Ketogenic diet in endocrine disorders: Current perspectives

Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for "diabesity."

Adaptive Radiotherapy for Carcinoma of the Urinary Bladder: Long-term Outcomes With Dose Escalation

AIMS

To report long-term outcomes with dose-escalated, image-guided adaptive radiotherapy (ART) for bladder preservation in muscle-invasive bladder cancer (MIBC).

MATERIALS AND METHODS

All MIBC patients receiving bladder-preserving ART at our institute from 2009 to 2018 were analysed. For ART, three anisotropic planning target volumes (PTV) were concentrically grown around the simulation bladder volume. A library of intensity-modulated radiotherapy plans was created for each patient. A total dose of 64 Gy in 32 fractions to the entire bladder and 55 Gy to pelvic nodes was planned, with 68 Gy to the tumour bed (2 Gy equivalent dose = 68.7 Gy, α/β = 10) as simultaneous integrated boost for solitary tumours. The most appropriate PTV encompassing the bladder ('plan-of-the-day') was chosen daily using on-board megavoltage imaging. Neoadjuvant and concurrent chemotherapy was prescribed for medically fit patients.

RESULTS

Of a total of 106 patients, most had T2 (68%) or T3 (19%) disease. Ninety-two patients (87%) completed 64 Gy to the whole bladder. Sixty-three patients (59%) received 68 Gy as tumour bed boost. Seventy-six per cent received concurrent weekly chemotherapy. At a median follow-up of 26 months, 3-year locoregional control, disease-free survival and overall survival were 74.3, 62.9 and 67.7%, respectively. Eighty-two per cent of patients retained disease-free bladder. Radiation Therapy Oncology Group grade III/IV acute genitourinary and gastrointestinal toxicities were 7.5% and 0%, respectively, and late genitourinary/gastrointestinal toxicities were 6.5% and 3.8%, respectively. Overall survival, disease-free survival, locoregional control and grade III/IV genitourinary/gastrointestinal toxicities did not differ significantly with dose escalation.

CONCLUSION

Plan-of-the-day ART is clinically safe and effective for bladder preservation and can be implemented in routine clinical practice. A high bladder preservation rate is achievable without compromising on survival or toxicities. Dose escalation does not seem to affect outcomes.

Thermal degradation of waste plastics under non-sweeping atmosphere: Part 1: Effect of temperature, product optimization, and degradation mechanism

Continuous generation of plastic waste has prompted substantial research efforts in its utilization as a feedstock for energy generation. Pyrolysis has emerged as one of the best waste management technique for energy extraction from the plastic waste. The objective of this work is to investigate the effect of operating temperature on the liquid product yields in the pyrolysis process by non-isothermal heating. Non-catalytic thermal pyrolysis of waste polyethylene (PE) [high density polyethylene (HDPE)], waste polypropene (PP), waste polystyrene (PS), waste polyethylene terephthalate (PET) and mixed plastic waste (MPW) was carried out in a non-sweeping atmosphere in a semi-batch reactor at four different temperatures 450, 500, 550, and 600 °C. The minimum degradation temperature of the mixed and individual plastics was obtained using a thermogravimetric apparatus (TGA) at a heating rate of 20^°C/min. The TGA results show that all plastics degrade in a single step and the degradation temperatures of PS > PET > PP > HDPE, while mixed plastic degradation indicates two distinct degradation steps. Further, a waste polymer shows a lower degradation temperature than the virgin polymer. The degradation of HDPE is found to produce the maximum oil yield with minimum solid residue. The degradation of PET results in the highest amount of solid and benzoic acid as crystals and gas with no oil. Degradation of mixed plastic causes oil yield in the intermediate range of pyrolysis of individual plastic wastes. Overall, 500 °C is observed to be an optimum temperature for the recovery of low-density pyrolytic oil with the highest liquid yield. The degradation of PE and PP is found to be caused by random chain scission followed by inter and intramolecular hydrogen transfer. The degradation of PS occurs by side elimination or end chain scission followed by β-scission mechanism. The degradation of mix plastics results from random chain scission followed by β-scission mechanism. The effect of temperature on oil and gas recovery as well as recovery time was also assessed.

Bladder Carcinoma Associated with BK Virus in a Renal Allograft Recipient

Bladder carcinoma is a relatively rare carcinoma reported in renal allograft recipients. While many oncogenic viruses have been implicated as causative factors for certain malignancies, questions have been raised about possible role of BK virus in pathogenesis of urothelial cancers. In this report, we have described a patient who developed BK virus nephropathy followed 3 years later by bladder carcinoma. Interestingly, while the tumor tissue demonstrated BK virus, the adjacent normal urothelium was stained negative for BK virus. Considering the viral potential to inhibit tumor suppressors and its differential localization within tumor tissue, it is possible that the virus contributes to tumorigenesis.

Mini-implant-supported twin-block appliance: An innovative modification

Twin block is a commonly used appliance for correction of retrognathic mandible in growing patients. However, it has a drawback of causing lower incisor proclination, which reduces its potential of achieving maximum skeletal effects. Thus, we introduced a novel modification in the present design to facilitate greater anteroposterior effects in skeletal dimension. The aim of the present case reports is to evaluate the efficacy of this modified twin block. Here we present two cases treated with mini-implant-supported twin-block appliance, which successfully controlled the lower incisor position, thereby increasing the envelope for orthopedic correction in class II myofunctional therapy. This modification is useful in growing patients with retruded mandible to achieve maximum skeletal effects.

Pulmonary Calcifications: Is it an Entity in the New World Dialysis Patient?

Metastatic pulmonary calcification (MPC) has been described in the literature to affect up to 60% of dialysis patients. Several case series of MPC were described in 1960s and 1970s. Patients are generally asymptomatic or may present with acute respiratory distress. This entity is associated with up to 60% mortality. We hereby report a case of chronic kidney disease on maintenance hemodialysis who presented with unexplained recurrent dyspnea despite adequate hemodialysis. She was evaluated and found to have a rare presentation of calciphylaxis.

28Si+ ion beams from Penning ion source based implanter systems for near-surface isotopic purification of silicon

Modern computing technology is based on silicon. To date, a cost-effective and easy to implement method to obtain isotopically pure silicon is highly desirable for attaining efficient heat dissipation in microelectronic devices and for hosting spin qubits in quantum computing. We propose that it is possible to use a ²⁸Si⁺ ion beam to obtain an isotopically pure near-surface region in wafer silicon. However, this requires a highly stable, high current, and isotopically pure ²⁸Si ion beam. This work presents and discusses the instrumentation details and experimental parameters involved in generating this required ion beam. Silane is used as the precursor gas and is decomposed in a Penning ion source to generate a ²⁸Si⁺ ion beam. The influence of key ion source parameters such as the gas flow rate, magnetic field strength, and anode voltage is presented. An isotopically pure ²⁸Si⁺ ion beam with 10 ± 0.5 μA current on the target is obtained at the GNS Science 40 kV ion implanter. The beam was observed to be stable for at least 8 h and contains less than 700 ppm of other Si isotopes. This high current and high purity provides opportunities to explore efficient modification of the isotopic distribution in a native Si substrate at ambient temperature. The results highlight opportunities offered by using Penning ion source based low energy ion implanters for the synthesis of isotopically modified Si surface regions-a technique also applicable to other materials such as diamonds and diamond-like carbon.