A Vacancy-Driven Intermetallic Phase: Rh3Cd5-δ (δ ∼ 0.56)

A nonstoichiometric line phase, Rh₃Cd_5-δ (δ ∼ 0.56), is found in close vicinity to RhCd and structurally characterized by single-crystal X-ray diffraction and energy-dispersive X-ray spectroscopy. The compound crystallizes in the cubic space group Im3m (No. 229) with lattice constant a = 6.3859(9) Å and represents a 2 × 2 × 2 superstructure of RhCd, which accommodates a vacancy concentration of nearly 6% in its crystal structure. The first-principles electronic structure calculation on a hypothetical ordered configuration of Rh₃Cd_5-δ reveals that Rh-Cd heteroatomic interaction plays a major role in the stability of the compound. A combination of the total energy, formation energy, and crystal orbital Hamilton population calculations on hypothetical model configurations establishes that the compound upholds an optimum vacancy concentration in the Cd2a (Cd1) site for the stability of the phase.

Thirty-Six-Month Follow-up of Diaphragm Pacing with Phrenic Nerve Stimulation for Ventilator Dependence in Traumatic Tetraplegia: The Way Forward for Spinal Cord Injury Rehabilitation in a Developing Country

Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator- free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.

Isolated saccular aneurysm of the external jugular vein

Venous aneurysm of the head and neck is a rare clinical entity due to its asymptomatic nature and tendency of clinicians to report only surgical results. Whereas the primary aneurysm of internal jugular vein (IJV) in children is being increasingly recognized, secondary aneurysms of veins of the head and neck in adults, notably the external jugular vein (EJV) aneurysm remains only in anecdotal case reports. We present the case of a 63-year-old previously healthy woman who presented with a gradually progressive right lateral neck swelling over the last 18 months. Following the evaluation, she was diagnosed as a case of isolated spontaneous right-sided EJV aneurysm and was managed by surgical excision of the aneurysm.

Two-sex life table and feeding dynamics of Spilosoma obliqua Walker (Lepidoptera: Arctiidae) on three green gram cultivars

The effect of three green gram cultivars (PDM 54, PUSA BAISAKHI and SAMRAT) on the biology of Spilosoma obliqua Walker (Lepidoptera: Arctiidae) was studied using age-stage, two-sex life table. We also studied food utilization efficiency measures of larvae on green gram cultivars. The nutritional and antinutritional factors of leaves of green gram cultivars were determined. The preadult development time of S. obliqua was shortest on PDM 54 (35.54 days) and longest on SAMRAT (39.29 days). The fecundity was highest on PDM 54 (318.32) and lowest on SAMRAT (250.20). The net reproductive rate (R0) ranged from 37.53 on SAMRAT to 79.58 on PDM 54. The intrinsic rate of increase (r) was higher on PDM 54 (0.1148 day-1) and PUSA BAISAKHI (0.1018 day-1) than SAMRAT (0.0875 day-1). The finite rate of increase (λ) was lowest on SAMRAT (1.0915 day-1). Mean generation time (T) was shortest on PDM 54 (38.12 days) and longest on SAMRAT (41.42 days). Population projection revealed that the population growth was slowest on SAMRAT. The growth rate of sixth instar larvae was highest on PDM 54 and lowest on SAMRAT. The lower level of nutritional factors such as total carbohydrates, proteins, lipids, amino acids and nitrogen content, and a higher level of antinutritional factors such as total phenols, flavonols and tannins influenced higher development time and lower fecundity of S. obliqua on SAMRAT than other cultivars. These findings suggested that SAMRAT is a less suitable cultivar to S. obliqua than other cultivars, and this cultivar can be promoted for cultivation.

Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

PURPOSE

Breast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India.

METHODS

We interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed.

RESULTS

We interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores.

CONCLUSION

QOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Crystal structures of two very similar 2 × 2 × 2 superstructures of γ-brass-related phases in ternary Ir-Cd-Cu system

A binary phase Ir₈Cd₄₁ in the Ir-Cd binary system and novel ternary phases in the Ir-Cd-Cu system have been synthesized from the constituent elements using high-temperature solid-state synthesis. The structure of previously reported Ir₈Cd₄₁ and newly found ternary phases in the Ir-Cd-Cu system have been characterized by single crystal X-ray diffraction and EDS analysis. The structural analysis reveals that Ir₈Cd₄₁ adopts V₈Ga₄₁-type structure and ternary Ir-Cd-Cu phases adopt two 2 × 2 × 2-superstructures of the γ-brass-related phase. The structures of ternary Ir-Cd-Cu phases are associated with structural disorder (vacancies as well as mixed site occupancies). The crystal structures of the ternary phases are viewed using layer description and cluster concept. The 2 × 2 × 2-superstructure of γ-brass-related phases in the Cu-poor region are not isostructural with the phases in the Cu-rich region, and they are consistent with the absence of a continuous phase region between two 2 × 2 × 2-superstructures of γ-brass-related phases. In the Cu-poor region, the structures contain ∼404 atoms per unit cell, whereas in the Cu-rich phases the structures contain ∼411 atoms in their respective unit cells. The crystal structures in the Cu-poor region represent a new type in the 2 × 2 × 2-superstructure of γ-brass-related phases in view of the combination of constituent cluster types, whereas the structures in the Cu-rich region adopt the Rh₇Mg₄₄ structure type.

A checklist for trauma quality improvement meetings: A process improvement study

BACKGROUND

Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI) program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM.

METHODS

This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO) TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop.

RESULTS

There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007) and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4-9.4, p = 0.004) and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001) and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001).

CONCLUSION

This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.

[An independent observatory in Vendée on ST-elevated acute myocardial infarction (the OVISCA Register). A Departmental evaluation of demographic trends, mortality and delays before treatment]

AIM

Mortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée.

PATIENTS AND METHODS

From 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2).

RESULTS

Between the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The "door-to-balloon" time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05).

CONCLUSIONS

In vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.

Strong links promote the emergence of cooperative elites

The maintenance of cooperative behavior is fundamental for the prosperity of human societies. Empirical studies show that high cooperation is frequently associated with the presence of strong social ties, but they are silent on whether a causal mechanism exists, how it operates, and what features of the social environment are conducive to its emergence. Here we show experimentally that strong ties increase cooperation and welfare by enabling the emergence of a close-knit and strongly bound cooperative elite. Crucially, this cooperative elite is more prevalent in social environments characterized by a large payoff difference between weak and strong ties, and no gradation in the process of strengthening a tie. These features allow cooperative individuals to adopt an all or nothing strategy to tie strengthening based on the well-known mechanism of direct reciprocity: participants become very selective by forming strong ties only with other cooperative individuals and severing ties with everyone else. Once formed, these strong ties are persistent and enhance cooperation. A dichotomous society emerges with cooperators prospering in a close-knit, strongly bound elite, and defectors earning low payoffs in a weakly connected periphery. Methodologically, our set-up provides a framework to investigate the role of the strength of ties in an experimental setting.

A 36-year-old Man with Limb Weakness and Dimness of Vision (NMO)

Neuromyelitis Optica (NMO) previously known as Devic disease is inflammatory disorder of central nervous system characterized by severe immune mediated demyelination and axonal damage predominating targeting optic nerves and spinal cord leading to blindness and paralysis. The spectrum of the disease has expanded based on the specificity of the autoimmune response to the aquaporin-4 (AQP-4) water channel expressed on the end feet of astrocytes in the central nervous system. The coordinated immunological attack against aquaporin-4 is mediated by B & T cells, innate cells including neutrophils and eosinophils and complement system as well as pathogenic antibodies.

A 20 Years Young Lady with Recurrent Convulsion since Childhood (Sturge-Weber Syndrome)

Sturge Weber Syndrome (SWS) is a sporadic neurocutanous disease characterized by facial port wine stain, ocular abnormalities and leptomengealangioma. We present here a 20 year old normotensive, non-diabetic lady hailing from Sarishabari, Jamalur District, Bangladesh got admitted in Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh on 15 July 2018 with the complaints of recurrent convulsion since 3 months of her life, weakness of the right side of the body for same duration according to the statement of the patients mother she was reasonably well until 3 months of her age. The precise pathogenesis is unknown. Clinical feature vary from gentle to full blown sickness with facial stain, seizures and glaucoma.

Lessons for all from the early years of the global surgery initiative

Six elements for future success

Precision Oncology With Radiogenomics: Non-invasive Interrogation of Liver Cancer Genomics to Select Drug Therapy and Monitor Patient Response

Background: Significant intratumoral heterogeneity is present in hepatocellular carcinoma (HCC) and single biopsy samples severely underread the genomic profile of the tumor. This confounds drug development in HCC and makes it extremely challenging to stratify and prognosticate patients to select therapy on the basis of genomic biomarkers. Multiregion sampling of surgically resected HCC allows for these intratumoral heterogeneity to be unraveled and this is currently carried out in our prospective PLANET (Precision Medicine in Liver Cancer across an Asia-Pacific Network) program. However, multiregion sampling is not practical in unresectable HCC cases, which comprise 80% of the disease burden. Radiogenomics studies on liver, lung and head-and-neck cancers have established the capability of radiomics analysis in capturing intratumor heterogeneity with the identification of radiomics signatures that are representative of underlying gene expression patterns. Aim: On this basis, our PLANET program has adopted a radiogenomics approach to characterize the intratumoral heterogeneity in HCC. Methods: This approach will leverage on the correlation of distinctive imaging traits in CT scans against the gene expression profiles of surgically resected HCC patients. Our PLANET program and the data-science enterprise Holmusk have embarked on close collaborative efforts to develop an algorithm that characterizes intratumoral heterogeneity based on distinctive traits in the CT scans. Results and conclusion: The development of such an algorithm is potentially ground-breaking as it allows for the noninvasive interrogation of liver cancer genomics and prognostication of HCC patients. This allows the easy screening of patients for therapeutic targets in vivo and will significantly improve the selection of drug therapy and monitoring of therapeutic response in HCC.

Spectrum of connectivity fluctuations including the effect of activity-dependent feedback

The spatiotemporal spectrum of feedback-driven fluctuations of brain connectivity is investigated using nonlinear neural field theory of the corticothalamic system. Weakly nonlinear dynamics of neural feedbacks are expanded in terms of first order perturbations of neural activity relative to a fixed point. Susceptibilities are used to quantify the change in connectivity per unit change in presynaptic or postsynaptic activity caused by nonlinear feedbacks such as facilitation, depression, sensitization, potentiation, and the effects of discrete eigenmode structure are included for a spherical brain geometry. Spectral signatures such as resonances are identified that allow the presence of particular presynaptic and postsynaptic feedback effects to be inferred. These include additional resonances at high frequencies and shifts of existing spectral peaks, mostly visible in the lowest spatial modes of the response.