Influence of Accuracy and Precision of Measurements of Long Bone Tumors in Imaging Studies-A Retrospective Study in Musculoskeletal Oncology.

The aim of this study is to evaluate the level of accuracy and precision of bone scan (BS), MRI, and digital radiography (DR) to measure long bone tumors to design custom-made prosthesis (CMP)/modular prosthesis (MP) in limb salvage surgery (LSS) with the help of phantom and patient's study. There are two separate groups: one is the phantom study and another one is the patient's study. The phantom study is done with the Jaszack Phantom for the Gamma camera and the indigenous phantom for the MRI and DR. Three independent imaging professionals (nuclear medicine physicians and radiologists) measured the distance between standardized, preselected points on the Jaszack phantom in the Gamma Camera (GC) and indigenous phantom on the coronal and sagittal view of the MRI scan and in digital radiography. The measured values were compared with the known values for phantom measurement. A total of 36 patients, which include 24 males and 12 females, 3 independent imaging professionals measured the patient's long bone in a bone scan, MRI and DR and compared it with histopathological specimen measurement after limb salvage surgery (LSS). Descriptive statistics using appropriate measures of central tendency and dispersion were employed to describe the data. Karl-Pearson correlation coefficient was used to establish the association between continuous covariates. Paired t-test was utilized to test the differences in paired values for statistical significance. A near-perfect positive correlation was evident between all three pairs of bone scan, MRI scan, and digital radiography values, and a positive agreement within 1 mm of the bone scan, MRI scan, and DR values of all three pairs was around 95%. For the phantom study, we conclude that Gamma camera and MRI measurements are equal in physical measurements (MCF-1). DR measurements were found to be near equal physical measurements and multiplication correction factor (MCF)-0.9104 and three observer's measurements values were also near normal. For the patient's study, we conclude that the bone scan, MRI, and DR measurements of 3 independent imaging professionals are near normal, and it was confirmed with pathological specimen after LSS, to confirm reliability, repeatability, reproducibility, and accuracy of the tumor length to do custom-made prosthesis or modular prosthesis for the patients who are affected by osteosarcoma and Ewing's sarcoma.

Role of Bone Scan and MRI in Designing of Customized Prosthesis for Limb Salvage Surgery of Long Bone Tumors: 4 Years of Single Institution Analysis.

The purpose of this study is to evaluate the role of bone scan (BS) and MRI measurement data in designing Custom Made Prosthesis (CMP) in Limb Salvage Surgery (LSS) in orthopedic oncology patients. The study was done on 126 patients, which include 88 males and 38 females. Pre-operative planning including determination of the osteotomy plane and dimension of the prosthesis was performed based on Tc99m MDP bone scan and MR images comparing with the histopathology examination (HPE) values. Descriptive statistics using appropriate measures of central tendency and dispersion were employed to describe the data. Karl-Pearson correlation coefficient was used to establish the association between continuous covariates. Paired t-test was utilized to test the differences in paired values for statistical significance. Bone scan and HPE values are positively correlated; p value is 0.913 (p < 0.001). However, mean difference between the HPE and bone scan is statistically significant (p < 0.001). MRI scan and HPE values are positively correlated 0.920 (p < 0.001) and mean difference is also statistically not significant (0.920; p < 0.001). If we apply ± 20% window, 94/126 patients (75%) bone scan measurements and 94/112 patients (84%) MRI measurements are matching with the HPE measurements. We conclude that bone scan measurements were found to be more or less equal to MR imaging for determining the tumor extent for the fit of the prosthesis and excellent functional results.

Aggressive Thoracic Hemangioma of Spine Presenting as Painful Adolescent Scoliosis - Diagnosis and Management.

Introduction: Spinal hemangioma is the most common benign lesion of the spine with an incidence of 10-12%. Aggressive hemangioma presents with back pain, deformity, or neurologic deficit. Aggressive hemangioma presenting as painful scoliosis is very rare and literature reporting them is very limited. Case Report: We present the case of a boy in his second decade who presented with back pain for 1 month radiating to his right chest with a deformity in his back. MRI showed a hyperintense lesion involving the sixth dorsal vertebra in the T2-weighted image and a hypointense lesion with striations in STIR images suggestive of hemangioma. Pre-operative embolization was done using micro platinum coils. The patient underwent a decompressive laminectomy and vertebral body decompression. The patient also underwent 12 cycles of radiotherapy. The patient had complete resolution of the deformity without any recurrence at 2 years. Conclusion: Management of aggressive hemangiomas with neurologic deficit needs a multidisciplinary approach with surgery, pre-operative embolization, and post-operative radiotherapy.

Crystal structure and Hirshfeld surface analysis of a pyrrolo-thia-zine complex.

In the title compound, diethyl 2,2-dioxo-4-(thio-phen-2-yl)-1-[(thio-phen-2-yl)meth-yl]-3,4,6,7,8,8a-hexa-hydro-1H-pyrrolo-[2,1-c][1,4]thia-zine-1,3-di-carboxyl-ate, C22H28NO6S3, the pyrrolo ring is in an envelope conformation while the thia-zine ring adopts a near chair conformation. The dihedral angles between the thia-zine ring and the methyl-thienyl, thienyl and pyrrolo rings are 64.0 (2), 87.92 (7) and 5.6 (2)°, respectively. In the crystal, the mol-ecules are linked by weak C-H⋯O hydrogen bonds. A Hirshfeld surface analysis was performed to investigate the inter-molecular inter-actions. Disorder of the methyl-thienyl group with site occupancies of 0. 792 (3) and 0.208 (3) is observed.

Clinicopathologic implications of epithelial cell adhesion molecule expression across molecular subtypes of breast carcinoma.

BACKGROUND: Epithelial cell adhesion molecule (EpCAM), a type I transmembrane protein of the epithelial tissues and known cell adhesion molecule, has been demonstrated to have critical role in carcinogenesis. In breast cancer, EpCAM expression has been associated with poor prognosis. The expression pattern of EpCAM across molecular subtypes of breast carcinoma has been studied in patients reporting to a South Indian multispecialty tertiary care hospital. The prognostic significance of EpCAM expression pattern and probable response to therapy has also been addressed. MATERIALS AND METHODS: EpCAM expression was assessed by immunohistochemical studies on 200 breast carcinoma tissue samples of different molecular subtypes, including luminal A, luminal B, Her2Neu, and triple-negative breast cancer (TNBC). The expression was scored using the standard scoring system. A correlation was drawn with detailed clinicopathologic annotation and available outcomes data to analyze the influence of EpCAM on prognosis. RESULTS: EpCAM expression varied significantly in the different intrinsic subtypes of breast carcinoma. Differential expression was also established with different grades of breast carcinoma with varying levels of differentiation. We observed strong EpCAM expression in TNBC among other subtypes. CONCLUSION: The differential expression of EpCAM among intrinsic subtypes of breast cancer and the correlation of EpCAM expression with high-grade breast carcinoma shown in the study have important implications in understanding the role of EpCAM and might form the basis for developing targeted therapies in breast cancer in the future.

A Method and an Experimental Setup for Measuring the Self-Noise of Piezoelectric Hydrophones.

Self-noise of hydrophone is one of the important parameters for critical sonar applications, as it finally decides the lowest detectable signal from a target. To measure the ambient noise of the ocean, the self-noise of the hydrophone should be much less than the sea state zero (SS0) noise. Hence, an experimental setup is required to measure the self-noise generated by the hydrophones. An experimental setup has been designed, developed, and demonstrated. The facility consists of a vibration-isolated and EMI-shielded vacuum chamber which encloses the sample holder assembly and effectively isolates the test hydrophones from external environmental noise sources, such as ground vibrations, electromagnetic interference, and airborne acoustic noises. This enables the measurement of self-noise that is originating purely within the hydrophone. A procedure is developed to remove the noise contribution of the preamplifier including its resistors from the measured output signal of the preamplifier. Uncertainty in measurement using this setup is estimated using the propagation of distribution method through Monte Carlo simulation. This article describes the factors contributing to the self-noise in piezoelectric (PE) transducers, the noise measurement principle, the constructional details of the experimental setup, and the calibration procedure. The technique is demonstrated by measuring the self-noise of a few different types of hydrophones. Thermal noise as low as 0.5 nV / √{Hz} with an estimated uncertainty of 0.5 nV / √{Hz} with a confidence level of 95% is achieved.

Crystal structure and mol-ecular Hirshfeld surface analysis of acenaphthene derivatives obeying the chlorine-methyl exchange rule.

Instances of crystal structures that remain isomorphous in spite of some minor changes in their respective mol-ecules, such as change in a substituent atom/group, can provide insights into the factors that govern crystal packing. In this context, an accurate description of the crystal structures of an isomorphous pair that differ from each other only by a chlorine-methyl substituent, viz. 5''-(2-chloro-benzyl-idene)-4'-(2-chloro-phen-yl)-1'-methyl-dispiro-[acenaphthene-1,2'-pyrrolidine-3',3''-piperidine]-2,4''-dione, C34H28Cl2N2O2, (I), and its analogue 1'-methyl-5''-(2-methyl-benzyl-idene)-4'-(2-methyl-phen-yl)di-spiro-[acenaphthene-1,2'-pyrrolidine-3',3''-piperidine]-2,4''-dione, C36H34N2O2, (II), is presented. While there are two C-H⋯O weak inter-molecular inter-actions present in both (I) and (II), the change of substituent from chlorine to methyl has given rise to an additional weak C-H⋯O inter-molecular inter-action that is relatively stronger than the other two. However, the presence of the stronger C-H⋯O inter-action in (II) has not disrupted the validity of the chloro-methyl exchange rule. Details of the crystal structures and Hirshfeld analyses of the two compounds are presented.

Interleukin-6 Receptor (IL-6R) Expression in Human Gastric Carcinoma and its Clinical Significance.

The aim of the study is to analyse the expression of Interleukin-6 receptor in different human gastric tissue and to correlate with the clinicopathological features of the patients. Immunohistochemistry was done against the IL-6R antibody and the Q-score was calculated from the staining pattern. Higher Q-scores were observed in tumour cells than the adjacent normal cells which were statistically significant. We also observed a significant correlation between the expressions of IL-6R and the clinicopathological features These findings suggest that IL-6R may represent as a therapeutic target for gastric carcinoma and serve as a prognostic indicator, as well.

Inhibitory effect of a resin coat-containing prereacted glass fillers on the enamel demineralization of the primary teeth: An in vitro pilot study.

BACKGROUND: With an increasing interest in preventive strategies, pedodontics research is now more focused on developing newer materials and techniques to coat the primary teeth to prevent onset of new carious lesions. AIM: The aim of this study is to evaluate the inhibitory effect of prereacted glass (PRG) filler-containing resin coat on enamel demineralization of the primary teeth. SUBJECTS AND METHODS: Eight de-rooted primary caries-free teeth sectioned into 4 mm × 4 mm were divided into either experimental group which received the PRG barrier coat or control group which was left uncoated. These were then immersed in acid buffer at pH 4.5 for 3 days. Mineral content was evaluated by scanning electron microscopy with energy dispersive X-ray analysis. STATISTICAL ANALYSIS: Data were collected and analyzed statistically using paired Student's "t" test, with a P < 0.05 being considered statistically significant. RESULTS: When the calcium/phosphorous (Ca/P) ratio (wt%) which is indicative of the mineral content of enamel was compared, the values were higher for the experimental group than that for the control group and the association was statistically significant (P < 0.01). CONCLUSION: The higher Ca/P ratio of experimental group was suggestive of the ability of PRG barrier coat to inhibit enamel demineralization in the primary teeth.

Isomorphous diethyl 1-(4-chloro-benz-yl)-4-(4-chloro-phen-yl)-2,2-dioxo-3,4,6,7,8,8a-hexa-hydro-1H-pyrrolo-[2,1-c][1,4]thia-zine-1,3-di-carboxyl-ate and its 1-(4-methyl-benz-yl)-4-(4-methyl-phen-yl)-substituted analogue obeying the chloro-methyl exchange rule.

Accurate studies on the effect of substituents on the crystal packing are essential for understanding the inter-molecular inter-actions and thus paving the way to crystal structure prediction. The crystal structures of diethyl 1-(4-chloro-benz-yl)-4-(4-chloro-phen-yl)-2,2-dioxo-3,4,6,7,8,8a-hexa-hydro-1H-pyrrolo-[2,1-c][1,4]thiazine-1,3-di-carboxyl-ate, C26H29Cl2NO6S, (I), and its isomorphous pair diethyl 1-(4-methyl-benz-yl)-4-(4-methyl-phen-yl)-2,2-dioxo-3,4,6,7,8,8a-hexa-hydro-1H-pyrrolo-[2,1-c][1,4]thia-zine-1,3-di-carboxyl-ate, C28H35NO6S, (II), are described. The mol-ecular aggregation patterns appear to be strikingly similar despite changes in the substituents, with a Cl atom in (I) being replaced by a methyl group in (II). Inspite of the chemical modifications, the structures of (I) and (I) are isomorphous, isostructural and found to obey the chlorine-methyl exchange rule. Both the structures feature C-H⋯O hydrogen bonding. However, a distinguishing feature between (I) and (II) is observed in the conformation of the pyrrole rings where the twist occurs on different C-N bonds. Hirshfeld analysis of both structures is presented and discussed.

Over-expression of 3-hydroxy-3- methylglutaryl-coenzyme A reductase 1 (hmgr1) gene under super-promoter for enhanced latex biosynthesis in rubber tree (Hevea brasiliensis Muell. Arg.).

Natural rubber (cis-1, 4-polyisoprene) is being produced from bark laticifer cells of Hevea brasiliensis and the popular high latex yielding Indian rubber clones are easily prone to onset of tapping panel dryness syndrome (TPD) which is considered as a physiological syndrome affecting latex production either partially or completely. This report describes an efficient protocol for development of transgenic rubber plants by over-expression of 3-hydroxy 3-methylglutaryl Co-enzyme A reductase 1 (hmgr1) gene which is considered as rate limiting factor for latex biosynthesis via Agrobacterium-mediated transformation. The pBIB plasmid vector containing hmgr1 gene cloned under the control of a super-promoter was used for genetic transformation using embryogenic callus. Putatively transgenic cell lines were obtained on selection medium and produced plantlets with 44% regeneration efficiency. Transgene integration was confirmed by PCR amplification of 1.8 kb hmgr1 and 0.6 kb hpt genes from all putatively transformed callus lines as well as transgenic plants. Southern blot analysis showed the stable integration and presence of transgene in the transgenic plants. Over expression of hmgr1 transgene was determined by Northern blot hybridization, semi-quantitative PCR and real-time PCR (qRT-PCR) analysis. Accumulation of hmgr1 mRNA transcripts was more abundant in transgenic plants than control. Increased level of photosynthetic pigments, protein contents and HMGR enzyme activity was also noticed in transgenic plants over control. Interestingly, the latex yield was significantly enhanced in all transgenic plants compared to the control. The qRT-PCR results exhibit that the hmgr1 mRNA transcript levels was 160-fold more abundance in transgenic plants over untransformed control. These results altogether suggest that there is a positive correlation between latex yield and accumulation of mRNA transcripts level as well as HMGR enzyme activity in transgenic rubber plants. It is presumed that there is a possibility for enhanced level of latex biosynthesis in transgenic plants as the level of mRNA transcripts and HMGR enzyme activity is directly correlated with latex yield in rubber tree. Further, the present results clearly suggest that the quantification of HMGR enzyme activity in young seedlings will be highly beneficial for early selection of high latex yielding plants in rubber breeding programs.

Effect of Enamel Deproteinization in Primary Teeth.

OBJECTIVE: To evaluate and compare the topographical features of enamel surface, etched with different materials. STUDY DESIGN: 10 extracted human primary molars were randomly selected and cut and trimmed to 1 mm2. Each group comprised of 10 blocks and the enamel was treated as follows: Group I-35% H3PO4; Group II-5.25% NaOCl + 35% H3PO4 ;Group III-5.25% NaOCl; Group IV no treatment was carried out. All the samples were prepared for Scanning electron microscope analysis. The images were obtained and evaluated for the quality type I-II etching of the enamel surface using Auto-CAD 2011 software. STATISTICAL ANALYSIS USED: Wilcoxon Signed Ranks Test (p<0.001). RESULTS: The mean surface area of type I and II etching pattern values for Group- I was 39608.18 µm2 and Group- II was 45051.34 µm2. CONCLUSION: Deproteinization with 5.25% Sodium hypochlorite prior to acid etching could be used to increase the surface area of adhesion of composite material with the tooth surface.

Multimodal intraoperative neuromonitoring in scoliosis surgery: A two-year prospective analysis in a single centre.

AIM: The present study is a prospective analysis of neuromonitoring [somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP)] in consecutive scoliosis surgeries done at a tertiary care spine centre. MATERIALS AND METHODS: Prospective analysis was performed on 52 consecutive patients undergoing scoliosis correction from 2013 to 2015. SSEPs were obtained by stimulating the median and tibial nerves with stimulus intensity level 20-25 mA. TcMEPs were recorded bilaterally from abductor pollicis brevis, biceps, and deltoid for the upper limb, and from tibialis anterior, quadriceps, gastrocnemius, and abductor hallucis for the lower limb. Stimulation was given in the form of a high voltage (300-400 V) stimulus. An "alert" was defined as reduction in the amplitude of at least 50% for SSEP and at least 65% for TcMEP compared to the baseline recordings and an increase in the latency by more than 10%. RESULTS: The mean age of the patients was 14.6 years (7-33 years). Thirty-nine of the patients were females and 13 were males. Baseline values in neuromuscular scoliosis were low compared to adolescent idiopathic scoliosis (AIS). There were no false negative incidents. False positive cases were due to low blood pressure and malfunctioning of the leads. CONCLUSION: Use of upper limb leads could help in identifying malposition or malfunctioning of leads to eliminate false positive results. Combined multimodal intraoperative monitoring helps in increasing the safety in scoliosis corrective surgeries with a high sensitivity and specificity. Baseline values in neuromuscular scoliosis patients are possibly lower than idiopathic scoliosis patients. Intraoperative variations must be interpreted with caution.

Crystal structures of 2'-benzoyl-1'-(4-methyl-phenyl)-1,1',2,2',5',6',7',7a'-octa-hydro-spiro-[indole-3,3'-pyrrolizin]-2-one and 2'-(4-bromo-benzoyl)-1'-(2-chloro-phen-yl)-1,1',2,2',5',6',7',7a'-octa-hydro-spiro-[indole-3,3'-pyrrolizin]-2-one.

The two title compounds, C28H26N2O2, (I), and C27H22BrClN2O2, (II), differ in their substituents, viz.4-methyl-phenyl and benzoyl rings in (I) replaced by 2-chloro-phenyl and 4- bromo-benzoyl, respectively, in (II). A significant difference between the two mol-ecules is found in the deviation of the benzoyl O atom from the least-squares plane of the ring to which it is attached [0.593 (4) and 0.131 (3) Å, respectively], a fact which may be attributed to the different participation of the benzoyl O atoms as acceptors in their inter-molecular C-H⋯O inter-actions. The chemical modifications in (I) and (II) do not seem to affect the type nor strength of the inter-molecular N-H⋯N and C-H⋯O hydrogen bonds responsible for the two crystal structures, such that the aggregation of mol-ecules appears similar in spite of the mol-ecular changes.

Spinal compression fractures due to pregnancy-associated osteoporosis.

OBJECTIVES: To report on unique cases of spinal compression fractures due to pregnancy-associated osteoporosis (PAO) and to suggest a satisfactory treatment modality. MATERIALS AND METHODS: A single-center retrospective study. We reviewed the data of 535 patients with osteoporotic spinal compression fractures over a period of 5-year. Two patients who developed spinal compression fractures due to PAO were identified and treated. RESULTS: The clinical presentation and blood investigations ruled out other causes of osteoporosis. Dual-energy X-ray absorptiometry was used to confirm the diagnosis. All patients improved with medical management. CONCLUSION: Vertebral fractures due to PAO should be considered as a differential diagnosis in patients with back pain who are in the third trimester of pregnancy or in postpartum. Early recognition and appropriate conservative management would be necessary to prevent complications such as new vertebral fractures and chronic back pain.

Quantum phase magnification.

Quantum metrology exploits entangled states of particles to improve sensing precision beyond the limit achievable with uncorrelated particles. All previous methods required detection noise levels below this standard quantum limit to realize the benefits of the intrinsic sensitivity provided by these states. We experimentally demonstrate a widely applicable method for entanglement-enhanced measurements without low-noise detection. The method involves an intermediate quantum phase magnification step that eases implementation complexity. We used it to perform squeezed-state metrology 8 decibels below the standard quantum limit with a detection system that has a noise floor 10 decibels above the standard quantum limit.

Radiological and Histopathological Outcome of Giant Cell Tumor of Femur with Denosumab Treatment: A Case Report.

Giant Cell Tumour of Bone (GCTB) is a benign but locally aggressive osteolytic skeletal neoplasm of young adults consisting of giant cells expressing RANK (Receptor Activator of Nuclear Factor-κB) and mesenchymal spindle-like stromal cells expressing RANKL (RANK ligand). The interaction of these cells leads to bone resorption. Recently, the RANKL inhibitor, denosumab, has demonstrated activity against giant-cell tumours. The current article reports a case of a Giant cell tumour of left distal femur with pathological fracture. A 34-year-old male patient presented with history of on and off dull aching pain in the left knee for 4 months followed by a history of trivial fall. He sustained a closed injury in the left knee, following which he was unable to bear weight and developed pain and swelling in left knee. Conventional radiographs and Computerized tomography (CT) was done which showed the presence of a left distal femoral osteolytic lesion and a histological analysis of a biopsy specimen confirmed the diagnosis of GCTB. The patient was treated with neoadjuvant denosumab therapy which resulted in successful downstaging of the tumour followed by extended curettage of the lesion with high speed burr and argon laser cautery. The post-curettage microscopic examination revealed the absence of osteoclast-type giant cells.

Visual functions of workers exposed to organic solvents in petrochemical industries.

AIM: The purpose of this study was to evaluate the visual functions of workers exposed to organic solvents in petrochemical industries. MATERIALS AND METHODS: Thirty workers from the petroleum refinery and 30 age-matched controls (mean age) were recruited. Visual functions and occupational exposure levels were assessed among both the groups. Visual acuity, contrast sensitivity, color vision, and visual fields were evaluated at the workplace. The biological samples, namely blood and urine, were collected at the workplace and transported to the laboratory for analysis. The urinary excretion of hippuric and methylhippuric acid as well as creatinine was measured by high performance liquid chromatography. RESULTS: The mean age of the workers and controls were 39.7 ± 7.6 years and 38.6 ± 8.1, years respectively. The mean years of experience of the workers were 15.6 ± 6.8 years. Visual acuity was >0.01 LogMAR among both the control and case groups. The contrast sensitivity was reduced at 12cpd among workers. Comparison between groups was done using independent sample t-test. The mean difference in color confusion index was 0.11 ± 0.05 (P = 0.037*). The mean difference in visual fields was -0.31 ± 0.36 dB (P = 0.933). The mean difference in urinary hippuric acid level (urinary metabolite of toluene) between the groups was 0.19 ± 0.96 g/g creatinine (P = 0.049FNx01). The mean difference in the excretion of methylhippuric acid (urinary metabolite of xylene) was 0.06 ± 0.04g/g creatinine (P = 0.154). We also found that exposure was a significant risk factor for color vision defect with an odds ratio of 4.43 (95% CI: 1.36-14.4); P = 0.013. CONCLUSION: The study results showed that contrast sensitivity and color vision were affected among workers in petrochemical industry.