Accuracy of Tibial Resection in Total Knee Arthroplasty in Patients with Proximal Tibia Vara

BACKGROUND: The tibial cut referenced to the center of the intercondylar eminence often leads to varus malalignment in the presence of preexisting proximal tibia vara. The purpose of this study was to investigate the effect of lateralization of the lateral tibial plateau reference point (based on the amount of proximal tibia vara) on the postoperative coronal plane alignment. METHODS: In this prospective cohort study, 62 patients (95 knees) with osteoarthritis and proximal tibia vara underwent primary total knee arthroplasty using a lateral tibial plateau reference point for the extramedullary jig. The pre- and postoperative radiographs were obtained for measurement of mechanical axis deviation, degree of tibia vara, proximal lateral reference point of the tibial condyle, and coronal alignment of the femoral and tibial components. The distance between the tibial reference point and the center of the intercondylar eminence was measured intraoperatively. RESULTS: The mean tibia vara was 7.1° (standard deviation [SD], 2.3°). The mean lateral displacement of the reference point was 7 mm (SD, 2.2 mm). Postoperative tibiofemoral angle was 6° to 10° of valgus in 94% of cases. There was a strong correlation between the magnitude of tibia vara and the amount of lateralization of the tibial reference point (R² = 0.79, p < 0.001). CONCLUSIONS: In total knee arthroplasty patients with proximal tibia vara, reasonable accuracy can be achieved with use of the extramedullary jig for tibial component alignment by lateralizing the proximal tibial reference point.

Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on ante- rolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.</p><p><b>METHODS</b>This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.</p><p><b>RESULTS</b>Full weight bearing was allowed in mean time period of 4.95 months (3-12 months). A major local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm).</p><p><b>CONCLUSION</b>The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.</p>

Long-Term Effects of Segmental Lumbar Spinal Fusion on Adjacent Healthy Discs: A Finite Element Study

STUDY DESIGN: Experimental study. PURPOSE: The aim of the study was to develop a finite element (FE) model to study the long-term effects of various types of lumbar spinal interventions on the discs adjacent to the fused segment. OVERVIEW OF LITERATURE: Earlier FE studies have been limited to one particular type of fusion and comparative quantification of the adjacent disc stresses for different types of surgical interventions has not been reported. METHODS: A computer aided engineering (CAE) based approach using implicit FE analysis assessed the stresses in the lumbar discs adjacent to the fused segment following anterior and posterior lumbar spine fusions at one, two and three levels (with and without instrumentation). RESULTS: It was found that instrumentation and length of fusion were the most significant factors in increasing adjacent level stresses in the lumbar discs. CONCLUSIONS: In the present study, a calibrated FE model that examined spinal interventions under similar loading and boundary conditions was used to provide quantitative data which would be useful for clinicians to understand the probable long-term effect of their choice of surgical intervention.

Long-Term Effects of Segmental Lumbar Spinal Fusion on Adjacent Healthy Discs: A Finite Element Study

STUDY DESIGN: Experimental study. PURPOSE: The aim of the study was to develop a finite element (FE) model to study the long-term effects of various types of lumbar spinal interventions on the discs adjacent to the fused segment. OVERVIEW OF LITERATURE: Earlier FE studies have been limited to one particular type of fusion and comparative quantification of the adjacent disc stresses for different types of surgical interventions has not been reported. METHODS: A computer aided engineering (CAE) based approach using implicit FE analysis assessed the stresses in the lumbar discs adjacent to the fused segment following anterior and posterior lumbar spine fusions at one, two and three levels (with and without instrumentation). RESULTS: It was found that instrumentation and length of fusion were the most significant factors in increasing adjacent level stresses in the lumbar discs. CONCLUSIONS: In the present study, a calibrated FE model that examined spinal interventions under similar loading and boundary conditions was used to provide quantitative data which would be useful for clinicians to understand the probable long-term effect of their choice of surgical intervention.

Proliferative Verrucous Leukoplakia and Verrucous Carcinoma-A Hybrid Epithelial Tumour

White lesions are relatively frequent in the oral cavity with a prevalence of approximately 24.8%. Among them is oral leukoplakia with a prevalence rate of 0.2–3.6%. There were various debates about the verrucous carcinoma and PVL (proliferative verrucous leukoplakia) being different entities or a part of spectrum at different stages of the disease process. In this article we are reporting a case with coexistence of two different histological features in the form of verrucous carcinoma and PVL of oral cavity with a need to throw some light to understand the pathogenesis of premalignant lesions.

Relative Contribution of Upper and Lower Lumbar Spinal Segments to Flexion/Extension: Comparison between Normal Spines and Spines with Disc Disease in Asian Patients

STUDY DESIGN: Prospective cohort study. PURPOSE: To evaluate the contribution of upper and lower lumbar segments to flexion and extension of the lumbar spine in normal and diseased spines. OVERVIEW OF LITERATURE: The specific contributions of upper and lower lumbar segments during flexion/extension have rarely been reported. Furthermore, no comparisons between the flexion/extension behaviors of normal and diseased spines have been reported until now. METHODS: Flexion and extension lateral radiographs of 52 adult, asymptomatic volunteers, and 67 adult patients with lumbar spine disc disease were measured using software for total lumbar lordosis, upper lumbar lordosis and lower lumbar lordosis and the intervertebral angles of all segments. RESULTS: In asymptomatic volunteers, the range of movement between flexion and extension was a mean of only 4.2degrees in the lower lumbar spine and a mean of 19.4degrees in the upper lumbar spine. In patients with disc degeneration, the range of movement between flexion and extension was an average 6.5degrees for lower lumbar spine and 15.6degrees for the upper lumbar spine. CONCLUSIONS: The results showed that upper lumbar spine contributes more to the range of motion in flexion and extension than the lower lumbar spine in asymptomatic individuals without lumbar disc disease, as well as in patients with disc degeneration.

Clostridium difficile infections in HIV-positive patients with diarrhoea.

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Protective effect of ferulic acid on ionizing radiation induced damage in bovine serum albumin

Ionizing radiation causes deleterious effects on living system mainly due to oxidative damages of macromolecules and protein is the major target due to its abundance. The aim of this study was to investigate the effects of ionizing radiation induced changes in the molecular properties of bovine serum albumin [BSA]; its secondary and tertiary structures, degradation, cross linking and radioprotective role of ferulic acid, a natural antioxidant on these radiation induced changes. This study was carried out to investigate the gamma radiation induced oxidative, structural damage of BSA and radioprotective efficacy of ferulic acid through SDS-PAGE, DTNB assay, DNPH assay, FOX assay methods. Hydroxyl radical scavenging capacity of ferulic acid was estimated using 2-deoxy ribose assay. Further, radiation induced changes in the anisotropy and excitation state lifetimes of BSA were examined. SDS -PAGE data suggested that the loss of protein was linearly dependent on the radiation dose. Gamma-irradiation of BSA caused the formation of protein carbonyls, hydroperoxides and loss of thiols. Ferulic acid protected the radiation induced loss of protein as well as reduced various oxidative damages. Ferulic acid protected the protein from radiation induced damages in a concentration dependent manner. The results provide insight into radiation induced molecular changes in the protein. Ferulic acid protected the BSA from oxidative modification caused by radiation suggesting that ferulic acid possesses strong antiradical properties. Ferulic acid is known to protect DNA, the prime target of radiation and further its ability to protect protein suggesting its ability to protect different biomolecules and therefore can be a good candidate for development radioprotector

Isolation, characterization and therapeutic potential assessment of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis

In the present study, the therapeutic potential of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis were isolated, identified and assessed. Staphylococcus aureus [host or indicator bacterium] was isolated from a goat suffering from clinical mastitis. Based on cultural, morphological, biochemical tests and amplification of S. aureus specific thermonuclease gene in PCR, the identity of the organism was confirmed as S. aureus. Bacteriophages were isolated from soil and faecal samples [n=42] collected from different parts of the Mathura district in Uttar Pradesh [India], and their identity was confirmed by amplification of the bacteriophage-specific endolysin gene fragment in PCR. The thermal tolerance study revealed that all phage isolates were stable at 30 and 40°C with 100% lytic efficacy and their activities reduced to 62-80% at 50°C declining sharply at 60°C with less than 5% efficacy. Likewise, at pH = 6.5 and 7.5, the survivability of all isolates was 100% which reduced to 70-79% and 84-91% at pH = 5.5 and 8.5, respectively. All isolates were stable up to 3 months at 37°C, and for 16 months at 4°C but the stability of their respective endolysins only lasted for 12-23 days at 37°C and 6 months at 4°C. Three of the bacteriophage isolates, S. aureus phage/CIRG/1, S. aureus phage/CIRG/4 and S. aureus phage/CIRG/5 exhibited lytic activity against over 80% of the staphylococcal isolates. The results of the present study provide insight for the use of lytic bacteriophages for therapeutic interventions against multi-drug-resistant S. aureus inducing mastitis in goats

Groundwater arsenic contamination and associated health risks in Bihar, India

The extent of groundwater arsenic [As] contamination and associated health-risks were studied in the four villages: Chaukia and Terahrasiya [Vaishali]; Mamalkha and Masharu [Bhagalpur] in Bihar, India. Groundwater samples were tested using the standard Silverdiethyledithiocarbamate method at 520nm by Thermo UV-1 spectrophotometer. The As levels in both the districts exceeded the WHO standard of 10microg/L for drinking water with a maximum value of 20microg/L in Vaishali and 143microg/L in Bhagalpur. However, the FAO standard of 100microg/L of As for irrigation water was only exceeded in Bhagalpur. The calculated range of the hazard index [HI] for Vaishali was 0.9 to 10, and for Bhagalpur was 10.40 to 40.47. Both ranges exceed the accepted normal toxic HI of 1.00. The cancer risk was derived as 1-5/1000 people to 5-16/10,000 people in Vaishali, and 7-21/1000 and 5-16/1000 people in Bhagalpur. Prevalence of skin pigmentation was double in Vaishali in comparison to Bhagalpur. The analysis of principal components showed that only two components had a fundamental role in defining variance for cancer risk assessment. A more extensive screening of As contamination of groundwater and a follow-up clinical study are necessary to accurately assess the likelihood of As-related cancers in these districts

Well-leg compartment syndrome after fracture fixation in hemilithotomy position: case report of a preventable condition

To report a case of subtrochanteric femur fracture that led to intraoperative compartment syndrome in the well leg. A 28-year-old obese male who presented with a comminuted subtrochanteric fracture underwent a prolonged open reduction and internal fixation using dynamic condylar screw. In the postoperative period, after the effect of epidural analgesia had worn off, the patient complained of severe pain and swelling of the well leg. A diagnosis of well-leg compartment syndrome was made and urgent two-incision fasciotomy was performed. Obesity and prolonged surgery could have caused the acute compartment syndrome of the well leg in this patient

Synchronized separation of atorvastatin-an antihyperlipidemic drug with antihypertensive, antidiabetic,antithrombotic drugs by RP-LC for determination in combined formulations / 药物分析学报

A new rapid and sensitive high performance liquid chromatography (HPLC) method has been developed for the simultaneous determination of atorvastatin-an antihyperlipidemic drug along with most commonly prescribed drugs (antihyperlipidemic,antihypertensive,antidiabetic,antithrombotic) in bulk and marketed combined formulations.The chromatographic separation was carried out by gradient elution mode with acetonitrile as organic modifier and 0.1％ triethylamine acetate (TEAA) buffer pH 5 at a flow rate of 1 mL/min and a diode array detector at wavelength 230 nm was employed for detection of the analytcs.Calibration curves were linear in the range of 5 -150 μg/mL for all the drugs with correlation coefficients of determination (r2 values) ≥ 0.999.Limits of detection (LODs) and Limits of quantification (LOQs) ranged from 0.1 to 0.27 μg/mL and 0.3 to 0.89 μg/mL respectively.Intra-day and inter-day precision was studied at three concentration levels (20,60 and 100 μg/mL).The intra-day and inter-day RSD for all compounds was less than 2.0％.The accuracy for all compounds was found to be between 98％ and 102％.Thus,the performance of the method described allows its use in quantification of atorvastatin along with 9 most commonly prescribed drugs available in market as atorvastatin combined dosage forms.

Light chain deposition disease presenting as cholestatic jaundice: a case report

Light-chain deposition disease [LCDD] is characterized by tissue deposition of the immunoglobulin light chains in multiple organs. These deposits appear similar to amyloid on routine sections, but differ in their staining properties and ultrastructural appearance. The deposits of LCCD are non -Congophilic and do not exhibit a fibrillar ultrastructure; while, the proteinaceous substance seen in primary amyloidosis is Congo red positive and fibrillar. One of the most common organs to be involved in LCDD is the kidney. Earlier reports on cases of LCDD have mostly shown simultaneous liver and renal involvement, there are very few cases in the literature describing LCDD of the liver without renal involvement. This report describes a patient who presented with severe cholestatic jaundice and liver cell failure with normal renal function

Evaluation of antioxidant activity of various fractions of methanolic extract of Terminalia bellirica roxb on diabetic neuropathic rat

Objective: The present study was aimed to investigate the antioxidant activity of various fractions of methanolic extract of Terminalia bellirica roxb in Diabetic Neuropathic rats

Materials and Methods: Diabetes was induced by Streptozotocin [50mg/kg, i.p] Diabetic neuropathy was assessed by thermal and chemical stimuli. Antioxidant status has been evaluated. In this preventive therapy treatment has started with various fractions and gallic acid one day before the induction of diabetes and continued till 5[th] week of diabetes. Blood glucose level has been checked for each group and sciatic nerve histopathological studies have also done

Results: Animals treated with Gallic acid, n-butanol and ethyl acetate fractions of methanolic extract of Terminalia bellirica showed an extremely significant increase in the level of SOD, Catalase, reduced glutathione and decrease in the level of TEARS when compared to diabetic control and also significantly [p<0.001] increased the reaction time in Hot plate test, Hot water Tail immersion and significantly reduced the number of flinches in each phase in Formalin test when compared to diabetic control. Moreover animals treated with all these fractions except water fraction was not showed any significant effect in reaction time when compared to normal rat indicated the prevention of neuropathic pain. Diabetic animals treated with all fractions showed a gradual decrease in blood sugar in each week. Gallic acid and N-butanol shown preserved fiber density and vascular thickening was not observed when compared to diabetic control

Conclusion: Gallic acid present in the methanolic extract of Terminalia bellirica is the better option for diabetic neuropathy, that will act through two mechanisms i) by reducing the blood glucose level ii) due to the antioxidant activity they may retain the antioxidant status in animals to prevent the development of diabetic neuropathy

Oligospermia azoospermia and testicular atrophy due to chemical warfare

Thirteen male victims of mustatd gas were investigated for infertility. They had received first and second degree burns and are at present doing well except suffering from infertility. Ten of them were married before exposure to chemical gas and had one or two children. Three patients were unmarried. The sperm counts in three patients are markedly reduced, with 70-80% nonmotile and in abnormal forms. The other ten patients are azoospermic. Testicular biopsies showed germ cell hypoplasia and atrophy. Testosterone levels were depressed in all patients. On follow-up three patients had normal recoveries. This study is aimed at investigating the mechanisms of mustard gas induced testicular atrophy and azoospermia from histological and biochemical perspectives