Histomorphological and morphometrical changes of placental terminal villi of normotensive and preeclamptic mothers

Placental morphology and cellular arrangement are altered in maternal diseases such as preeclampsia (PE) in which oxygen delivery from the mother to the fetus is greatly disturbed, ultimately resulting in cellular oxidative stress. The present study was conducted at the Department of Anatomy and included 112 placentas (56 each from mothers with and without PE [controls]) collected at the Department of Obstetrics and Gynecology. A histological study was performed using hematoxylin and eosin staining. The morphology of stem and terminal villi (TV) was studied, and the surface area and diameter of TV and capillaries were measured. The gross placental morphometrical study revealed that the mean placental weight, thickness, diameter, and surface area were significantly lower in placentas with PE than in controls. The histomorphometrical findings of the villous surface area and diameter were lower in placentas with PE, whereas the TV density was higher in placentas with PE than in controls, and the differences were significant (P<0.0001). In these TV, the diameter and density of fetal blood vessels of placentas with PE were significantly lower than those of controls (P<0.05). In conclusion, the both morphological and histological changes in PE placentas are indicative of the pathogenesis of maternal and fetal morbidity and mortality in women with PE. The observed and comparative histomorphometrical changes indicate a decline in all aspects of the PE placenta, except the number of TV.

Familial isolated hyperparathyroidism: role of intra operative parathormone assay

Primary Hyperparathyroidism (PHPT) has been reported to occur in members of same family either alone or in syndromic association. We report a family of patients with multi glandular disease wherein we have successfully used intra operative PTH (IOPTH) to assess the completeness of resection. Three members of one family were affected (One male and two females). Two of them had symptomatic disease whereas one was asymptomatic. Since the genetic studies are not available we used a combination of radiological, clinical and laboratory findings to rule out the other components of MEN syndromes. Extent of surgery in familial isolated hyperparathyroidism (FIHP) is controversial. Hence for confirmation of adequate parathyroid tissue resection we used IOPTH. Role of IOPTH has been well established in sporadic PHPT but controversial in multi glandular syndromes. IOPTH was successfully used to confirm the excision and establish cure.

A mitochondrial DNA variant 10398G>A in breast cancer among South Indians: an original study with meta-analysis

The m.10398G>A polymorphism in the MT-ND3 gene has been linked to the manifestation of several neurodegenerative disorders and cancers. Several research groups have analyzed the association between m.10398G>A polymorphism and breast cancer; however, the results do not follow a consensus. We have studied this polymorphism in three Dravidian populations from South India. Analysis on 716 cases and 724 controls found no association between m.10398G>A polymorphism and breast cancer [OR = 0.916 (0.743-1.128); P = 0.409]. Menopausal stratification also revealed no significant association in either pre-menopausal or post-menopausal breast cancer groups. In addition, we undertook a meta-analysis on 16 study groups, comprising a total of 7202 cases and 7490 controls. The pooled odds ratio suggested no significant association of m.10398G>A substitution with breast cancer [OR = 1.016 (0.85-1.22); P = 0.86]. In conclusion, there is no evidence of association between m.10398G>A polymorphism and breast cancer risk among South Indian women. Meta-analysis suggested no overall correlation between this polymorphism and breast cancer risk.

Post total thyroidectomy hypocalcemia: A novel multi-factorial scoring system to enable its prediction to facilitate an early discharge

CONTEXT

No single factor can predict the occurrence of post total thyroidectomy (TT) hypocalcemia.

AIMS

This study was conducted to look at various factors usually implicated in post TT clinically significant hypocalcemia (CSH) and to develop a scoring system using a combination of these factors to predict CSH.

SETTINGS AND DESIGN

Prospective study, tertiary care center.

MATERIALS AND METHODS

145 patients, who underwent total thyroidectomy for benign goiters and early carcinoma thyroid ( < T2/N0/M0), were included. Age of the patient, presence, or absence of hyperthyroidism, pre-operative levels of serum calcium and 25 OH vitamin D, post-operative iPTH at 8 hours and calcium at 12 hours, intra-operative parathyroid preservation status, and nodule size were studied. CSH prediction score (0 to 8) was designed based on these 8 factors.

STATISTICAL ANALYSIS

SPSS 13 software was used. For comparison between groups' independent samples T-test and Chi-square test was used. Statistical significance was set at P<0.05. A logistic regression analysis model was built to assess the significant predictors.

RESULTS

There were 22 males and 123 females. 64.82% had euthyroid multinodular goiters, 24.82% had toxic MNG, and 10.34% had an early carcinoma of thyroid. 30.34% developed CSH. CSH was observed in patients with low pre-operative calcium (P=0.008), low 25 OH vitamin D (P=0.001), low post-operative iPTH at 8 hours (P=0.001), low serum calcium at 12 hours after surgery (P=0.001) and lesser number of parathyroid identification at surgery (P=0.001). Patient age (P=0.2) and nodule size (P - 0.17) was not significant. Hypocalcemia risk score of > 3 had 91% sensitivity, 84% specificity with a PPV of 71% and NPV of 95%, whereas score of ≥ 4 had 100% specificity and PPV in predicting CSH.

CONCLUSIONS

CSH after TT is multi-factorial, and a combination of factors (Hypocalcemia prediction score > 3) can be used to predict it so as to discharge patients within 24 hours after surgery.

Remineralization of artificial enamel lesions by theobromine

OBJECTIVE

This study investigated the remineralization potential of theobromine in comparison to a standard NaF dentifrice.

METHODS

Three tooth blocks were produced from each of 30 teeth. Caries-like lesion was created on each block using acidified gel. A smaller block was cut from each block for baseline scanning electron microscopy imaging and electron-dispersive spectroscopy (EDS) analysis for surface Ca level. A tooth slice was cut from each lesion-bearing block for transverse microradiography (TMR) quantification of baseline mineral loss (Δz) and lesion depth (LD). Then baseline surface microhardness (SMH) of each lesion was measured. The three blocks from each tooth were assigned to three remineralizing agents: (1) artificial saliva; (2) artificial saliva with theobromine (0.0011 mol/l), and (3) NaF toothpaste slurry (0.0789 mol/l F). Remineralization was conducted using a pH cycling model with storage in artificial saliva. After a 28-day cycle, samples were analyzed using EDS, TMR, and SMH. Intragroup comparison of pre- and posttest data was performed using t tests (p < 0.05). Intergroup comparisons were performed by post hoc multistep comparisons (Tukey).

RESULTS

SMH indicated significant (p < 0.01) remineralization only with theobromine (38 ± 32%) and toothpaste (29 ± 16%). With TMR (Δz/lD), theobromine and toothpaste exhibited significantly (p < 0.01) higher mineral gain relative to artificial saliva. With SMH and TMR, remineralization produced by theobromine and toothpaste was not significantly different. With EDS, calcium deposition was significant in all groups, but not significantly different among the groups (theobromine 13 ± 8%, toothpaste 10 ± 5%, and artificial saliva 6 ± 8%).

CONCLUSION

The present study demonstrated that theobromine in an apatite-forming medium can enhance the remineralization potential of the medium.

Outcomes and follow-up after obstetric anal sphincter injuries

INTRODUCTION AND HYPOTHESIS

To determine if the classification of obstetric anal sphincter injuries (OASIs) affected clinical and functional outcome and to assess the need for follow-up of 3a tears in secondary care

METHODS

Prospective data collection in 255 patients who sustained OASIs during repair with follow-up in a specialist clinic after 6 months.

RESULTS

One hundred and thirty-two patients (51.7 %) sustained 3a tears, 81 (31.7 %) 3b tears, 27 (10.6 %) 3c tears and 15 (5.8 %) had 4th degree tears. Twenty-three patients (9 %) reported symptoms at 6-month follow-up. Eight patients reported anal incontinence of liquid or solid stool. Among patients who sustained 3a tears, 8 patients were symptomatic: 7 had urgency and 1 had flatus incontinence. None of the patients who sustained 3a tears reported incontinence of solid/liquid stool. There appears to be no correlation with scan findings and symptoms at follow up. Most patients are asymptomatic. Urgency of faeces is the commonest symptom.

CONCLUSIONS

The vast majority of patients are asymptomatic. The necessity of seeing all these patients in secondary care for follow-up needs to be questioned. With effective primary care follow-up, there may be a place to follow up patients with 3a tears in the community during the routine 6-week postnatal check and refer the symptomatic patients to the hospital for further review.

Experimental evaluation of the nitrite sensitivity coefficient in granular anammox biomass

Nitrite is widely reported to inhibit anammox activity and growth. One modeling approach for nitrite impairment of anammox growth is the use of a nitrite sensitivity coefficient which increases the endogenous decay coefficient of anammox bacteria proportionally to nitrite concentration. The objective of this study was to measure nitrite concentration profiles within active anammox granules incubated at fixed bulk nitrite concentrations and to compare these with nitrite concentration profiles predicted by a biofilm model that incorporates the nitrite sensitivity coefficient. We developed an apparatus for the repeated measurement of nitrite concentration profiles along the radius of granular anammox biomass over a period of 6 days at fixed bulk nitrite concentrations. Granular anammox biomass was obtained from a two-stage bench-scale partial nitritation/anammox reactor system. There was no apparent effect of nitrite concentration on nitrite utilization kinetics after 6 days at exposures up to 90 mg NO(2)(-)-N/L. These findings suggest that anammox bacteria tolerate extended exposures to elevated nitrite concentrations, and in its present form, the nitrite sensitivity coefficient is not applicable for anammox growth modeling.

Implementation of CFD modeling in the performance assessment and optimization of secondary clarifiers: the PVSC case study

The water industry and especially the wastewater treatment sector has come under steadily increasing pressure to optimize their existing and new facilities to meet their discharge limits and reduce overall cost. Gravity separation of solids, producing clarified overflow and thickened solids underflow has long been one of the principal separation processes used in treating secondary effluent. Final settling tanks (FSTs) are a central link in the treatment process and often times act as the limiting step to the maximum solids handling capacity when high throughput requirements need to be met. The Passaic Valley Sewerage Commission (PVSC) is interested in using a computational fluid dynamics (CFD) modeling approach to explore any further FST retrofit alternatives to sustain significantly higher plant influent flows, especially under wet weather conditions. In detail there is an interest in modifying and/or upgrading/optimizing the existing FSTs to handle flows in the range of 280-720 million gallons per day (MGD) (12.25-31.55 m(3)/s) in compliance with the plant's effluent discharge limits for total suspended solids (TSS). The CFD model development for this specific plant will be discussed, 2D and 3D simulation results will be presented and initial results of a sensitivity study between two FST effluent weir structure designs will be reviewed at a flow of 550 MGD (∼24 m(3)/s) and 1,800 mg/L MLSS (mixed liquor suspended solids). The latter will provide useful information in determining whether the existing retrofit of one of the FSTs would enable compliance under wet weather conditions and warrants further consideration for implementing it in the remaining FSTs.

Vitamin d deficiency and insulin resistance in normal and type 2 diabetes subjects

Vitamin D is recognized to serve a wide range of biological functions. The presence of vitamin D receptors on different tissues explains it's diversity of actions. Reduced levels of vitamin D is associated with insulin resistance and increased diabetes risk. The study included 50 normal healthy individuals and 49 type 2 diabetes subjects. Fasting blood glucose, total cholesterol, triglycerides, HDLc, fasting insulin, parathyroid hormone, calcium, albumin and Homeostasis model for assessment of insulin resistance (HOMAIR) were measured in all the study participants. Type 2 diabetes subjects were divided into group 1 with 25 hydroxy vitamin D (25(OH)D) ≤20 ng/ml and group 2 with 25(OH)D >20 ng/ml. By the results of this study, the mean 25(OH)D level was low (20.09 ng/ml) in type 2 diabetes compared to controls (23.89 ng/ml) and the p value was 0.02. The estimated insulin resistance by HOMAIR was more in group 1 than in group 2 of diabetes with p value of 0.037. The Pearson's correlation-coefficient was negative for 25(OH)D and insulin in type 2 diabetes (r = -0.294), 25(OH)D was negatively correlated with HOMAIR in total subjects. Type 2 diabetes subjects had reduced levels of vitamin D than normal individuals. The insulin resistance was more in vitamin D deficiency state. Hence vitamin D has a role in glucose metabolism, deficiency can result in insulin resistance and diabetes.

Seckel syndrome: a report of a case

Seckel syndrome, first defined by Seckel in 1960, is a rare (incidence 1:10,000), genetically heterogeneous autosomal recessive disorder presenting at birth. This syndrome is characterized by a proportionate dwarfism of prenatal onset, a severe microcephaly with a "bird-headed" like appearance (beaked nose, receding forehead, prominent eyes, and micrognathia), and mental retardation. The significance of dental alterations in this syndrome resides in the defect, hypoplastic enamel, being limited to the primary dentition; in most instances the second primary molar tooth is not affected. A case of the Seckel syndrome is presented.

In situ remineralization of early caries by a new high-fluoride dentifrice

The present study evaluated the ability of a high-fluoride dentifrice containing tricalcium phosphate to remineralize white spot lesions and inhibit lesion formation. Three demineralized enamel blocks and three healthy blocks (cut from a group of 30 molars), were exposed in pairs (one demineralized, one sound) via an appliance worn by 30 adults in a three-phase crossover study lasting 28 days per phase. The pairs were exposed to three dentifrices: one contained 5,000 ppm fluoride with tricalcium phosphate, one contained 5,000 ppm fluoride alone, and one contained no fluoride at all. Lesion status was analyzed using surface microhardness and transverse microradiography. Surface microhardness showed that the two dentifrices containing fluoride significantly inhibited enamel demineralization (p < 0.05) and significantly remineralized white spot lesions (p < 0.05), while the fluoride-free dentifrice did not. The results indicate that combining fluoride with tricalcium phosphate could provide more anti-caries benefits compared to using fluoride alone.

SU-E-T-516: Dosimetric Validation of AcurosXB Algorithm in Comparison with AAA & CCC Algorithms for VMAT Technique

PURPOSE

To dosimetrically validate AcurosXB algorithm for Volumetric Modulated Arc Therapy (VMAT) in comparison with standard clinical Anisotropic Analytic Algorithm(AAA) and Collapsed Cone Convolution(CCC) dose calculation algorithms.

METHODS

AcurosXB dose calculation algorithm is available with Varian Eclipse treatment planning system (V10). It uses grid-based Boltzmann equation solver to predict dose precisely in lesser time. This study was made to realize algorithms ability to predict dose accurately as its delivery for which five clinical cases each of Brain, Head&Neck, Thoracic, Pelvic and SBRT were taken. Verification plans were created on multicube phantom with iMatrixx-2D detector array and then dose prediction was done with AcurosXB, AAA & CCC (COMPASS System) algorithm and the same were delivered onto CLINAC-iX treatment machine. Delivered dose was captured in iMatrixx plane for all 25 plans. Measured dose was taken as reference to quantify the agreement between AcurosXB calculation algorithm against previously validated AAA and CCC algorithm. Gamma evaluation was performed with clinical criteria distance-to-agreement 3&2mm and dose difference 3&2% in omnipro-I'MRT software. Plans were evaluated in terms of correlation coefficient, quantitative area gamma and average gamma.

RESULTS

Study shows good agreement between mean correlation 0.9979±0.0012, 0.9984±0.0009 & 0.9979±0.0011 for AAA, CCC & Acuros respectively. Mean area gamma for criteria 3mm/3% was found to be 98.80±1.04, 98.14±2.31, 98.08±2.01 and 2mm/2% was found to be 93.94±3.83, 87.17±10.54 & 92.36±5.46 for AAA, CCC & Acuros respectively. Mean average gamma for 3mm/3% was 0.26±0.07, 0.42±0.08, 0.28±0.09 and 2mm/2% was found to be 0.39±0.10, 0.64±0.11, 0.42±0.13 for AAA, CCC & Acuros respectively.

CONCLUSIONS

This study demonstrated that the AcurosXB algorithm had a good agreement with the AAA & CCC in terms of dose prediction. In conclusion AcurosXB algorithm provides a valid, accurate and speedy alternative to AAA and CCC algorithms in a busy clinical environment.

Critical modeling parameters identified for 3D CFD modeling of rectangular final settling tanks for New York City wastewater treatment plants

New York City Environmental Protection is in the process of incorporating biological nitrogen removal (BNR) in its wastewater treatment plants (WWTPs) which entails operating the aeration tanks with higher levels of mixed liquor suspended solids (MLSS) than a conventional activated sludge process. The objective of this paper is to discuss two of the important parameters introduced in the 3D CFD model that has been developed by the City College of New York (CCNY) group: (a) the development of the 'discrete particle' measurement technique to carry out the fractionation of the solids in the final settling tank (FST) which has critical implications in the prediction of the effluent quality; and (b) the modification of the floc aggregation (K(A)) and floc break-up (K(B)) coefficients that are found in Parker's flocculation equation (Parker et al. 1970, 1971) used in the CFD model. The dependence of these parameters on the predictions of the CFD model will be illustrated with simulation results on one of the FSTs at the 26th Ward WWTP in Brooklyn, NY.

Development of a flocculation sub-model for a 3-D CFD model based on rectangular settling tanks

To assess performance and evaluate alternatives to improve the efficiency of rectangular Gould II type final settling tanks (FSTs), New York City Department of Environmental Protection and City College of NY developed a 3D computer model depicting the actual structural configuration of the tanks and the current and proposed hydraulic and solids loading rates. Fluent 6.3.26™ was the base platform for the computational fluid dynamics (CFD) model, for which sub-models of the SS settling characteristics, turbulence, flocculation and rheology were incorporated. This was supplemented by field and bench scale experiments to quantify the coefficients integral to the sub-models. The 3D model developed can be used to consider different baffle arrangements, sludge withdrawal mechanisms and loading alternatives to the FSTs. Flocculation in the front half of the rectangular tank especially in the region before and after the inlet baffle is one of the vital parameters that influences the capture efficiency of SS. Flocculation could be further improved by capturing medium and small size particles by creating an additional zone with an in-tank baffle. This was one of the methods that was adopted in optimizing the performance of the tank where the CCNY 3D CFD model was used to locate the in-tank baffle position. This paper describes the development of the flocculation sub-model and the relationship of the flocculation coefficients in the known Parker equation to the initial mixed liquor suspended solids (MLSS) concentration X0. A new modified equation is proposed removing the dependency of the breakup coefficient to the initial value of X0 based on preliminary data using normal and low concentration mixed liquor suspended solids values in flocculation experiments performed.

Remineralization of early caries by a nano-hydroxyapatite dentifrice

OBJECTIVE

The purpose of this randomized, double-blind, crossover, in situ study was to evaluate the efficacy of nano-hydroxyapatite (nHAP) dentifrices on caries remineralization and demineralization inhibition.

METHODS

Three demineralized enamel blocks (A,B,C) and one healthy block (D), cut from each of 30 molars, were exposed respectively to dentifrices of A) 5% nHAP, B) 10% nHAP, C) 1100 ppm fluoride, and D) 10% nHAP via an intra-oral appliance worn by 30 adults in this four-phase study lasting 28 days per phase. Baseline and post-test mineral loss (delta Z) and lesion depth (LD) were quantified using microradiography.

RESULTS

Pair-wise comparison (baseline versus test) demonstrated significant (p < 0.001) reductions in delta Z and LD in A, B, and C. ANOVA showed no significant differences among the three products in percent mineral gain. No demineralization occurred in the sound enamel specimens exposed intra-orally while using 10% nHAP.

CONCLUSION

nHAP dentifrice caused remineralization comparable to a fluoride dentifrice, and inhibited caries development, thus suggesting that an nHAP dentifrice can be an effective alternative to fluoride toothpaste.