Paratesticular Liposarcoma Presenting as an Inguinal Swelling: A Diagnostic Conundrum.

Paratesticular tumours are rare malignancies that are frequently misdiagnosed on presentation. We present a case of an elderly male with a six-month history of painless, progressively increasing left inguinal swelling. On preliminary examination and investigation, the swelling was misdiagnosed as a lymph nodal mass. Subsequently, a magnetic resonance imaging study detected a lesion that was not distinct from the spermatic cord. Biopsy testing of the said lesion was suggestive of poorly differentiated spindle cell neoplasm. The patient then underwent a high inguinal orchidectomy. Histopathological examination confirmed the diagnosis of a high-grade paratesticular dedifferentiated liposarcoma with rhabdomyoblastic differentiation. Due to the rarity of such tumours, the need for adjuvant chemotherapy and radiotherapy is debated.

Systematic Review on Apolipoprotein E: A Strong Genetic Cause of Hemorrhagic Stroke.

Stroke is one of the commonest causes of mortality among the world. Hemorrhagic stroke accounts nearly 15% of all the strokes. Different risk factors have been identified, of them hypertension, anti-coagulation therapy and previous history of ischemic strokes are significant. Regarding the genetic causes of intracerebral hemorrhage (ICH) monogenic causes play a small role. It was found that Apolipoprotein E (APOE) gene has a strong association with ICH. This is a 299 amino acids long protein located in chromosome 19. APOE has three alleles, they are epsilon 2, 3 and 4. Total 10 meta-analysis were reviewed in this article which involved 52,705 participants. When looking for the association, ∈2 and ∈4 showed positive and ∈3 showed negative association with ICH. Association of ∈4 (OR mean 1.77) was stronger than that of ∈2 (OR mean 1.71).

Monopole antenna array design for 3 T and 7 T magnetic resonance imaging.

PURPOSE: Ultra-high field magnetic resonance imaging poses a number of challenges for robust radio frequency coil designs. A monopole antenna array can potentially overcome key limitations of birdcage coil designs and may provide a useful radio frequency coil for brain imaging. METHODS: Four, 8 and 12 element monopole antenna arrays were simulated using 3 T and 7T magnetic resonance imaging frequencies. For comparison, 4, 8 and 12 element birdcage coils were also simulated. Coil performance was evaluated and compared and the impact of shielding was assessed. A 4 element monopole antenna array was fabricated and bench tested. RESULTS: Comparison of the 4, 8 and 12 element designs suggest that the monopole antenna array leads to better field properties than the birdcage coil in all configurations studied: unloaded, loaded with saline and loaded using a head phantom. Improvements in field properties and homogeneity were evident at both field strengths, implying that the monopole antenna array has potential for head imaging. The monopole antenna array also appears to be more efficient than the comparable birdcage coil design. Additionally, the former is scalable via the addition of more elements whereas our results suggest that this is not the case for the latter. Bench testing results show that the monopole antenna array is well matched with the transmission line, and mutual coupling between elements is sufficiently low. CONCLUSION: We found the monopole antenna array generated a larger field intensity than the birdcage coil design, whilst also producing a more useful magnetic resonance imaging field as measured by radio frequency field homogeneity. Our study suggests that magnetic resonance imaging of the brain can likely benefit from the use of radio frequency monopole antenna arrays.

An insight into the ecobiology, vector significance and control of Hyalomma ticks (Acari: Ixodidae): A review.

Ticks (Acari:Ixodoidea) are important ectoparasites infesting livestock and human populations around the globe. Ticks can cause damage directly by affecting the site of infestation, or indirectly as vectors of a wide range of protozoa, bacteria and viruses which ultimately lead to lowered productivity of livestock populations. Hyalomma is a genus of hard ticks, having more than 30 species well-adapted to hot, humid and cold climates. Habitat diversity, vector ability, and emerging problem of acaricidal resistance in enzootic regions typify this genus in various countries around the world. This paper reviews the epidemiology, associated risk factors (temperature, climate, age, sex, breed etc.), vector role, vector-pathogen association, and reported control strategies of genus Hyalomma. The various proteins in saliva of Hyalomma secreted into the blood stream of host and the prolonged attachment are responsible for the successful engorgement of female ticks in spite of host immune defense system. The various immunological approaches that have been tried by researchers in order to cause tick rejection are also discussed. In addition, the novel biological control approaches involving the use of entomo-pathogenic nematodes and Bacillus thuringiensis (B. thuringiensis) serovar thuringiensis H14; an endotoxin, for their acaricidal effect on different species and life cycle stages of Hyalomma are also presented.

Accuracy of co-morbidity data in patients undergoing abdominal wall hernia repair: a retrospective study.

OBJECTIVES: To determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of routinely collected co-morbidity data in patients undergoing abdominal wall hernia repair. METHODS: All patients aged > 18 who underwent umbilical, para-umbilical, inguinal or incisional hernia repair between 1 January 2015 and 1 November 2016 were identified. All parts of the clinical notes were searched for co-morbidities by two authors independently. The following co-morbidities were considered: hypertension, ischaemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), hypercholesterolemia, obesity and smoking. The co-morbidities data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database to calculate accuracy, sensitivity, specificity, PPV and NPV of HES codes for co-morbidities. To assess the agreement between clinical notes and HES data, we also calculated Cohen's Kappa index value as a more robust measure of agreement. RESULTS: Overall, 346 patients comprising 3460 co-morbidity codes were included in the study. The overall accuracy of HES codes for all co-morbidities was 77% (Kappa: 0.13). When calculated separately for each co-morbidity, the accuracy was 72% (Kappa: 0.113) for hypertension, 82% (Kappa: 0.232) for IHD, 85% (Kappa: 0.203) for diabetes, 86% (Kappa: 0.287) for asthma, 91% (Kappa: 0.339) for COPD, 92% (Kappa: 0.374) for CVD, 94% (Kappa: 0.424) for CKD, 74% (Kappa: 0.074) for hypercholesterolemia, 71% (Kappa: 0.66) for obesity and 24% (Kappa: 0.005) for smoking. The overall sensitivity, specificity, PPV and NPV of HES codes were 9, 100, 100, and 77%, respectively. The results were consistent when individual co-morbidities were analyzed separately. CONCLUSIONS: Our results demonstrated that HES co-morbidity codes in patients undergoing abdominal wall hernia repair are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. The presence of a relatively large number of false negative or missed cases in HES database explains our findings. Better documentation of co-morbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.

The epidemiology of and outcome from pancreatoduodenal trauma in the UK, 1989-2013.

INTRODUCTION: Pancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989-2013. METHODS: The Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both. RESULTS: Of 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14-35) for blunt trauma and 14 (IQR: 9-18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation. CONCLUSIONS: Isolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.

A comprehensive propagation prediction model comprising microfacet based scattering and probability based coverage optimization algorithm.

Although ray tracing based propagation prediction models are popular for indoor radio wave propagation characterization, most of them do not provide an integrated approach for achieving the goal of optimum coverage, which is a key part in designing wireless network. In this paper, an accelerated technique of three-dimensional ray tracing is presented, where rough surface scattering is included for making a more accurate ray tracing technique. Here, the rough surface scattering is represented by microfacets, for which it becomes possible to compute the scattering field in all possible directions. New optimization techniques, like dual quadrant skipping (DQS) and closest object finder (COF), are implemented for fast characterization of wireless communications and making the ray tracing technique more efficient. In conjunction with the ray tracing technique, probability based coverage optimization algorithm is accumulated with the ray tracing technique to make a compact solution for indoor propagation prediction. The proposed technique decreases the ray tracing time by omitting the unnecessary objects for ray tracing using the DQS technique and by decreasing the ray-object intersection time using the COF technique. On the other hand, the coverage optimization algorithm is based on probability theory, which finds out the minimum number of transmitters and their corresponding positions in order to achieve optimal indoor wireless coverage. Both of the space and time complexities of the proposed algorithm surpass the existing algorithms. For the verification of the proposed ray tracing technique and coverage algorithm, detailed simulation results for different scattering factors, different antenna types, and different operating frequencies are presented. Furthermore, the proposed technique is verified by the experimental results.

New ray tracing method to investigate the various effects on wave propagation in medical scenario: an application of wireless body area network.

The advent of technology with the increasing use of wireless network has led to the development of Wireless Body Area Network (WBAN) to continuously monitor the change of physiological data in a cost efficient manner. As numerous researches on wave propagation characterization have been done in intrabody communication, this study has given emphasis on the wave propagation characterization between the control units (CUs) and wireless access point (AP) in a hospital scenario. Ray tracing is a tool to predict the rays to characterize the wave propagation. It takes huge simulation time, especially when multiple transmitters are involved to transmit physiological data in a realistic hospital environment. Therefore, this study has developed an accelerated ray tracing method based on the nearest neighbor cell and prior knowledge of intersection techniques. Beside this, Red-Black tree is used to store and provide a faster retrieval mechanism of objects in the hospital environment. To prove the superiority, detailed complexity analysis and calculations of reflection and transmission coefficients are also presented in this paper. The results show that the proposed method is about 1.51, 2.1, and 2.9 times faster than the Object Distribution Technique (ODT), Space Volumetric Partitioning (SVP), and Angular Z-Buffer (AZB) methods, respectively. To show the various effects on received power in 60 GHz frequency, few comparisons are made and it is found that on average -9.44 dBm, -8.23 dBm, and -9.27 dBm received power attenuations should be considered when human, AP, and CU move in a given hospital scenario.

Evaluation of surgical outcome scores according to ISGPS definitions in patients undergoing pancreatic resection.

AIMS: To evaluate the role of the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), the Portsmouth variant (p-POSSUM) and the Glasgow Prognostic Score (GPS) in predicting outcome after pancreatic surgery with reference to the International Study Group of Pancreatic Surgery (ISGPS) definitions of post-pancreatectomy complications. METHODS: All consecutive patients undergoing major pancreatic resection over a 32- month period were included. POSSUM, p-POSSUM and GPS score were calculated for each patient and correlated against the observed mortality and morbidity using the ISGPS definitions. RESULTS: The observed:expected ratios for POSSUM mortality, POSSUM morbidity and p-POSSUM mortality were 0.24 (p < 0.0001), 0.86 (p < 0.0001) and 0.79 (p = 0.09), respectively. POSSUM had a 'poor fit' with respect to predicting morbidity (χ(2) = 16.4, 8 d.f., p = 0.04). Multifactorial regression analysis revealed the GPS as an independent predictor of post-operative outcome (GPS 1, p = 0.03, OR 2.99, 95% CI 1.4-7.9, and GPS 2, p = 0.02, OR 4.3, 95% CI 1.8-15.5). CONCLUSION: POSSUM has a limited role as an outcome score in pancreatic resection. The GPS may be a novel alternative to POSSUM as a pre-operative predictor of outcome.

Isolation, characterization and beneficial effects of rice associated plant growth promoting bacteria from Zanzibar soils.

This study was undertaken to isolate and characterize plant growth promoting bacteria (PGPB) occurring in four soils of Zanzibar, Tanzania as well as to evaluate their potential use as biofertilizers for rice. A total of 12 PGPB strains were isolated from rice and studied for growth characteristics, carbon/nitrogen source utilization patterns using QTS-24 kits, phosphate solubilization, indole acetic acid (IAA) production, antibiotic resistance patterns and growth at different pH, temperature and salt concentrations. All the isolates were motile and gram negative except Z3-4. Acetylene reduction activity was detected in all isolates ranging from 5.9-76.4 nmole C2H2 reduced/h x mg protein while 9 isolates produced IAA ranged from 20-90.8 mg/l. Most of the isolates showed resistance against different environmental stresses like 10-40 degrees C temperature, 0.2-1 M salt concentration and 4-8.5 pH range. Only one isolate Z2-7 formed clear zones on Pikovskaia's medium showing its ability to solubilize phosphates. Z3-2 was used to develop fluorescent antibodies to check the cross reactivity of the isolates. Inoculation of these bacterial isolates resulted in higher plant biomass, root area, and total N and P contents on Tanzanian rice variety BKN PRAT3036B under controlled conditions. Bacillus sp. Z3-4 and Azospirillum sp. Z3-1 are effective strains and, after further testing under field conditions, can be used for inoculum production of rice in Tanzania. The plant growth promoting effects of these PGPRs suggest that these can be exploited to improve crop productivity of rice in Tanzania.