Experimental setup for thermal measurements at the nanoscale using a SThM probe with niobium nitride thermometer.

Scanning Thermal Microscopy (SThM) has become an important measurement technique for characterizing the thermal properties of materials at the nanometer scale. This technique requires a SThM probe that combines an Atomic Force Microscopy (AFM) probe and a very sensitive resistive thermometer; the thermometer being located at the apex of the probe tip allows for the mapping of temperature or thermal properties of nanostructured materials with very high spatial resolution. The high interest of the SThM technique in the field of thermal nanoscience currently suffers from a low temperature sensitivity despite its high spatial resolution. To address this challenge, we developed a high vacuum-based AFM system hosting a highly sensitive niobium nitride (NbN) SThM probe to demonstrate its unique performance. As a proof of concept, we utilized this custom-built system to carry out thermal measurements using the 3ω method. By measuring the V3ω voltage on the NbN resistive thermometer under vacuum conditions, we were able to determine the SThM probe's thermal conductance and thermal time constant. The performance of the probe is demonstrated by performing thermal measurements in-contact with a sapphire sample.

Social capital and dental caries among 3-5-year-old Indian children. A cross-sectional study.

AIM: The aim of the study is to investigate the association between social capital and dental caries among 3-5-year-old preschool children in a rural region of southern India. METHODS: A cross-sectional study was conducted among 260 children ranging from 3 to 5 years-old and their parents from 13 preschools of the Udupi region of south India between December 2018, and February 2019. A 16-item Social Capital Scale (SCS) was used to collect data from the children's parents regarding their social capital. The diet history was collected from the parents and the children were examined for dental caries using the dmft index in their schools. CONCLUSION: Dental caries among preschool children had a negative association with parental social capital, and significantly contributed to variances in dental caries along with socioeconomic and dietary factors.

Underreporting and Underrepresentation of Racial and Ethnic Minority Patients in Lymphedema Clinical Trials: A Systematic Review.

The generalizability of findings from Clinical Trials (CTs) investigating lymphedema treatment modalities requires an accurate representation of the target population. This study aims to evaluate racial and ethnic reporting and representation in lymphedema CTs. A comprehensive systematic literature search was conducted during May 2023 using multiple databases, following the PRISMA guidelines. All CTs published from 2018 to 2023 were included. A total of 84 articles were included in this review, from which 6,546 participants were included in the analysis. Seventy-four (88.1%) articles addressed secondary lymphedema, of which 60 (81.1%) were related to breast cancer. Only 12 (13%) of CTs reported at some extend race or ethnicity. Of these, five (41.6%) reported race and two (16.6%) reported ethnicity according to FDA guidelines. White race had the highest pooled prevalence (80%; 95% CI 72-86%; I2=90%), followed by Black (7%; 95% CI 2- 15%; I2= 94.3%) and Asian (4%; 95% CI 1-8%; I2= 89.9%). In studies reporting ethnicity, participants were predominantly non-Hispanic (92.1%; 95% CI 90 - 94%). There is an underreporting and underrepresentation of racial and ethnic minorities among lymphedema CTs, limiting their generalizability. It is imperative to future development of strategies to enhance diversity in the study sample.

Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases.

INTRODUCTION: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. MATERIALS AND METHODS: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland - Altman plot. RESULTS: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6-8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases. CONCLUSION: Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.

Bilateral idiopathic temporal bone meningoencephaloceles - An unusual presentation.

Meningoencephaloceles (MECs) occur due to herniation of brain tissue through a bony defect in the skull base. They can be spontaneous or acquired. These are secondary to trauma, infection or neoplasia. Adult-onset spontaneous or idiopathic MECs are rare. Temporal bone MECs can present with watery discharge from the ear, conductive hearing loss or symptoms of meningitis like headache, fever, vomiting or seizures. These symptoms mimic chronic suppurative or serous otitis media. Computed tomography scan and magnetic resonance imaging differentiate between them. Awareness of this disease entity is necessary for early detection to avoid complications. We report a case of bilateral idiopathic temporal bone MECs with a rare presentation of autophony as the chief complaint. The differentiating features on computed tomography scan and magnetic resonance imaging and the surgical management are discussed.

Predicting Quadruple Semitendinosus Graft Size for Anterior Cruciate Ligament Reconstruction by Patient Anthropometric Variables: A Cohort Study of 280 Cases

@#Introduction: Pre-operative identification of patients with inadequate hamstring graft for anterior cruciate ligament reconstruction is still a subject of interest. The purpose of this study is to correlate dimension of a harvested dimensions graft with patient physical anthropometric variables. Materials and methods: This cohort study included 280 patients (male = 226, female = 54) scheduled for primary anterior cruciate ligament (ACL) reconstruction. Interrelationships between quadruple semitendinosus (ST) graft and anthropometric parameters (age, sex, height, weight, and BMI) were assessed using Pearson Correlation test and regression analysis. Difference among gender was analysed using Mann Whitney and t test. The observed graft diameter was also compared with the literature using Bland – Altman plot. Results: Mean age of cohort was 29 years (range, 17-50 years), mean height was 1.69m (range, 1.6-1.9m), mean weight was 75 kg (range, 50-116kg) and mean BMI was 26kg/m2 (range 16.65-40.40kg/m2). Mean quadruple length of harvested ST graft was 7cm (7.1±0.6 cm, range, 5.6- 8.8cm) and mean diameter was 8mm (8.2±0.8mm, range, 6.5-10mm). Only height and weight were significantly correlated with graft length and diameter in both sex (p value <0.05). Female, compared to male, had significantly smaller (p<0.0001) and thinner graft (p<0.0001). There was a strong agreement between the literature and our observed graft diameter, but with an overestimated graft diameter in 18.5% of the cases. Conclusion: Among anthropometric parameter, only height and weight had moderate positive correlation with graft diameter. Males had longer and wider ST graft in contrast to age-matched female group.

Development and validation of a scale measuring the locus of control orientation in relation to socio-dental effects.

AIM: To develop a socio-dental impact locus of control scale (SILOC) and to study its relationship with oral health status as well as dental attendance. STUDY DESIGN: Observational cross-sectional study design. METHOD: A seven-item SILOC scale based on locus of control and the WHO international classification of diseases' criteria for "Disability" in relation to oral health was developed. In the pilot study, 100 adolescent school children returned completed forms containing the multidimensional health locus of control (MHLC) and the (SILOC) scale. After confirmation of reliability and validity, 509 adolescent school children returned completed SILOC questionnaires and were examined for caries, plaque and gingivitis. A history of postponement of needed dental treatment was also elicited. RESULTS: The SILOC scores were highly correlated with the MHLC scores. Factor analysis revealed a two-factor solution accounting for 59 % of the variance. A Cronbach's alpha of 0.75 showed its internal consistency. Those with higher SILOC scores had greater levels of caries, plaque, gingivitis, and a history of postponing needed dental visits. Multiple logistic regression analysis after adjusting for potential confounders showed that those with high SILOC scores were more likely to have caries (OR = 3.32, p < 0.001), plaque (OR = 1.83, p = 0.026), gingivitis (OR = 1.80, p = 0.012) and a history of 'Postponement of needed dental treatment' (OR = 4.5, p < 0.001) as compared with the others. CONCLUSIONS: The SILOC scale showed satisfactory reliability and validity in measuring locus of control orientation in an Indian adolescent population.

The inferior turbinate flap: a novel technique for prosthetic preparation of a total rhinectomy defect.

For total rhinectomy defects, the decision to proceed with a prosthetic versus surgical reconstruction is multifactorial, taking into account patient risk factors, availability of donor tissues, the need for tumor surveillance, and personal preferences. When a prosthetic approach is chosen, the reconstructive surgeon is tasked with preparing the defect to maximize prosthetic retention and prevent ulcerations. Stable bone coverage is critical to achieve this aim. Although skin grafting has been described previously for bone coverage, the periosteum is often stripped. We present a novel use of the inferior turbinate flap for preparation of rhinectomy defects that can be utilized regardless of the presence or absence of the periosteum and provides a more durable coverage than skin grafts.

Chronic rhinosinusitis assessment using the Adelaide Disease Severity Score.

AIM: This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis. STUDY DESIGN: A prospective cohort study supplying level 2b evidence. METHODS: Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund-Mackay computed tomography scores and Lund-Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation. RESULTS: Mean scores (95 per cent confidence intervals) were 22.31 (21.47-24.15) for the Adelaide Disease Severity Score and 30.6 (27.15-34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund-Mackay score (p = 0.04) and with the Lund-Kennedy score (p = 0.03). CONCLUSION: The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund-Mackay and Lund-Kennedy tools.

Kinetics of sorption of lead on bed sediments of River Hindon, India.

A number of low cost waste sorbent have been used for removal of heavy metals, however, few studies have been carried out on the sorption process on riverbed sediments in their natural state of occurrence. Stream sediments adsorb certain solutes from streams, thereby significantly changing the solute composition, but little is known about quantitatively describing sorption phenomena and rates of these processes. In the present investigation, sorption of lead ions on river bed sediments of river Hindon, a tributary of river Yamuna, India has been studied to demonstrate the role of bed sediments in controlling metal pollution. The effect of various operating variables, viz., initial concentration, solution pH, sediment dose, contact time and particle size has been studied. The sorption of lead ions increased with respect to pH and sorbent dose and decreased with sorbent particle size. Two important geochemical phases, iron and manganese oxide, also play important role in the sorption process. The sorption data were analysed using Langmuir and Freundlich isotherm models to determine the mechanistic parameters related to the sorption process. Further, although lead ions have more affinity for the fine fraction of the sediment, but the overall contribution of coarser fraction to sorption is more as compared to clay and silt fraction. The kinetic data suggest that the sorption of lead on bed sediments is an endothermic process, which is spontaneous at low temperature. The uptake of lead is controlled by both bulk and intraparticle diffusion mechanism.

Estimating nutrient loadings using chemical mass balance approach.

The river Hindon is one of the important tributaries of river Yamuna in western Uttar Pradesh (India) and carries pollution loads from various municipal and industrial units and surrounding agricultural areas. The main sources of pollution in the river include municipal wastes from Saharanpur, Muzaffarnagar and Ghaziabad urban areas and industrial effluents of sugar, pulp and paper, distilleries and other miscellaneous industries through tributaries as well as direct inputs. In this paper, chemical mass balance approach has been used to assess the contribution from non-point sources of pollution to the river. The river system has been divided into three stretches depending on the land use pattern. The contribution of point sources in the upper and lower stretches are 95 and 81% respectively of the total flow of the river while there is no point source input in the middle stretch. Mass balance calculations indicate that contribution of nitrate and phosphate from non-point sources amounts to 15.5 and 6.9% in the upper stretch and 13.1 and 16.6% in the lower stretch respectively. Observed differences in the load along the river may be attributed to uncharacterized sources of pollution due to agricultural activities, remobilization from or entrainment of contaminated bottom sediments, ground water contribution or a combination of these sources.

Adjuvant chemotherapy for small intestine adenocarcinoma.

BACKGROUND: Although the small intestine represents 75% of the length and over 90% of the mucosal surface of the alimentary tract, it is the site of only about 2% of malignant gastrointestinal tumours. Adenocarcinoma is the most common histological subtype, accounting for about 40% of all malignant small intestinal tumours. The infrequent occurrence when compared with malignancies of the stomach and colon is accompanied by non-specific clinical symptoms. The consequences are a significant delay in diagnosis and the finding of advanced, incurable disease at operation. Wide surgical resection of early lesions is the only potentially curative treatment, but it is possible only in a minority of patients. The rare nature of adenocarcinomas of the small intestine has led to a paucity of information about the benefits of adjuvant chemotherapy but there are reports of overall better survival for those patients that receive combination treatment. Most chemotherapy regimens consist of 5-fluorouracil (5-FU), alone or in combination with a variety of other agents like doxorubicin, cisplatin, mitomycin C, cyclophosphamide and oxaliplatin. OBJECTIVES: To determine the role of adjuvant chemotherapy in the management of adenocarcinoma of the small intestine compared to another adjuvant treatment, a placebo or no other adjuvant treatment. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2006), EMBASE (1974 to 2006), PubMed and CINHAL using the Cochrane highly sensitive search strategy for randomised controlled trials. SELECTION CRITERIA: Phase III randomised controlled trials comparing post-operative adjuvant chemotherapy for adenocarcinoma of the small intestine with other adjuvant therapies, placebo or no adjuvant treatment. DATA COLLECTION AND ANALYSIS: No suitable trials were identified. MAIN RESULTS: No studies fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: There is a need for high quality randomised controlled trials to evaluate the effectiveness of adjuvant chemotherapy in the management of adenocarcinoma of the small intestine.

Management of solid-pseudopapillary neoplasms of the pancreas: a comparison with standard pancreatic neoplasms.

BACKGROUND: Solid-pseudopapillary neoplasms (SPNs) of the pancreas are increasingly diagnosed, but the exact surgical management in terms of extent of the resection is not well defined. MATERIALS AND METHODS: Patients operated on in our hospital between January 1993 and March 2005 formed the study groups. RESULTS: From 659 consecutive resections for pancreatic neoplasms, 12 female patients (1.8%) with a median age of 21 years who underwent resection for (SPN) are compared with the remaining 647 pancreatic resection patients. Jaundice (SPN 0 versus PR 73%, p < 0.001) and weight loss (SPN 0 versus PR 49%, p = 0.001) occurred significantly less often. Neoplasms were distributed equally among the pancreatic head (SPN 5 out of 12 patients versus PR 88%, p < 0.001) and corpus/tail (SPN 6 out of 12 patients versus PR 8%, p < 0.001). The operative time was significantly shorter (SPN 233 min versus PR 280 min, p = 0.012), and there were significantly fewer complications (SPN 1 of 12 patients versus PR 48%, p = 0.007). The mortality was not different (SPN 0 versus PR 1.6%, p = 1.000), and the hospital stay was significantly shorter (SPN 9 days versus PR 15 days, p = 0.012). The median size of the neoplasms was significantly larger (SPN 6.9 cm versus PR 2.5 cm). The median number of lymph nodes harvested was significantly fewer (SPN 1 versus PR 6, p = 0.001), and lymph node metastases occurred significantly less often (SPN 0 versus PR 64%, p < 0.001). The 5-year survival of SPN patients was 100% and is significantly better compared with survival of patients with pancreatic adenocarcinoma (12%, p < 0.001) and ampulla of Vater adenocarcinoma (22%, p = 0.005). CONCLUSIONS: Patients with solid-pseudopapillary neoplasms of the pancreas present differently and the course of the disease is more benign. These patients can be adequately managed by pylorus-preserving pancreatoduodenectomy or spleen-preserving distal pancreatectomy with excellent early and long-term results.

Palliative management of hilar cholangiocarcinoma.

Around 80% of the patients with hilar cholangiocarcinoma are candidates for palliative management due to extensive co-morbidity for major surgery, metastases or advanced loco-regional disease. The primary aim of treatment is to provide biliary drainage with long-term relief from pruritus, cholangitis, pain and jaundice. Endoscopically placed self-expanding metallic biliary stent has low procedure-related complications and is probably the modality of choice for patients with unresectable tumour on preoperative assessment. Percutaneous biliary drainage has comparable results and is an alternative when endoscopic expertise is not available or has failed or there are multiple isolated segments with cholangitis. Surgical cholangiojejunostomy provides lasting biliary drainage but has limitations of associated morbidity and mortality. In the absence of high-quality studies, comparing these modalities the choice of biliary drainage procedure should be guided by the available local expertise. Other modalities of treatment like radiotherapy, chemotherapy and photodynamic therapy currently remain investigational.

Metal pollution assessment of sediment and water in the River Hindon, India.

The metal pollution in water and sediment of the River Hindon in western Uttar Pradesh (India) was assessed for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn. The metal concentrations in water showed wide temporal variation compared with bed sediment because of variability in water discharge and variations in suspended solid loadings. Metal concentrations in bed sediments provided a better evaluation of the degree and the extent of contamination in the aquatic environment, Santagarh and Atali being the most polluted sites of the river. The ratio of heavy metals to conservative elements (Fe, Al, etc.) may reveal the geochemical imbalances due to the elevated metal concentrations normally attributed to anthropogenic sources. Metal/A1 ratios for the bed sediments of the river Hindon were used to determine the relative mobility and general trend of relative mobility occurred Fe > Mn > Zn > Cr > Ni > Pb > Cu > Cd.

Adsorption of zinc on bed sediment of River Hindon: adsorption models and kinetics.

The paper presents a study of zinc adsorption using the experimental data on bed sediments of River Hindon in western Uttar Pradesh (India). The effect of various operating variables, viz., initial concentration, solution pH, sediment dose, contact time, and particle size, have been studied. The optimum contact time needed to reach equilibrium was of the order of 60 min and was independent of initial concentration of zinc ions. The extent of adsorption increased with an increase of pH. Furthermore the adsorption of zinc increases with increasing adsorbent doses and decreases with the adsorbent particle size. The content of iron, manganese and organic matter in various fraction of sediment decreases with increasing particle size indicating the possibility of the two geochemical phases to act as the active support material for the adsorption of zinc ions. The adsorption data follows both Langmuir and Freundlich adsorption models. Isotherms were used to determine thermodynamic parameters, viz., free energy change, enthalpy change and entropy change. The negative values of free energy change indicate spontaneous nature of the adsorption while positive values of enthalpy change suggest the endothermic nature of the adsorption of zinc on bed sediment of the River Hindon. The positive values of entropy change indicate randomness at the solid/solution interface.

Triage score for severity of illness.

OBJECTIVE: To evolve a triage scoring system for severity of illness based on clinical variables related to systemic inflammatory response syndrome (SIRS). DESIGN: Prospective study in a tertiary-care hospital. METHODS: Consecutive pediatric patients admitted to the ward or pediatric intensive care unit (PICU) were studied. The respiratory rate, heart rate, capillary refill time, oxygen saturation (SpO2), systolic blood pressure and temperature were noted, Sensorium level was assessed on AVPU score. Variables were based on SIRS criteria and criteria mentioned in Advanced Pediatric Life Support (APLS). Each study variable was scored as 0 or 1 (normal or abnormal) and total score for each child obtained. The survival at discharge was correlated with the study variables and the total score. Another score based on the magnitudes of the coefficients in multiple logistic regression analysis was computed and the correlation between this score and mortality was also studied. ROC curve analysis was performed to see the overall predictive ability of the score as well as a cut off at which maximum discrimination occurred. RESULTS: Of 1099 children studied, 44 died. Of the seven variables, only five variables were abnormal in the study subjects. Except heart rate and respiratory rate, all other variables and age showed significant association with survival status (P < 0.01). The mortality increased with increase in the number of abnormal variables: 0.4% 2.2% 6.1% 15.3% 19.4% and 29.4%for scores of 0,1,2,3,4 and 5 respectively and the linear trend was significant (P < 0.01). Mortality also increased with a decrease in age (P < 0.01). Children with a score of 2 or more (2 or more abnormal clinical variables) had significantly higher mortality as compared to those with no abnormal clinical variables (score = 0). Based on the regression coefficients, the maximum possible score was 9.8. Regression based score was found to predict survival status well. The area under the ROC curve was 0.887, indicating that overall 88.7% of the subjects could be predicted correctly. Maximum discrimination was observed at a score of 2.5 (sensitivity 84.1% specificity 82.2%). CONCLUSION: For triage scoring, any child with 2 or more abnormal clinical variables should be taken as serious that might lead to death. With a more detailed scoring, score of 2.5 can be taken as cut-off to select children who possibly need admission and closer observation.