Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas

AIMS

Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey.

MATERIALS AND METHODS

This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified.

RESULTS

In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors.

CONCLUSION

This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.

The surprising robustness of visual search against concurrent auditory distraction

People often complain about distraction by irrelevant sounds that reportedly hamper performance on concurrent visual tasks demanding the allocation of focused attention toward relevant stimuli, such as processing street signs during driving. To study this everyday issue experimentally, we devised a cross-modal distraction paradigm, inspired by a standard visual-distraction paradigm (additional-singleton paradigm) that is highly sensitive to measure interference on the allocation of attention. In a visual-search pop-out task, participants reported whether a salient target (a tilted bar) was present or absent, while a completely irrelevant, but salient auditory distractor accompanied some trials. To our surprise, the results revealed no notable distraction on visual-search performance (controlled for speed-accuracy tradeoffs). Reliable auditory distraction failed to occur even when the distractor was a (highly salient) auditory oddball or was additionally presented with a temporal advantage of 300 ms. However, when the auditory modality was made relevant globally while maintaining its irrelevance to the visual-search task, we finally observed the expected interference effect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Microglial NF-κB Signaling Deficiency Protects Against Metabolic Disruptions Caused by Volatile Organic Compound via Modulating the Hypothalamic Transcriptome

Prolonged exposure to benzene, a prevalent volatile organic compound (VOC), at concentrations found in smoke, triggers hyperglycemia, and inflammation in mice. Corroborating this with existing epidemiological data, we show a strong correlation between environmental benzene exposure and metabolic impairments in humans. To uncover the underlying mechanisms, we employed a controlled exposure system and continuous glucose monitoring (CGM), revealing rapid blood glucose surges and disturbances in energy homeostasis in mice. These effects were attributed to alterations in the hypothalamic transcriptome, specifically impacting insulin and immune response genes, leading to hypothalamic insulin resistance and neuroinflammation. Moreover, benzene exposure activated microglial transcription characterized by heightened expression of IKKβ/NF-κB-related genes. Remarkably, selective removal of IKKβ in immune cells or adult microglia in mice alleviated benzene-induced hypothalamic gliosis, and protected against hyperglycemia. In summary, our study uncovers a crucial pathophysiological mechanism, establishing a clear link between airborne toxicant exposure and the onset of metabolic diseases.

The Distractor Positivity Component and the Inhibition of Distracting Stimuli

There has been a long-lasting debate about whether salient stimuli, such as uniquely colored objects, have the ability to automatically distract us. To resolve this debate, it has been suggested that salient stimuli do attract attention but that they can be suppressed to prevent distraction. Some research supporting this viewpoint has focused on a newly discovered ERP component called the distractor positivity (PD), which is thought to measure an inhibitory attentional process. This collaborative review summarizes previous research relying on this component with a specific emphasis on how the PD has been used to understand the ability to ignore distracting stimuli. In particular, we outline how the PD component has been used to gain theoretical insights about how search strategy and learning can influence distraction. We also review alternative accounts of the cognitive processes indexed by the PD component. Ultimately, we conclude that the PD component is a useful tool for understanding inhibitory processes related to distraction and may prove to be useful in other areas of study related to cognitive control.

THE ROLE OF GENETICS IN DISEASE DIAGNOSIS AND TREATMENT MITOCHONDRIAL RESPIRATORY CHAIN DYSREGULATION IN GENOMIC MEDICINE

Although mitochondrial DNA respiration circuit abnormalities are among the most common metabolic diseases to manifest in children, identification can be difficult due to their medical variability. Given the multisystem nature of the condition and its diverse and generalized manifestations, making a final diagnosis often takes a long time. Within this summary, they give an in-depth account of the physical signs of adolescent Mitochondrial Respiratory Chain Disorders (MRCDs),analyze the available diagnostics and treatment possibilities, and emphasize current developments in this field of study. During the discovery of fresh biomarkers and the development of next generation sequencing (NGS) technology, extensive research over the years has considerably enhanced the regularity that precise diagnoses are produced. Given the intricate nature of mitochondrial DNA biology and its double genomic investments, Sequencing has made significant progress in identifying the genetic basis of Mitochondrial Respiratory Chain Disorders (MRCDs). Research studies have been created employing a variety of various methods of therapy in an effort to shift the goal on therapy that is mainly curative to possibly having a positive impact on the natural course of the trouble. That's because there is gained a greater awareness of the underlying causes of this category of ailments.

Plan quality score to evaluate the dwell time deviation restricted inverse planning by simulated annealing and graphically optimized treatment plans for template based interstitial brachytherapy

PURPOSE

To evaluate the impact of dwell time deviation constraint (DTDC) on the quality of IPSA-optimized treatment plans in comparison with graphical plans using plan quality scores (PQS).

MATERIAL AND METHODS

Seventy optimized plans (graphical & IPSA with different DTDC values) of ten cervical cancer patients were generated. Various DVH parameters like D₉₀, V₁₀₀, V₁₅₀, V₂₀₀, V₃₀₀ were compared to evaluate the impact of DTDC on target coverage and high dose regions inside target for different plans. Similarly, for the OAR dose, values of D_2cc were compared. Various planning parameters like CI, COIN, DHI, DNR, ODI, EI and gain factor (GF) for different OARs were calculated. Based on these indices a plan quality score (PQS) was formulated and calculated. PQS values were used to see the impact of DTDC on plan quality of IPSA in comparison with dosimetric quality of graphical plan.

RESULTS

We have found that target coverage is similar for IPSA and graphically optimized treatment plans. However, dose homogeneity was improved in IPSA compared to graphical optimization whereas conformality was better in graphically optimized plans. OAR dose was less in IPSA plans. High-dose regions inside the target were also reduced in IPSA comparatively. However, IPSA plans optimized with various values of DTDC did not necessarily reduce high-dose regions beyond 0.6. Plan quality scores (PQS) were 6.31, 6.31, 6.34, and 6.17 for the graphically optimized plan, IPSA with DTDC values of 0.0, 0.4, and 1.0 respectively.

CONCLUSION

We found that IPSA is dosimetrically advantageous over graphical optimization. IPSA with a DTDC value of 0.4 improved overall plan quality. However, DTDC value beyond 0.6 produces dosimetrically sub-optimal plans hence the use of DTDC should be very selective and limited.

Knowledge, Attitude and Practice Regarding Medication use among Pregnant Women Attending Antenatal Clinic: A Cross-sectional Study

Introduction: Medication use during pregnancy is a major concern in India and poor awareness is driven by non scientific information sources. Primary care providers play a role in providing information on risk of teratogenic and folate deficiency birth defects. Aim: To assess Knowledge, Attitude and Practice (KAP) of pregnant women attending antenatal clinic regarding medication use and self-medication during pregnancy. Materials and Methods: This cross-sectional study was conducted on 100 pregnant women attending the antenatal clinic in a tertiary care teaching hospital of Eastern India from August to October 2021. The study looked at sources of drug information, attitudes regarding medication use and practice of medication use and self-medication among pregnant mothers attending antenatal clinic of the hospital. Consenting women were enrolled in the study and the qualitative data gathered from the women were analysed using tools of descriptive statistics. Results: This study included 100 pregnant women with mean age of 22±2.0 years of which 42% were primigravida. Of the participants 80% had atleast high school education. Two third of the mothers 66% cited their family members as source of their drug information and 76% were aware of the risks of selfmedication during pregnancy. Self medication practice was seen in 25% pregnant women mainly with Paracetamol use for pain or over-the-counter drugs to control acid reflux and morning sickness symptoms. All the participants (100%) took their iron and folic acid supplements as advised. Conclusion: The pregnant women attending the hospital showed adequate knowledge and satisfactory practices regarding medication use. Counselling of the mothers attending the clinic regarding drug use and possible harms to the mother and baby can help reduce long-term risks.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Frequency, risk and predictors of type 2 myocardial infarction hospitalizations in young obese patients: A nationwide population-based analysis in the United States

Funding Acknowledgements

Type of funding sources: None.

Background

Obesity in the young population is emerging as a challenging health concern. Though there is a rising prevalence of obesity and its potential association with demand ischemia-related myocardial infarction, data remains non-existent to evaluate the association of obesity or higher body mass index (BMI) with type 2 myocardial infarction (T2MI). We aim to identify the frequency, risk and predictors of T2MI in young hospitalized obese patients compared to non-obese patients in this population-based study.

Methods

We used National Inpatient Sample (2018, ICD-10 codes) to identify T2MI in young (18-44 years) hospitalized patients. Obesity was identified from comorbidities or using diagnostic codes for BMI>30 kg/m2. We performed multivariable regression analysis for the primary outcome of odds of T2MI in young obese patients compared to non-obese patients. The frequency of T2MI was compared between obese vs non-obese patients in overall and subgroup populations. Sociodemographic characteristics and comorbidities in T2MI-obese vs. T2MI-non-obese cohorts were also compared. A p<0.05 was considered a threshold for statistical significance.

Results

Out of 1,268,255 young hospitalized patients with obesity, 555 had T2MI. T2MI was significantly higher in young obese than non-obese (44 T2MI/100000 hospitalizations in young obese patients vs. 17 T2MI/100000 hospitalizations in young non-obese patients, overall 0.04% in obese vs. 0.02% in non-obese, p<0.001). Multivariate analysis revealed higher odds of T2MI in obese than nonobese when adjusted for demographics (aOR 2.65, 95% CI:2.42-2.90, p<0.001) and social demographics with comorbidities (aOR 1.60, 95% CI:1.24-2.07, p<0.001). In young obese, higher risk was found with advancing age (OR 1.07, 95% CI 1.03-1.11, p=0.001), in males than females (aOR 2.70, p<0.001), and blacks (aOR 2.22, p=0.011) and Native Americans (OR 3.91, 95% CI: 1.13-13.49, p=0.011) vs whites. Comorbidities including chronic obstructive pulmonary disease (OR 1.86), chronic kidney disease (CKD, OR 2.36), rheumatoid arthritis/collagen vascular disease (RA/CVD, OR 3.04) Iin young obese patients independently increased the risk of T2MI hospitalizations [Table 1]. The T2MI-obese cohort had a significantly higher rate of hyperlipidemia, hypertension, diabetes, COPD, and prior history of MI and TIA/stroke compared to the T2MI-nonobese cohort [Table 2].

Conclusion

This nationwide analysis revealed a significantly higher risk of T2MI in young obese patients compared to nonobese after excluding patients with concomitant diagnoses of T1MI. Males, blacks compared to females and whites, and comorbidities including COPD, CKD and RA/CVD predicted a higher risk of T2MI in young obese patients. Future studies are warranted to evaluate the role of higher body mass index in myocardial oxygen demand-supply mismatch and short-term/long-term risk and outcomes of T2MI.

Nationwide frequency, risk and outcomes of type-2 myocardial infarction in patients with versus without previously revascularized myocardial infarction (type 1)

Funding Acknowledgements

Type of funding sources: None.

Background

Type 2 myocardial infarction (T2MI), due to a mismatch between myocardial oxygen demand and supply, is being increasingly recognized with improved diagnostics. The upsetting concern of developing T2MI in patients with prior revascularized occlusive acute myocardial infarction (AMI) or type 1 MI (T1MI) makes it crucial to define the clinical profile and outcomes of T2MI in revascularized patients of ACS.

Purpose

To determine the risk and prognosis of T2MI in patients who had previously had coronary revascularization (PCI or CABG)

Methods

We used the National Inpatient Sample (2018) dataset from the United States to identify T2MI adult hospitalizations using ICD-10 codes and define our study arm as T2MI excluding secondary T1MI diagnoses but having prior revascularized (with percutaneous coronary intervention or coronary artery bypass grafting) AMI. We then compared demographics and comorbidities in T2MI cohort with vs without personal history of revascularized AMI. We used multivariate analysis to study the odds of T2MI hospitalizations with prior revascularized AMI and in-hospital outcomes (all-cause mortality, cardiogenic shock and resource utilization) adjusting for confounders.

Results

There were 33155 T2MI adult hospitalizations after excluding AMI (median age 71 years, 50.6% male, 67.3% white); 1435 (4.3%) had previously revascularized AMI. T2MI in the study arm had higher chances of hospitalization with prior revascularized AMI when adjusted for socio-demographics (aOR 6.92, 95% CI:6.50-7.36, p<0.001) and socio-demographics with comorbidities (aOR 5.70, 95%CI: 5.48-5.94, p<0.001) (Table 1). Study arm often had elderly (≥65 years old, 78.4% vs 65.8%), male (66.6% vs 49.9%), white (76.7% vs 66.9%), upper socio-economic class (20.2 vs 16.8%), patients who were often admitted to non-electively (99.3 vs 97.1%) and to rural (10.5 vs 9.3%) hospitalizations compared to control arm. The study arm had a significantly higher prevalence of diabetes mellitus, hyperlipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, renal failure, deficiency anemias, prior TIA/stroke, depression and smoking. T2MI cohort with prior revascularized AMI did not show any significant association with in-hospital all-cause mortality (1.7 vs 3.0%, aOR 0.49, 95%CI 0.18-1.34, p=0.164) and cardiogenic shock (1.7% vs 2.1%, p=0.399) however, had lower hospital expenditure (median USD 31273 vs 36567) and fewer transfers to other facilities (19.5 vs 22.1%) than those without prior revascularized AMI (Table 2).

Conclusion

Population-based analysis of this nationally representative sample revealed up to six times higher risk of developing T2MI in patients with prior history of AMI (revascularized) but without any significant impact on all-cause in-hospital mortality or cardiogenic shock. Future studies are warranted to assess the short-term/long-term outcomes of T2MI in high risk patient population with previously revascularized AMI.

Knowledge regarding Snakebite and its Management among Second Year Nursing Students

Introduction: Snakebite is considered as Neglected Tropical Disease (NTD) by the World Health Organisation (WHO). Nursing personnel are often the first point of contact for snakebite patients and it is imperative that their knowledge about first aid and management is sound and based on standard treatment guidelines. Aim: To assess the knowledge regarding snakebite and its treatment modalities among second year Nursing students. Materials and Methods: This cross-sectional study was conducted among 192 students of 2nd Year, Bachelor of Science (BSc). Nursing, from Nil Ratan Sircar Medical College and Hospital (NRSMC) and ID and BG Hospital, Kolkata, West Bengal, India. A set of 10 pretested and validated questions was given to them to be filled anonymously answering only one option for each question. Each of the responses were calculated as one for ‘Yes’ option and zero for ‘No’ or ‘Uncertain’responses. The overall knowledge was considered inadequate, if the score was less than 70% (A score of seven and less). Descriptive statistics were used to analyse the data. Results: About 184 (95.84%) students were aware that not all snakes in India are poisonous. However, only 29 (15.10%) were aware of the fact that tourniquet is not a requirement for transport of snakebite patients to referral centers. Among this study population, 121 (63.02%) correctly said that 20 minutes Whole Blood Clotting Time should be performed and 160 (83.33%) correctly said that Adrenaline should be part of the emergency tray during management. Overall, only 89 (46.35%) of the students scored 70% or more and the rest had inadequate knowledge regarding first aid and management of snakebites. Conclusion: The study showed that the knowledge regarding first aid and management of snakebites among second year BSc Nursing students was inadequate. The study participants were not aware of the standard treatment guidelines of snakebite management and there was a need to adequately sensitise them regarding the same during their course of study.

100 Assessing the Admission Proforma: A Multi-Cycle Audit Evaluating the Quality of Documentation of The Burnsadmission Proforma At the Regional Mersey Burn Unit

Introduction

A thoroughly completed Burns Proforma can provide vital information for the effective management of a burn and enables the sharing of information with other members of the multidisciplinary team.

Aim

We aimed to assess the quality of record-keeping of the new Burns Proforma, compared it with the previous cycle, and identified areas of improvement.

Method

Data on 76 fields on version 4.0 of the Mersey Burns Proforma was collected for 92 patients between January and February 2020. The data was compared to cycle 1of the audit collected in July 2019.

Results

Assessing the 61 comparable fields between audit cycles, 58 fields (95%) improved while 3 (5%) deteriorated. 21 fields achieved a completion rate greater than 80%. Vital information such as history, comorbidities, and drug history achieved 100% completion, up from 94%, 94%, and 95%, respectively. Total body surface area (TBSA) increased to 93% from 83%, the use of the Lund & Browder chart remained the same, treatment plan documentation increased to 95% from 91%, documentation of admission increased from 24% to 51%, consultant confirmation of TBSA increased to 10% from 5%, but this requires further improvement. Comments stated the proforma was clearer and provided a flowchart layout which made documentation easier.

Conclusions

The Burns Admission Proforma has made significant improvements. Working with the nursing staff and consultant body, we aim to improve our completion rates of vital information further. It sets a high standard for data collection and presents itself as a useful tool for other Burns Units across the United Kingdom.

282 Cholecystoappendicular Fistula- 1st Ever Reported Case

A 30-year-old male presented with a history of recurrent episodes of acute cholecystitis; first acute attack associated with fever and nausea was 18 months prior to this presentation, for which he was managed conservatively for acute cholecystitis with antibiotics and analgesia following an ultrasound that showed features of acute cholecystitis with no obvious gallstones.

The patient had further episodes of acute cholecystitis with no signs of obstructive jaundice and subsequent ultrasound showed multiple small gallstones. Due to the severity of his symptoms, he was scheduled for a planned cholecystectomy.

During surgery (right subcostal incision)- findings were that of a contracted gall bladder with dense adhesions, after careful dissection a fistulous tract between the appendix and gallbladder was identified along with a cholecystoduodenal fistula.

An en-bloc cholecystectomy plus appendicectomy was performed with the duodenotomy repaired. On the first day post op there was approximately 300 ml of bilious effluent in drain, a white cell count-8.1 x 109 and hemoglobin -12.1 g/dL, Serum bilirubin-1.4mg/dL, ALP-104mg/dL. The second and third post-operative days were uneventful with minimal bile mixed serous fluid in drain respectively with no other complains, following which the drains were removed and patient discharged home.

Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is a cholecystoduodenal (70%), followed by cholecystocolic (10–20%), and the least common is the cholecystogastric fistula accounting for the remainder of cases.

No case of cholecystoappendicular fistula has been reported so far.

Effect of heat stress amelioration through open-ridge ventilated thatched roof housing on production and reproduction performance of crossbred Jersey cows

The present study was conducted to assess the impacts of loose house roofing designs and materials on modulation of micro-climate of the cow shed and its influences on production and reproduction performance of lactating crossbred Jersey cows. The control group (T0) was kept in a traditional single-slope asbestos roof shed and treatment group (T1) at a specially designed open-ridge ventilated, double-slope thatch roof shed. Lactation stage, average daily milk yield, and average parity at the beginning of the experiment were kept similar between T0 and T1 cows. The specifically designed T1 shed had significantly (P < 0.05) lower temperature, humidity, and thermal humidity index as compared to the traditional shed (T0). The T1 shed was cooler and more comfortable than T0. Housing significantly (P < 0.05) influenced cardinal physiological parameters of resident cows. Body temperature, pulse rate, respiration rate, and discomfort index were significantly (P < 0.05) higher in T0 as compared to those in T1 cows. Improved housing significantly (P < 0.01) influenced milk yield, composition, quality, and udder health of cows. Daily milk yield depending on parity, monthly milk yield, milk fat, SNF, and protein were significantly (P < 0.01) higher in T1 than those in T0 cows. The milk somatic cell count, modified California mastitis test score, electrical conductivity, and pH of milk samples of T0 cows were significantly (P < 0.0) higher than those of T1. Effect of housing type, parity, and interaction of housing × parity did not cause any significant (P > 0.05) differences in reproductive traits such as service period, break period, calving interval, pregnancy rate, and other cow fertility parameters. Post-partum body condition score and body weight loss did not differ significantly (P > 0.05) between the two groups; however, more loss occurred in T0 than T1. The estimated net profit from housing of cows (N = 20) in a comfortable shed was 2200 kg milk per annum, i.e., 110 kg/cow/annum. The study concluded that a central open-ridge ventilated, double-slope thatched roof design created a favorable micro-environment and it significantly affected cows' comfort index; thermo-comfortable housing significantly reduced the heat stress-oriented drop in milk yield and decline in milk composition, and improved udder health and other milk production traits; however, its impact was non-significant on reproduction and fertility traits in Jersey crossbred cows.

Myths, facts and scope of spinal cord tolerance dose revision in Intensity modulated SIB treatment of locally advanced head and neck cancer: A dosimetrical and radiobiological demonstration

PURPOSE

To explore the possibility of revising the spinal cord tolerance dose in Simultaneously Integrated Boost (SIB) intensity modulated treatment plan of locally advanced head and neck (H&N) cancer and assessment of achieved planning gain due to the revision. In SIB regimen, the Organ at Risk (OARs) tolerance dose is equally distributed throughout the treatment. Clinicians have usually considered the spinal cord tolerance to be the same as in conventional technique. However, in SIB fractionation regimen with intensity modulation treatment, the spinal cord may receive a physical dose of 45Gy, with much lesser dose per fraction than 2Gy per fraction. So when the dose of spinal cord is distributed throughout the treatment, the tolerance dose limit of physical dose can be considered higher than the usual conventional dose limits. In this study, an attempt has been made to explore the possibilities of dose escalation and treatment planning benefits while exploiting this "Window of Opportunity (WoO)" of increase in spinal cord and Planning Risk Volume (PRV) spinal cord tolerance dose.

MATERIAL AND METHODS

A total of 12 patients CT data set along with approved structure set of H&N cancer used for treatment planning in. Three independent SIB VMAT plans named as SPC, SPR and SPDE were generated for the 12 patients. First plan (SPC) was generated by considering standard spinal cord tissue constraint of maximum dose of 45Gy and PRV spinal cord maximum dose 50Gy as per QUANTEC summary and second plan (SPR) was generated considering spinal cord tissue constraint of maximum dose 52.50Gy and PRV spinal cord maximum dose 56.35Gy while optimization and dose calculation. The objectives for rest of the Organ at Risk (OAR) were kept same in both the plans during optimization and dose calculation. The SPC plan was copied for creation of third plan (SPDE) in which dose was escalated by increasing dose per fraction for target volumes such that dose to spinal cord reached a maximum dose of 52.50Gy and PRV spinal cord maximum dose of 56.35Gy. In this plan there have been changes to only dose per fraction, however dose optimization and dose calculation have not been performed. Radiobiological parameters TCP and NTCP were also calculated by using indigenously developed software.

RESULTS

Considering the increase of spinal cord tolerance dose as "window of opportunity", a sufficient escalation in physical dose, Biological Effective Dose (BED) and Tumor Control Probability (TCP) was observed for all target volumes with acceptable level of NTCP values.

CONCLUSION

Sufficient dose escalation and increased in TCP for target volumes or effective planning benefits can be achieved by revising the spinal cord tolerance dose in intensity modulated SIB treatment of locally advanced H&N cancers.

Readily usable strategies to control mastitis for production augmentation in dairy cattle: A review

Mastitis in dairy cattle is the most common management disorder that causes higher economic losses by lowering production and quality of milk leads to substantial economical loss. The aim of this article was to review worldwide important advances in strategies to control mastitis for production augmentation in dairy cattle. Many scientists worked to identify effective strategies to control mastitis caused by Streptococcus agalactiae, Staphylococcus aureus, and others. It is necessary to identify mechanisms of infection, define clinical and subclinical states of disease, determine exposure time, and identify pathogen-specific characteristics. Evolvement of management strategies that incorporated hygienic procedures (animal, floor, and milkman), post milking standing period of animal and strategic use of antibiotic or herbal therapy at dry-off, nutritional supplementation, fly control, body condition score optimization, etc., resulted in widespread control of mastitis. The udder, teat of animal, scientific management of milking, automatic milking procedure, genetic selection are considered as important factors to control mastitis. As farm management changed, scientists were directed to redefine control of mastitis caused by opportunistic pathogens of environmental sources and have sought to explore management strategies which will maintain animal well-being in a judicial way. Although significant advances in mastitis management have been made changing herd structure, changing climatic scenario and more rigorous milk processing standards ensure that mastitis will remain important issue for future research.

Effect of reducing energy intake during the dry period on milk production, udder health, and body condition score of Jersey crossbred cows in the tropical lower Gangetic region

To find out the effect of reducing energy intake during dry period on milk production, udder health, and body condition, the experiment was conducted on 14 Jersey crossbred cows during whole dry period and continued up to 120 days of lactation. Reduction in energy intake was done during far-off period for each dry cow of treatment group as compared to control group. Statistically analyzed data revealed that overall significantly (P < 0.01) lower DMI and WI were recorded in control than treatment group. Overall significantly (P < 0.01) higher total milk production was found in treatment than control group. Overall significantly (P < 0.01) lower milk SCC, MCMT, pH, and EC were found in treatment than control group. Nonsignificant difference in milk fat, SNF, total solid, total protein, and fat:protein ratio was found. Overall significantly (P < 0.01) better quality milk (MBRT) was found in treatment than control groups. BCS during dry period and at calving was significantly (P < 0.01) different between groups. Significantly (P < 0.01) higher plasma NEFA concentration was estimated in control than treatment groups in all stages. No significant difference was found for plasma concentrations of glucose, urea, and total protein. The coefficients of correlation indicated significant (P < 0.01) correlation among BCS, milk production, milk SCC, MCMT, pH, and EC. It can be concluded that reducing energy intake during far-off dry period can lead to achieve optimum BCS at calving. Suitable BCS at calving was beneficial to get higher milk production with improved quality, better maintenance of udder health and body condition of Jersey crossbred cows at tropical lower Gangetic region.

Study of 14N(ρ,γ)15O resonance reaction at Eplab= 278 keV

An implanted target (14N on Ta) is prepared and characterized via surface and bulk characterization processes. The depth profile of the implanted ions is obtained experimentally by populating a narrow resonance state of 15O through 14N(ρ,γ) reaction induced with a laboratory proton energy of 278 keV. The experimental profile is then compared with devoted simulations to under- stand the locations of the implantated ions in the lattice structure. Later, the lifetimes of a few excited states of 15O, relevant for applications in astrophys- ical scenario, have been determined using Doppler Shift Attenuation Method(DSAM).

Pregabalin and Amitriptyline as Monotherapy or as Low-Dose Combination in Patients of Neuropathic Pain: A Randomized, Controlled Trial to Evaluate Efficacy and Safety in an Eastern India Teaching Hospital

Objectives:

The main objective is to compare efficacy and safety of pregabalin and amitriptyline monotherapy with their low-dose combination in patients of neuropathic pain (NeuP).

Methodology:

In this parallel-group, open-label interventional study at the Neurology Outpatient Department of Bankura Sammilani Medical College, a total of 147 patients were randomly allocated into three groups and were prescribed the following drugs – Group P (n = 42) pregabalin 150 mg once daily, Group A (n = 34), amitriptyline 25 mg once daily, and Group Z (n = 37) = pregabalin (75 mg) + amitriptyline (10 mg) as combination once daily. They were followed up after 4, 8, and 12 weeks. Efficacy was assessed by NeuP symptom inventory score (NPSI) and safety was assessed by treatment-emergent adverse events.

Results:

Final assessment was done on 92 patients (P = 31, A = 31, Z = 30). Males were predominant (71.7%). NPSI score significantly decreased in every group from baseline (P < 0.0001). There was no difference of NPSI score between groups at any level of follow-up. Percentage of adverse drug reactions were maximum (44.9%) in amitriptyline monotherapy group and lowest in combined group. However, amitriptyline monotherapy was the cheapest treatment option among these three.

Conclusion:

Combining pregabalin and amitriptyline at low doses proved to be equally effective but more tolerable compared to individual higher dosage monotherapy. However, if tolerability is good, amitriptyline monotherapy can be an attractive choice in economically challenged group of patients.

Thermophilic ligno-cellulolytic fungi: The future of efficient and rapid bio-waste management

To accelerate the process of decomposition using consortia of thermophilic ligno-cellulolytic fungi, different crop residues viz. sorghum (SG), soybean (SS), maize (MS), sugarcane (SC), cotton (CS) and pigeon pea (PS) with a varied C:N ratio and sawdust (SD) having high lignin content were collected and used for decomposition process. Compost quality assessed by evaluating different maturity and stability indices at five succeeding stages [first mesophilic (M1), thermophilic (T), second mesophilic (M2), cooling (C) and humification (H)]. A significant reduction was observed in the C:N ratio, biodegradability index, nitrification index, ratio of water-soluble carbon to organic nitrogen (WSC/Org.N) with an increase in concomitant over time while Ash (%), organic matter loss (%), CEC/TOC ratio, cellulose biodegradation ratio (BR) and lignin/cellulose ratio were significantly increased with time. By correlation study, biodegradability index (BI) and fluorescein diacetate (FDA) hydrolysis emerged as the most suitable compost maturity and stability parameters, respectively. Principal component analysis (PCA) results confirmed that BI, BR, WSC/Org. N and FDA can be regarded as key indicators for assessing compost quality. Our findings conclude that fungal consortia of Tricoderma viride, Rhizomucor pusillus, Aspergillus awamori and Aspergillus flavus can accelerate decomposition time from 8 to 12 months (which is normal farming practice) to 120 days.

New insights from nuclear and mitochondrial markers on the genetic diversity and structure of the Indian white shrimp Fenneropenaeus indicus among the marginal seas in the Indian Ocean

Genetic variation in wild stocks of a major commercial shrimp, Fenneropenaeus indicus, from the marginal seas in the Indian Ocean was analysed using polymorphic microsatellite loci and mitochondrial COI gene. The average observed heterozygosity (Ho = 0.44 ± 0.02) and the expected heterozygosity (He = 0.73 ± 0.01) were high across loci and populations indicating high microsatellite variation. Pairwise F_ST and Bayesian clustering indicated the occurrence of four genetically distinct stocks out of the eight sampled populations with implications for specific management approaches. Mantel test for isolation by distance proved that genetic differentiation is not related to geographic distance between populations. Mitochondrial COI sequence analysis showed concordant differentiation pattern as well indicated the relevance of COI in population genetics of shrimps. Pairwise ɸST and phylogenetic and Bayesian analyses revealed four distinct clades, as observed with nuclear markers. Divergence time analysis revealed the origin and initial divergence of F. indicus corresponds to late Miocene and divergence to phylogroups in the Pleistocene. BSP analysis presented a long stable population size with a slight decrease in the late Pleistocene and gradually expanded to the current status. The information here will be useful in commercial shrimp breeding and selection programmes and management of natural stocks of Indian white shrimp.

Monte Carlo Study of Unflattened Photon Beams Shaped by Multileaf Collimator

INTRODUCTION

This study investigates basic dosimetric properties of unflattened 6 MV photon beam shaped by multileaf collimator and compares them with those of flattened beams.

MATERIALS AND METHODS

Monte Carlo simulation model using BEAM code was developed for a 6MV photon beam based on Varian Clinic 600 unique performance linac operated with and without a flattening filter in beam line. Dosimetric features including lateral profiles, central axis depth dose, photon and electron spectra were calculated for flattened and unflattened cases, separately.

RESULTS

An increase in absolute depth dose with a factor of more than 2.4 was observed for unflattened beam which was dependent on depth. PDDs values were found to be lower for unflattened beam for all field sizes. Significant decrease in calculated mlc leakage was observed when the flattening filter was removed from the beam line. The total scatter factor, S_CP was found to show less variation with field sizes for unflattened beam indicating a decrease in head scatter. The beam profiles for unflattened case are found to have lower relative dose value in comparison with flattened beam near the field edge, and it falls off faster with distance.

CONCLUSION

Our study showed that increase in the dose rate and lower peripheral dose could be considered as realistic advantages for unflattened 6MV photon beams.

Breeding for robustness: investigating the genotype-by-environment interaction and micro-environmental sensitivity of Genetically Improved Farmed Tilapia (Oreochromis niloticus)

Robustness has become a highly desirable breeding goal in the globalized agricultural market. Both genotype‐by‐environment interaction (G × E) and micro‐environmental sensitivity are important robustness components of aquaculture production, in which breeding stock is often disseminated to different environments. The objectives of this study were (i) to quantify the degree of G × E by assessing the growth performance of Genetically Improved Farmed Tilapia (GIFT) across three countries (Malaysia, India and China) and (ii) to quantify the genetic heterogeneity of environmental variance for body weight at harvest (BW) in GIFT as a measure of micro‐environmental sensitivity. Selection for BW was carried out for 13 generations in Malaysia. Subsets of 60 full‐sib families from Malaysia were sent to China and India after five and nine generations respectively. First, a multi‐trait animal model was used to analyse the BW in different countries as different traits. The results indicate a strong G × E. Second, a genetically structured environmental variance model, implemented using Bayesian inference, was used to analyse micro‐environmental sensitivity of BW in each country. The analysis revealed the presence of genetic heterogeneity of both BW and its environmental variance in all environments. The presence of genetic variation in residual variance of BW implies that the residual variance can be modified by selection. Incorporating both G × E and micro‐environmental sensitivity information may help in selecting robust genotypes with high performance across environments and resilience to environmental fluctuations.

Fluoxetine enhances maximal electroshock seizure threshold in Albino rat model when compared to phenytoin

Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats.

Study on Airborne Heavy Metals in Industrialized Urban Area of Delhi, India

This study assessed the concentrations of airborne heavy metals (HMs) in particulate matter with a cutoff size of 10 µm (i.e., PM₁₀) in an industrialized urban area (Naraina Industrial Area) of New Delhi, India. The samples were collected from January to December, 2011. The annual mean concentrations of selected HMs were as follows As (0.002 ± 0.002), Cd (0.030 ± 0.020), Co (0.003 ± 0.002), Cr (0.170 ± 0.081), Cu (0.183 ± 0.120), Fe (4.774 ± 1.889), Mn (0.258 ± 0.145), Ni (0.170 ± 0.146), Pb (0.345 ± 0.207) and Zn (1.806 ± 1.042) µg/m³. The seasonal trend for HMs followed the order postmonsoon > winter > premonsoon > monsoon. Principal component analysis-multiple linear regression (PCA-MLR) suggested the three major emission sources: industrial emission (70 %), mobile and stationary combustion sources (16 %), and suspended/re-suspended dust (14 %). Mean seasonal concentrations of PM₁₀ exceeded both the 24-hour and annual Indian National Ambient Air Quality Standards (NAAQS) of 60 and 100 µg/m³, respectively, in all four seasons. Mean seasonal Ni concentrations in Delhi ambient air also exceeded the 24-h annual NAAQS of 0.020 µg/m³ during all four seasons. Mean Pb concentrations exceeded the annual NAAQS of 0.50 µg/m³ only during the post monsoon season. The high levels of Ni- and Pb-contaminated PM₁₀ would appear to present the possibility of significant health risks.

The Analysis of Fatal Accidents in Indian Coal Mines

This paper describes the analysis of fatal incidents of Indian coal mines from April 1989 to March 1998. It is found that Indian mines have considerably higher accident and fatality rates compared to those in USA and South Africa, respectively. While open cast mines are generally known to be safer than underground mines, the Indian open cast mines are shown to be at least as hazardous to the workers as the Indian underground mines. Analysis of the accident rates is made via a few regression models involving the effects of working shifts, the various companies, the types of mine, manshift and production. The accident-prone combinations of mine type and company are identified for follow-up action. The break-up of the accidents by cause is also studied.

AMS (2000) Subject Classification: Primary 62-07; Secondary 62P99, 62N05.

Comparison of Effectiveness and Safety of Add-on Therapy of Saroglitazar and Fenofibrate with Metformin in Indian Patients with Diabetic Dyslipidaemia

INTRODUCTION

Diabetic dyslipidaemia poses a therapeutic challenge. New therapies have emerged in this patient subgroup to enhance outcome and improve compliance.

AIM

The aim of this study was to compare the effectiveness and safety of add on therapy of saroglitazar and fenofibrate with metformin in Indian patients with diabetic dyslipidaemia.

MATERIALS AND METHODS

Adults patients with diabetic dyslipidaemia fulfilling the inclusion criteria were randomized in two groups. Group A patients received metformin (1000 mg/ day) and fenofibrate (160 mg/day) while group B patients received metformin (1000 mg/day) and saroglitazar (4 mg/day). Glycosylated haemoglobin (HbA1C), triglyceride (TG), LDL- cholesterol (LDL-C), HDL-cholesterol (HDL-C) levels were measured at baseline and week 12 visits. Fasting plasma glucose (FPG) and post prandial plasma glucose (PPPG) were measured at baseline and on week 4, 8 and 12 visits.

RESULTS

TG and HbA1C levels decreased significantly at week 12 from their respective baseline values (p< 0.05) in both groups. FPG and PPPG levels significantly decreased at weeks 4, 8 and 12 compared to their pretreatment values (p< 0.05) in both groups. TG and HbA1C levels in group B decreased significantly compared to group A at week 12. FPG and PPPG levels in group B also decreased significantly compared to group A at every interval. Inter group analysis did not show any statistically significant change in body weight, LDL-C and HDL-C at week 12.

CONCLUSION

Add on therapy of saroglitazar with metformin significantly decreased TG, HbA1C, FPG and PPPG levels compared to add on therapy of fenofibrate with metformin in Indian patients with diabetic dyslipidaemia.

B CHROMOSOMES IN ANGIOSPERM--A REVIEW

A review article on B chromosomes (Bs) in angiosperms is documented considering occurrence, morphology, polymorphic B forms, divisional phase heterogeneity, chromatin organization and gene content, sequence composition, origin, evolutionary aspects and significant role on host with an objective to foresee the evolutionary perspectives as it still remains an enigma. Irrespective of the origin of Bs, it seems that they have attained the following modifications, namely, insertion of centromeric and telomeric sequences, structural reorganization and procuring mitotic and meiotic drives but shows genetic inertness and present in the host as selfish DNA. In the context, few questions are raised. Further, scientific quest may unravel the unexplored information about Bs to ascertain its evolutionary perspectives, if any.