Improving the Accuracy of Corrective Osteotomy for Congenital Radio Ulnar Synostosis using the Axis of Rotation of the Forearm as a Guide.

Introduction: Despite several techniques for corrective osteotomy in congenital radioulnar synostosis (CRUS) the published literature lacks a guide for radiographic planning and rationale for the site and level of the osteotomy. The primary objective of this study is to report a technique of radiographically controlled corrective osteotomy using the axis of rotation of the forearm in CRUS. Materials and methods: Children with CRUS underwent corrective osteotomy based on radiographic planning; the extent of rotational correction and functional outcomes were assessed at a mean of 27 months after the operation. Results: Seven forearms in six children of an average of 6.25 years were assessed for correction and functional outcomes. The average pre-operative pronation deformity was 71.5°. The average correction achieved was 64°. At follow-up, there were five excellent and two good functional outcomes. All children could perform daily tasks besides eating with hand and personal hygiene. Conclusion: Radiographic determination of the osteotomy sites by the method described is effective, consistent, and reproducible in achieving optimal functional outcomes in congenital radioulnar synostosis.

Improving the Accuracy of Corrective Osteotomy for Congenital Radio Ulnar Synostosis using the Axis of Rotation of the Forearm as a Guide

@#Introduction: Despite several techniques for corrective osteotomy in congenital radioulnar synostosis (CRUS) the published literature lacks a guide for radiographic planning and rationale for the site and level of the osteotomy. The primary objective of this study is to report a technique of radiographically controlled corrective osteotomy using the axis of rotation of the forearm in CRUS. Materials and methods: Children with CRUS underwent corrective osteotomy based on radiographic planning; the extent of rotational correction and functional outcomes were assessed at a mean of 27 months after the operation. Results: Seven forearms in six children of an average of 6.25 years were assessed for correction and functional outcomes. The average pre-operative pronation deformity was 71.5°. The average correction achieved was 64°. At follow-up, there were five excellent and two good functional outcomes. All children could perform daily tasks besides eating with hand and personal hygiene. Conclusion: Radiographic determination of the osteotomy sites by the method described is effective, consistent, and reproducible in achieving optimal functional outcomes in congenital radioulnar synostosis.

Patient-reported outcomes predict survival and adverse events following anticancer treatment initiation in advanced HER2-positive breast cancer.

BACKGROUND: The prognostic value of patient-reported outcomes (PROs) has been minimally explored in advanced breast cancer (BC), and their comparative prognostic performance against Eastern Cooperative Oncology Group performance status (ECOG PS) is largely unknown. PATIENTS AND METHODS: This study pooled individual participant data from clinical trials CLEOPATRA, EMILIA, and MARIANNE. Pre-treatment PRO associations with overall survival (OS), progression-free survival (PFS), and grade ≥3 adverse events were evaluated via Cox proportional hazards regression. Prognostic performance was assessed with the C-statistic (c). PRO values were collected via the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire. All analyses were stratified by study and treatment arms. Analyses adjusted for known prognostic variables were conducted. Exploratory analysis of the prognostic performance of PROs compared to ECOG PS was undertaken. RESULTS: The study included data from 2894 patients initiated on contemporary therapies including pertuzumab (n = 765), trastuzumab (n = 1173), trastuzumab emtansine (n = 1225), taxanes (n = 1173), lapatinib (n = 496), and capecitabine (n = 496). On univariable and adjusted analysis, patient-reported physical well-being, functional well-being, and BC subscale were all identified to be associated with OS, PFS, and grade ≥3 adverse events (P < 0.05). Patient-reported physical well-being was the most prognostic PRO for all assessed outcomes. The OS prognostic performance of physical well-being (c = 0.58) was superior to ECOG PS (c = 0.56) (P < 0.05), with multivariable analysis indicating that both provide independent information (P < 0.0001). CONCLUSIONS: PROs were identified as independent prognostic factors for OS, PFS, and grade ≥3 adverse events in patients with human epidermal growth factor receptor 2 (HER2)-positive advanced BC initiating contemporary treatment options. Further, patient-reported physical well-being was more prognostic of OS than ECOG PS and contained independent information. PROs have value as prognostic and stratification factors for clinical use and research trials of anticancer treatment in HER2-positive ABC.

Anomalous behaviour of ozone under COVID-19 and explicit diagnosis of O3-NOx-VOCs mechanism.

Air pollution is linked to higher rates of human mortality especially those infected with COVID 19. Ozone is a harmful pollutant and is responsible for many health issues. However, some reports suggest that ozone is a strong disinfectant, and can kill the viruses. We hereby, report on the vulnerability of ozone due to COVID-19 lockdown whose levels flutter from surging to saturation in a highly polluted Indian capital, due to significant decline in anthropogenic emissions of ozone precursors. Average observed levels stabilized at 30 ppb, 12 ppb, 740 ppb, and 900 ppb for ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO) and volatile organic compounds (VOCs) respectively during lockdown period from 27th March to 10th April 2020. The NO2, CO and VOC declined by 50 %, 37 %, 38 % respectively during the lockdown period of 2020 as compared to similar period in 2019. The anomalous response of ozone during the lockdown is explained by resolving the poorly known complex O3-NOx-VOCs mechanism with the help of data from air monitoring stations in Delhi, India. The data obtained from this study advances the fundamental understanding of ozone chemistry that may lead to improved ozone parameterization in chemical transport models and better planning of ozone risk management strategies for any global mega cities.

Pseudo-winging of Scapula due to Ventral Scapular Osteochondroma: A Case Report and Literature Review.

INTRODUCTION: Osteochondroma is the most common benign tumor of bone. Scapula is a very rare site for its occurrence. CASE REPORT: A 6-year-old male presented with swelling over the left scapular region for 3 months, which was insidious in onset and gradually progressing. There was a single swelling of approximately 3 × 3 × 2 cm3 over medial border of the left scapula. It was hard in consistency with well-defined margin and irregular surface, non-tender, immobile, arising for the underlying bone, and non-adherent to skin. There was pseudo-winging of scapula. The patient was referred with an anteroposterior view radiograph and a computed tomography scan. A working diagnosis of ventral scapular osteochondroma was made. Excision of lesion was done in prone position. There was no pseudo-winging post-excision. Osteochondroma is rare for scapula. Further, pseudo-winging of scapula is seldom. CONCLUSION: Prone position with internal rotation of shoulder can make the surgery easy. Excision of the tumor helps get rid of pseudo-winging.

COVID-19 and environmental -weather markers: Unfolding baseline levels and veracity of linkages in tropical India.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe due to its contagion nature. We hereby report the baseline permanent levels of two most toxic air pollutants in top ranked mega cities of India. This could be made possible for the first time due to the unprecedented COVID-19 lockdown emission scenario. The study also unfolds the association of COVID-19 with different environmental and weather markers. Although there are numerous confounding factors for the pandemic, we find a strong association of COVID-19 mortality with baseline PM2.5 levels (80% correlation) to which the population is chronically exposed and may be considered as one of the critical factors. The COVID-19 morbidity is found to be moderately anti-correlated with maximum temperature during the pandemic period (-56%). Findings although preliminary but provide a first line of information for epidemiologists and may be useful for the development of effective health risk management policies.

Sonochemical synthesis of Graphene-Ce-TiO2 and Graphene-Fe-TiO2 ternary hybrid photocatalyst nanocomposite and its application in degradation of crystal violet dye.

The present work deals with the preparation of graphene oxide (GO) using Hummers-Offeman method in the presence of ultrasonic irradiations. Further loading of TiO2 photocatalyst on prepared GO was accomplished which is basically oxidation reduction reaction between graphene oxide and titanium isopropoxide that leads to the formation of graphene-TiO2 nanocomposite. Graphene-Ce-TiO2 and Graphene-Fe-TiO2 nanocomposites were prepared using one step in-situ ultrasound assisted method using GO, titanium isopropoxide, cerium nitrate, ferric nitrate, and 2-propanol. The successfully prepared graphene-TiO2, Graphene-Ce-TiO2, Graphene-Fe-TiO2 nanocomposites were then characterized using XRD, SEM and TEM analysis. The obtained XRD patterns clearly indicates the formation of anatase TiO2 on graphene nanosheets and it also indicates the presence of Ce and Fe in the Graphene-Ce-TiO2 and Graphene-Fe-TiO2 nanocomposite respectively. Further the use of the prepared nanocomposites as a photocatalyst have been studied for the degradation of crystal violet dye. The effect of various parameters such as catalyst doping, catalyst loading and initial concentration of dye on its degradation were studied. The effectiveness of the prepared catalysts were compared for the degradation of crystal violet dye. It has been observed that Graphene-Fe-TiO2 exhibits maximum photocatalytic activity compared to Graphene-Ce-TiO2 and Graphene-TiO2 nanocomposite photocatalyst.

Coronary computed tomographic angiography: from anatomical to functional assessment of coronary artery disease.

Contrast enhanced computed tomography angiography (CTA) has seen rapid progress in its utility for the assessment of coronary artery disease (CAD) in the last few years. More and more technological enhancements have widened the horizons for the use of this non-invasive modality beyond its traditional role in assessment of coronary anatomy. Present article is an attempt to review the evolution of CTA from the point of view of its clinical utility. The review provides an update on the literature for this transition of CTA from anatomical to physiological assessment of CAD. Multicenter studies showed that coronary computed tomography angiography (CCTA) has a very high diagnostic accuracy and prognostic ability in symptomatic patients; however improvements are still needed for reducing the overestimation of CAD severity and assessment of plaque composition. In asymptomatic populations, there is a lack of studies that show an improved prognostic power of CCTA over other modalities. Additionally, CT has been evaluated for the assessment of the myocardium, myocardial perfusion and viability, cardiac function, wall motion, as well as cardiac valves. Tremendous progress has been made to reduce the radiation dose; however, much effort is still required for making the assessment of myocardial and valvular function an integrative part of the image interpretation for a comprehensive assessment of all aspects of coronary heart disease.

Comprehensive epitope analysis of human immunodeficiency virus type 1 (HIV-1)-specific T-cell responses directed against the entire expressed HIV-1 genome demonstrate broadly directed responses, but no correlation to viral load.

Cellular immune responses play a critical role in the control of human immunodeficiency virus type 1 (HIV-1); however, the breadth of these responses at the single-epitope level has not been comprehensively assessed. We therefore screened peripheral blood mononuclear cells (PBMC) from 57 individuals at different stages of HIV-1 infection for virus-specific T-cell responses using a matrix of 504 overlapping peptides spanning all expressed HIV-1 proteins in a gamma interferon-enzyme-linked immunospot (Elispot) assay. HIV-1-specific T-cell responses were detectable in all study subjects, with a median of 14 individual epitopic regions targeted per person (range, 2 to 42), and all 14 HIV-1 protein subunits were recognized. HIV-1 p24-Gag and Nef contained the highest epitope density and were also the most frequently recognized HIV-1 proteins. The total magnitude of the HIV-1-specific response ranged from 280 to 25,860 spot-forming cells (SFC)/10(6) PBMC (median, 4,245) among all study participants. However, the number of epitopic regions targeted, the protein subunits recognized, and the total magnitude of HIV-1-specific responses varied significantly among the tested individuals, with the strongest and broadest responses detectable in individuals with untreated chronic HIV-1 infection. Neither the breadth nor the magnitude of the total HIV-1-specific CD8+-T-cell responses correlated with plasma viral load. We conclude that a peptide matrix-based Elispot assay allows for rapid, sensitive, specific, and efficient assessment of cellular immune responses directed against the entire expressed HIV-1 genome. These data also suggest that the impact of T-cell responses on control of viral replication cannot be explained by the mere quantification of the magnitude and breadth of the CD8+-T-cell response, even if a comprehensive pan-genome screening approach is applied.

Biliary distensibility during per-operative cholangiography as compared to pre-operative ultrasound: a four year follow-up study.

INTRODUCTION: It is well recognized that corrected bile duct diameters, as measured by endoscopic retrograde cholangiography (ERC), are often significantly greater than the corresponding ultrasound measurement. This can be attributed to variation in bile duct distensibility and is particularly noted in post cholecystectomy patients, possibly due to loss of the gall bladder reservoir effect. It has been suggested that increased bile duct distensibility may be related to the post-cholecystectomy syndrome. We have observed a similar discrepancy between ultrasound and per-operative cholangiography (POC). This trial investigates whether the discrepancy between ultrasound and POC measurements has clinical significance. METHOD: Seventy-five patients with normal pre-operative ultrasound and POC undergoing standard open cholecystectomy (with benzodiazepine pre-medication) in 1990 were identified. After allowance for magnification, maximum biliary diameters were obtained for the proximal extra-hepatic bile duct. Follow-up was obtained in 67 patients from clinical case notes and contact with general practitioners. RESULTS: Considerable variation of bile duct distensibility was recorded (range 83% to 410%) with 12 cases having POC biliary diameters outside radiological guidelines (12 mm as recorded on the radiograph). This distension is shown to increase with age. After 4 years, 16 patients had recurrent abdominal pain of which nine had undiagnosed right upper quadrant pain. There were no clinical cases of retained stone post-operatively. There was no correlation between POC measured bile duct diameter or distensibility and post-operative or long term problems. This study suggests that the bile duct has a normal variation of distensibility which increases with age and that radiological guidelines, as regards the upper limit for normal POC biliary diameters can be relaxed.