Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community

AIMS

Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK.

MATERIALS AND METHODS

All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported.

RESULTS

Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01).

CONCLUSION

Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.

Suicide by a construction nail fired from a pistol

Penetrating head injury to accomplish suicide by a non-ammunition-related projectile discharged from a nail-gun is a very rare entity. The authors describe even much rarer, and the first reported case of a suicide penetrating head injury by a construction nail discharged from a blank cartridge of a pistol. The absence of beveling and muzzle impression, the non-ejection of the discharged cartridge, and the exit of just the tip of the nail from the other side of wound were the atypical features in this firearm fatality sustained at a contact-range. The entry wound prototypes like abrasion and grease collar, and blackening were absent. An improvisation to insert a construction nail into the chamber of firearm, for utilization as a projectile was another unique highlight here. The deceased was a construction builder. Being debt-ridden, he probably could not manage to purchase even one live cartridge for his licensee pistol to bring suicidal ideation to culmination.

STING dependent BAX-IRF3 signaling results in apoptosis during late-stage Coxiella burnetii infection

STING (STimulator of Interferon Genes) is a cytosolic sensor for cyclic dinucleotides (CDNs) and initiates an innate immune response upon binding to CDNs. Coxiella burnetii is a Gram-negative obligate intracellular bacterium and the causative agent of the zoonotic disease Q fever. The ability of C. burnetii to inhibit host cell death is a critical factor in disease development. Previous studies have shown that C. burnetii inhibits host cell apoptosis at early stages of infection. However, during the late-stages of infection, there is host cell lysis resulting in the release of bacteria to infect bystander cells. Thus, we investigated the role of STING during late-stages of C. burnetii infection and examined STING's impact on host cell death. We show that the loss of STING results in higher bacterial loads and abrogates IFNβ and IL6 induction at 12 days post-infection. The absence of STING during C. burnetii infection significantly reduces apoptosis through decreased caspase-8 and -3 activation. During infection, STING activates IRF3 which interacts with BAX. BAX then translocates to the mitochondria, which is followed by mitochondrial membrane depolarization. This results in increased cytosolic mtDNA in a STING-dependent manner. The presence of increased cytosolic mtDNA results in greater cytosolic 2'-3' cGAMP, creating a positive feedback loop and leading to further increases in STING activation and its downstream signaling. Taken together, we show that STING signaling is critical for BAX-IRF3-mediated mitochondria-induced apoptosis during late-stage C. burnetii infection.

Infant death resulting from sharing a cot with a 10-year-old boy

An infant may die from unintentional suffocation if their exhausted, or inebriated or sedated mothers fall asleep while breast feeding or just sharing a bed and roll over on to them. The mother wakes up to find the baby dead in the morning. Diagnosis is complex due to minuscule autopsy findings and denial by parents about overlaying although it was accidental. Unusually, in this case, the baby was "over layed" by a young male child from the same family. The female baby was found listless next morning by her mother and died after three months of treatment. Death circumstances, non-sudden outcome, and unusual circumstances of overlaying the baby.

Death of a child due to venom toxicity following multiple honey bee stings: A case report

Most bee stings are not life-threatening. Bee venom often causes local, mild allergic reactions in people, but even a single bee sting may induce a fatal anaphylactic reaction. Usually, anaphylactic reaction is the cause of death, but, when a child suffers multiple stings (more than 30), direct toxicity of venom can also be fatal. A three-year-old male child was brought to the hospital with pain, swelling and redness at the sting sites. He had more than 35 stings at various sites over his face, on his tongue and over his body. He died 10 hours after the incidence of the honey bee stings and was maintaining oxygen saturation until the terminal stage of his life. At autopsy, the honey bee sting sites showed redness, swelling and a small effusion of blood surrounding the stinger tracks. On the tongue two stingers were found in situ. Facial puffiness and eyelid swelling, along with congested organs, were also found, but features suggestive of anaphylactic death like airway oedema, mucous plug or cyanosis were absent. Hospital treatment records show that blood pressure remained low with tachycardia despite treatment. Having regard for all the evidence it was concluded that death was due to multiple honey bee stings that caused direct venom toxicity.

Atmospheric pressure pin-to-plate cold plasma effect on physicochemical, functional, pasting, thermal, and structural characteristics of proso-millet starch

The present work aimed to study the influence of atmospheric pressure pin-to-plate cold plasma on the physicochemical (pH, moisture, and amylose content), functional (water & oil binding capacity, solubility & swelling power, paste clarity on storage, pasting), powder flow, thermal and structural (FTIR, XRD, and SEM) characteristics at an input voltage of 170-230 V for 5-15 min. The starch surface modification by cold plasma was seen in the SEM images which cause the surge in WBC (1.54 g/g to 1.93 g/g), OBC (2.22 g/g to 2.79 g/g), solubility (3.05-5.38% at 70 °C; 37.11-52.98% at 90 °C) and swelling power (5.39-7.83% at 70 °C; 25.67-35.33% at 90 °C) of starch. Reduction in the amylose content (27.82% to 25.07%) via plasma-induced depolymerization resists the retrogradation tendency, thereby increasing the paste clarity (up to ̴ 39%) during the 5 days of refrigerated storage. However, the paste viscosity is reduced after cold plasma treatment yielding low-strength starch pastes. The relative crystallinity of starch increased (37.35% to 45.36%) by the plasma-induced fragmented starch granules which would aggregate and broaden the gelatinization temperature, but these starch fragments reduced the gelatinization enthalpy. The fundamental starch structure is conserved as seen in FTIR spectra. Thus, cold plasma aids in the production of soluble, low-viscous, stable, and clear paste-forming depolymerized proso-millet starch.

A service evaluation of patch technology compared with traditional holter monitoring in a stroke pathway

Background

Atrial fibrillation (AF) is a known risk factor for embolic stroke. Establishing a diagnosis of AF will guide clinical decision making and help with downstream secondary stroke prevention. Patch technology is increasingly used for long-term cardiac monitoring for arrhythmia detection, as healthcare organisations look for new innovative ways to streamline service delivery. We were selected as a host site to evaluate the service and patient benefits of Zio XT in AF detection for cryptogenic stroke, as part a Artificial Intelligence Award.

Purpose

To evaluate the service and patient benefits of patch technology versus traditional Holter in a Stroke / TIA pathway.

Methods

The Zio XT data were collected between March and December 2021. A total of 778 patients were included. We only selected patients who were referred for a long-term ambulatory monitoring following a recent diagnosis of stroke or transient ischaemic attack (TIA) of an unknown cause (cryptogenic). The stroke pathway operates across three sites and all were included. We undertook a retrospective analysis of our previous pathway using Holter monitoring and sampled 100 stroke / TIA patients who underwent 24–72 hours of monitoring between January to June 2019. In order to obtain the requisite data a variety of sources were scrutinised: referral letters, test reports, patient medical records, internal clinical systems and third-provider platforms.

Results

The comparison of the ECG technologies showed the Zio XT used less staff time. We found a 50% reduction in-clinic monitor fitting when compared with Holter. Zio XT were all analysed by the provider staff resulting in significant savings in service resource time for analysis. The Zio XT had a faster test turnaround time (referral to report available), 19 days (inclusive of 14 days wear time) for Zio compared with 60 days for Holters. The rapid Zio turnaround led to a 27.5% reduction in repeat clinic appointments, due to results being unavailable for the consultation (table 1). Zio XT also had fewer repeat testing due to inconclusive results, 1% for Zio versus 16% for Holter. AF yield did not vary significantly between technologies, 3% yield for both Holter and Zio, which could be due to the young mean age of the stroke/ TIA the patient cohort: 63.8 years for Holter versus 62.9 years for Zio XT.

Conclusion

Introducing new ECG technologies such as Zio XT could increase outpatient and diagnostic capacity due to patches being more readily available than Holters, reduced reliance on clinical staff for fitting and analysis as well as fewer repeat clinic appointments. Overall, access to rapid long term cardiac monitoring has benefits over traditional Holter monitoring for TIA/stroke patients and service delivery.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): AI award from the Accelerated Access Collaborative (ACC) in partnership with NHSX and National Institute for Health Research

Patho-mechanical comparative morpho-characterization of contre-coup injuries of liver by cadaveric experimental simulation for medico-legal and forensic implications

BACKGROUND

Liver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ.

PURPOSE

The authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA.

METHODOLOGY

One hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers.

RESULTS

The patterns of contre-coup rupture/s of liver were established in all the twenty-eight out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J.

CONCLUSION

This series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms "large" and "very large" depicting the quantum of force/s delivered out of an impact or blow.

Diagnosis of urogenital tuberculosis by multiplex-nested PCR targeting mpt64 (Rv1980c) and IS6110: comparison with multiplex PCR and GeneXpert® MTB/RIF

A multiplex-nested PCR (M-nested PCR) targeting mpt64 (Rv1980c) + IS6110 was designed to detect Mycobacterium tuberculosis (Mtb) DNA within urine (n = 35), endometrial biopsies (n = 22) and menstrual blood (n = 3) of male/female UGTB patients, and results were compared with M-PCR using the same targets. Detection limit of the purified Mtb DNA was found to be 1 fg by M-nested PCR, which was 10⁶ -fold lower than M-PCR. Moreover, sensitivities of 100% and 81·8% were obtained in confirmed (n = 5) and clinically suspected UGTB (n = 55) cases, respectively, by M-nested PCR, with a specificity of 97·1% (n = 70). Sensitivities attained by M-nested PCR were significantly higher (p < 0·05) than M-PCR in both clinically suspected and total UGTB (n = 60) cases. To confirm the true PCR-negative results, an internal amplification control, that is, human β-globin gene (hbb) was incorporated in the M-nested PCR/M-PCR assays, wherein all the clinical specimens (positive/negative for mpt64/IS6110) were found to be positive for hbb. Some UGTB specimens (n = 35) were also subjected to GeneXpert® MTB/RIF assay that revealed a significantly lower (p < 0·001) sensitivity (17·1 vs 88·6%) than M-nested PCR, although high specificity (100%) was attained with GeneXpert. After validating the results in a higher number of UGTB specimens, our M-nested PCR may be translated into an attractive diagnostic kit.

Baclofen (fun drug) and ethanol combined poisoning in humans: A histopathology and morphometry model

BACKGROUND

- This study intends to address the scarcity of data regarding the pathogenesis of Baclofen poisoning in humans, which has seen a recent increase, worldwide, especially amongst the young people. Another reason for the conduction of this study was lack of the substantial data about the histo-pathological findings of lungs, in synergistic toxicity of Baclofen with Ethanol, in-spite of it being very common in humans, and both being respiratory depressant with similar mechanism of action.

PURPOSE

- The authors aimed to understand the pathogenesis of fatal poisonings in humans due to Baclofen in combination with Ethanol via an animal research model. The enhancement of the overall scientific literature by extending research along the lines of the handful studies available in this regard was another adjunct goal of the study.

MATERIAL AND METHODS

Fifteen Wistar rats were divided into control and test group of five and ten subjects respectively. The test group was further divided into two sub-groups of five each, with Baclofen administered to one, and it in conjunction with Ethanol to the other, in lowest dosages adjusted for the humans. Rats in both the groups were euthanized by dislocation of the cervical vertebrae for the histopathology examination.

RESULTS

Capillary and venous plethora, hemorrhages in the inter-alveolar septi, hemorrhages into the alveoli and sludging was seen in the 1st sub-group. The plethora of venules, capillaries and arterioles, with sludging by the WBC (white blood corpuscle) infiltrates was seen in the 2nd sub-group. Desquamation of the ciliated epithelium and edematous thickening of the intra-alveolar septi, along with features suggestive of the peri-vascular edema was seen in the 2nd sub-group. The morphometric analysis of the micro vessels showed a significantly higher value of the arteriolar diameter in the 2nd sub-group, in comparison to 1st, but the venular diameter in the two sub-groups did not differ to any extent.

Forensic medical characteristics of firearm exit wounds in cases with armour protection

BACKGROUND

The very limited literature about the characteristic morphology of the firearm ammunition wounds in the body armored victims led authors to conduct an experimental study to understand this issue of great forensic and medico-legal importance.

PURPOSE

An autopsy of a male sniper was fraught with a challenge to differentiate between a firearm ammunition entry and exit wound. He was wearing body armour when shot at during a hostage rescue operation. The study was conducted to standardize the findings and answer the queries in such cases of forearms with inherent legal implications.

METHODOLOGY

The modifying effect of the clothing and the armour on the firearm injuries in humans was studied by test firings on animal (pig) cadaver tissues, which has closest simulation to the human body tissues. These firings were preceded by X-ray fluorescence, and followed by stereoscopic and spectroscopic examinations. All the events were recorded by the high-resolution video camera shoots.

RESULTS

An extensive cavitation in the form of a cone shaped crater, and a tissue defect with precipitated edges and patching of the epidermal layers indicated a firearm entry and exit wound, respectively, in victims wearing body armour at the time of the firearm injury.

Gaslighting in alleged assault ascertained as Munchausen syndrome transcending to malingering in highly counterintuitive self inflicted acid burns

A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.

Computer assisted three-dimensional reconstruction of scene in firearm homicide

Worldwide advances in computer techniques are not yet recognised in the practice of forensic medicine. A promising application is their use in making a three-dimensional reconstruction of the crime scene. This study analyses this technique in a homicide by firearm. Queries regarding the direction and number of shots, position of the victim inside the car when shot at and presence of the accused at the crime scene were answered by a scientific model. Similar reconstruction of the scene, nailing the accused in a heinous crime, has not previously been reported as a study or a case. The paper anticipates impetus to the growth of literature in criminology and forensic sciences. It will also expedite the delivery of justice based on scientific evidence in controversial causes of death.

An Origami-Based Soft Robotic Actuator for Upper Gastrointestinal Endoscopic Applications

Soft pneumatic actuators have been explored for endoscopic applications, but challenges in fabricating complex geometry with desirable dimensions and compliance remain. The addition of an endoscopic camera or tool channel is generally not possible without significant change in the diameter of the actuator. Radial expansion and ballooning of actuator walls during bending is undesirable for endoscopic applications. The inclusion of strain limiting methods like, wound fibre, mesh, or multi-material molding have been explored, but the integration of these design approaches with endoscopic requirements drastically increases fabrication complexity, precluding reliable translation into functional endoscopes. For the first time in soft robotics, we present a multi-channel, single material elastomeric actuator with a fully corrugated design (inspired by origami); offering specific functionality for endoscopic applications. The features introduced in this design include i) fabrication of multi-channel monolithic structure of 8.5 mm diameter, ii) incorporation of the benefits of corrugated design in a single material (i.e., limited radial expansion and improved bending efficiency), iii) design scalability (length and diameter), and iv) incorporation of a central hollow channel for the inclusion of an endoscopic camera. Two variants of the actuator are fabricated which have different corrugated or origami length, i.e., 30 mm and 40 mm respectively). Each of the three actuator channels is evaluated under varying volumetric (0.5 mls-1 and 1.5 mls-1 feed rate) and pressurized control to achieve a similar bending profile with the maximum bending angle of 150°. With the intended use for single use upper gastrointestinal endoscopic application, it is desirable to have linear relationships between actuation and angular position in soft pneumatic actuators with high bending response at low pressures; this is where the origami actuator offers contribution. The soft pneumatic actuator has been demonstrated to achieve a maximum bending angle of 200° when integrated with manually driven endoscope. The simple 3-step fabrication technique produces a complex origami pattern in a soft robotic structure, which promotes low pressure bending through the opening of the corrugation while retaining a small diameter and a central lumen, required for successful endoscope integration.

P15: EVALUATING THE INTERNATIONAL USABILITY OF A LOW-COST LAPAROSCOPIC TRAINER IN LOW- AND HIGH-INCOME SETTINGS

Introduction

Limited access to equipment and trained personnel restrict the adoption of laparoscopic surgery globally. There are a wide range of laparoscopic trainers available; however, most of these are not affordable. We propose an ultra-low-cost laparoscopic trainer (Lap-Pack), designed for portability, ease of assembly and compatibility with smart devices. The study aims to evaluate the usability of Lap-Pack as a training tool in low- and high-income settings.

Method

An international usability study was conducted in India and the UK in 2019. The participants (n=60), consisting of senior surgeons (n=18), junior trainees (n=20) and medical students (n=22), were asked to complete two tasks using Lap-Pack. Participants then scored Lap-Pack in a 25-point questionnaire, including a pre-established Face-Validity Criteria and four major evaluation categories – Usability, Camera, View, Material.

Result

Lap-Pack scored highly in Face-Validity with a combined mean score of 4.63 (95%CI: 4.31, 4.95, p &lt;0.05) of a possible 6. In both cohorts, the Usability and Camera categories scored highest, with combined values respectively of 6.10 (95%CI: 6.01, 6.19, p &lt;0.05) and 6.09 (95%CI: 5.88, 6.31, p &lt;0.05) of a possible 7. For both centres, the highest-scoring individual criteria were its light weight and portability.

Conclusion

Overall, Lap-Pack was received positively by medical students and consultants alike, suggesting it is a suitable device for development of skills as part of a larger laparoscopic training curriculum. Its ease of assembly, portability and versatility show promise of increasing access to training opportunities worldwide.

Take-home message

Lap-Pack is an ultra-low-cost, portable laparoscopic simulator featuring compatibility with smart devices designed to help increase access to laparoscopic training worldwide. An international usability study found medical students, junior trainees and senior surgeons rated its usability and camera features highly, suggesting its employability as a laparoscopic training tool on a global scale.

Plasmodium falciparum DDX17 is an RNA helicase crucial for parasite development

Malaria is one of the major global health concerns still prevailing in this 21st century. Even the effect of artemisinin combination therapies (ACT) have declined and causing more mortality across the globe. Therefore, it is important to understand the basic biology of malaria parasite in order to find novel drug targets. Helicases play important role in nucleic acid metabolism and are components of cellular machinery in various organisms. In this manuscript we have performed the biochemical characterization of homologue of DDX17 from Plasmodium falciparum (PfDDX17). Our results show that PfDDX17 is an active RNA helicase and uses mostly ATP for its function. The qRT-PCR experiment results suggest that PfDDX17 is highly expressed in the trophozoite stage and it is localised mainly in the cytoplasm and in infected RBC (iRBC) membrane mostly in the trophozoite stage. The dsRNA knockdown study suggests that PfDDX17 is important for cell cycle progression. These studies report the biochemical functions of PfDDX17 helicase and further augment the fundamental knowledge about helicase families of P. falciparum.

•

Biochemical characterization of homologue of DDX17 from Plasmodium falciparum (PfDDX17) is presented.

•

Results show that PfDDX17 is an active RNA helicase and uses mostly ATP for its function.

•

Results also suggest that PfDDX17 is highly expressed in the trophozoite stage.

•

dsRNA knockdown study revealed that PfDDX17 is important for cell cycle progression.

A Clinical Comparative Evaluation Of The Wear Of Enamel Antagonist To Monolithic Zirconia And Metal Ceramic Crowns

PURPOSE

To evaluate and compare the wear of natural enamel against a metal-ceramic and a monolithic zirconia crown, with the null hypothesis that there is no difference in the wear of enamel between antagonist metal-ceramic and monolithic zirconia crowns.

MATERIALS AND METHODS

In 30 subjects (irrespective of sex and within the age range of 18 to 40 years), two bilaterally opposing molars (maxillary/mandibular) were prepared to receive monolithic zirconia or metal-ceramic crowns with feldspathic porcelain veneer. A polyvinyl siloxane impression of the opposing arch was taken at the time of cementation and 1 year after cementation. Casts were poured in type III gypsum and scanned, and the images were superimposed on each other. AutoCAD was used to calculate the difference between two images, which corresponded to the linear wear of the antagonist teeth. Statistical analysis of the data was done using one-way analysis of variance (ANOVA) and post hoc Tukey honest significant difference test for intergroup comparison. The P value obtained by one-way ANOVA was 1.1102e^-16 (< .05), and by post hoc Tukey test was .001 (< .01).

RESULTS

The mean wear of enamel against enamel was 14.8 ± 1.3 μm, enamel against metal-ceramic was 87.1 ± 18.3 μm, and enamel against monolithic zirconia was 59.4 ± 13.6 μm. The P values obtained; ie, 1.1102e^-16 (one-way ANOVA) and 0.001 (post hoc Tukey), indicated that the difference in wear of the antagonist tooth between monolithic zirconia and feldspathic porcelain was significant.

CONCLUSION

It can be concluded that monolithic zirconia causes less wear of the antagonist tooth than feldspathic porcelain.

Parallel Helix Actuators for Soft Robotic Applications

Fabrication of soft pneumatic bending actuators typically involves multiple steps to accommodate the formation of complex internal geometry and the alignment and bonding between soft and inextensible materials. The complexity of these processes intensifies when applied to multi-chamber and small-scale (~10 mm diameter) designs, resulting in poor repeatability. Designs regularly rely on combining multiple prefabricated single chamber actuators or are limited to simple (fixed cross-section) internal chamber geometry, which can result in excessive ballooning and reduced bending efficiency, compelling the addition of constraining materials. In this work, we address existing limitations by presenting a single material molding technique that uses parallel cores with helical features. We demonstrate that through specific orientation and alignment of these internal structures, small diameter actuators may be fabricated with complex internal geometry in a single material-without- additional design-critical steps. The helix design produces wall profiles that restrict radial expansion while allowing compact designs through chamber interlocking, and simplified demolding. We present and evaluate three-chambered designs with varied helical features, demonstrating appreciable bending angles (>180°), three-dimensional workspace coverage, and three-times bodyweight carrying capability. Through application and validation of the constant curvature assumption, forward kinematic models are presented for the actuator and calibrated to account for chamber-specific bending characteristics, resulting in a mean model tip error of 4.1 mm. This simple and inexpensive fabrication technique has potential to be scaled in size and chamber numbers, allowing for application-specific designs for soft, high-mobility actuators especially for surgical, or locomotion applications.

Murderer who spread table salt over his victim's corpse unintentionally preserved it from putrefaction

Adipocere is medico-legally exigent post-mortem change alternative to putrefaction. Sprinkling table salt over corpse to hasten disintegration and keep carnivores and nibblers off is a feature of ritualistic burial. We describe an unusual murder concealment wherein assailant put quantum of table salt over and around dead body while burying in jungle to hasten disintegration. Unexpected adipocere involving table salt preserved the body and firearm injuries. A mystifying thanatological aspect was the basic fact of table salt osmotically drawing even intrinsic body water needed for adipocere in non-damp conditions. It exceptionally formed in a week, and in a shallow grave, its formation in such conditions being very unusual and unreported.

Plasmodium falciparum DDX31 is DNA helicase localized in nucleolus

Malaria is a major infectious disease and is responsible for millions of infections every year. As drug resistance strains of Plasmodium species are emerging, there is an urgent need to understand the parasite biology and identify new drug targets. Helicases are very important enzymes that participate in various nucleic acid metabolic processes. Previously we have reported several putative DEAD box helicases in the genome of Plasmodium falciparum 3D7 strain. In this study, we present biochemical characterization of one of the members of Has1 (Helicase associated with SET1) family of DEAD box proteins from P. falciparum 3D7 strain. PfDDX31 is a homologue of human DDX31 helicase and contains all the conserved characteristics motifs. The core PfDDX31C exhibits DNA and RNA dependent ATPase activity and unwinds partially duplex DNA by utilizing ATP or dATP only. The immunofluorescence assay results show that PfDDX31 is expressed throughout all the intraerythrocytic developmental stages in P. falciparum 3D7 strain. The co-localization with nucleolar marker PfNop1 further suggests that PfDDX31 is mostly present in nucleolus, a discrete nuclear compartment.

Biochemical characterization of Plasmodium falciparum parasite specific helicase 1 (PfPSH1)

Malaria, a disease caused by infection with parasites of the genus Plasmodium, causes millions of deaths worldwide annually. Of the five Plasmodium species that can infect humans, Plasmodium falciparum causes the most serious parasitic infection. The emergence of drug resistance and the ineffectiveness of old therapeutic regimes against malaria mean there is an urgent need to better understand the basic biology of the malaria parasite. Previously, we have reported the presence of parasite‐specific helicases identified through genome‐wide analysis of the P. falciparum (3D7) strain. Helicases are involved in various biological pathways in addition to nucleic acid metabolism, making them an important target of study. Here, we report the detailed biochemical characterization of P. falciparum parasite‐specific helicase 1 (PfPSH1) and the effect of phosphorylation on its biochemical activities. The C‐terminal of PfPSH1 (PfPSH1C) containing all conserved domains was used for biochemical characterization. PfPSH1C exhibits DNA‐ or ribonucleic acid (RNA)‐stimulated ATPase activity, and it can unwind DNA and RNA duplex substrates. It shows bipolar directionality because it can translocate in both (3′–5′ and 5′–3′) directions. PfPSH1 is mainly localized to the cytoplasm during early stages (including ring and trophozoite stages of intraerythrocytic development), but at late stages, it is partially located in the cytoplasm. The biochemical activities of PfPSH1 are upregulated after phosphorylation with PKC. The detailed biochemical characterization of PfPSH1 will help us understand its functional role in the parasite and pave the way for future studies.

Fatal monocrotophos poisoning by cutaneous absorption while sleeping: A remarkable case study

Organophosphate poisoning is a continued menace associated with high morbidity and mortality in both resource-crunched developing and developed countries. Cases have been described of deliberate self-poisoning which has higher mortality than accidental exposure. Fatal poisoning by accidental dermal absorption is rarely reported for monocrotophos. Authors detail fatal accidental monocrotophos poisoning in adult female by dermal exposure while sleeping. Pesticide was detected in post-mortem blood and skin by chromatography and spectroscopy. Extraction along with review of literature for monocrotophos poisoning is adjuncted in this study.

Design and Modeling of a Three-Degree-of-Freedom Articulating Robotic Microsurgical Forceps for Trans-Oral Laser Microsurgery

Trans-oral laser microsurgery (TLM) is a surgical procedure for removing malignancies (e.g., cysts, polyps, tumors) of the laryngeal region through laser ablation. Intraoperative microsurgical forceps (i.e., microforceps) are used for tissue manipulation. The microforceps are rigid, single degree-of-freedom (DOF) devices (open–close) with precurved jaws to access different parts of the curved cylindrical laryngeal region. These microforceps are manually handled and are subject to hand tremors, poor reachability, and nonergonomic use, resulting in poor efficacy and efficiency in the surgery. A novel 3DOF motorized microforceps device is presented here, integrated with a 6DOF serial robotic manipulator. The device, referred to as RMF-3, offers three motorized DOFs: (i) open–close forceps jaw; (ii) tool rotation; and (iii) tool-tip articulation. It is designed to be compliant with TLM spatial constraints. The manual handling is replaced by tele-operation device, the omega.7. The design of the RMF-3 is characterized through theoretical and experimental analysis. The device shows a maximum articulation of 38 deg and tool rotation of 100 deg. Its performance is further evaluated through user trials using the ring-in-loop setup. The user trials demonstrate benefits of the 3DOF workspace of the device along with its teleoperation control. RMF-3 offers an improved workspace and reachability within the laryngeal region. Surgeons, in their preliminary evaluation of the device, appreciated the ability to articulate the tip, along with rotation, for hard-to-reach parts of the surgical site. RMF-3 offers an ergonomic robotic teleoperation control interface which overcomes hand tremors and extreme wrist excursion which leads to surgeon pain and discomfort.

A robotic microsurgical forceps for transoral laser microsurgery

PURPOSE

In transoral laser microsurgery (TLM), the close curved cylindrical structure of the laryngeal region offers functional challenges to surgeons who operate on its malignancies with rigid, single degree-of-freedom (DOF) forceps. These challenges include surgeon hand tremors, poor reachability, poor tissue surface perception, and reduced ergonomy in design. The integrated robotic microsurgical forceps presented here is capable of addressing the above challenges through tele-operated tissue manipulation in TLM.

METHODS

The proposed device is designed in compliance with the spatial constraints in TLM. It incorporates a novel 2-DOF motorized microsurgical forceps end-effector, which is integrated with a commercial 6-DOF serial robotic manipulator. The integrated device is tele-operated through the haptic master interface, Omega.7. The device is augmented with a force sensor to measure tissue gripping force. The device is called RMF-2F, i.e. robotic microsurgical forceps with 2-DOF end-effector and force sensing. RMF-2F is evaluated through validation trials and pick-n-place experiments with subjects. Furthermore, the device is trialled with expert surgeons through preliminary tasks in a simulated surgical scenario.

RESULTS

RMF-2F shows a motion tracking error of less than 400 μm. User trials demonstrate the device's accuracy in task completion and ease of manoeuvrability using the Omega.7 through improved trajectory following and execution times. The tissue gripping force shows better regulation with haptic feedback (1.624 N) than without haptic feedback (2.116 N). Surgeons positively evaluated the device with appreciation for improved access in the larynx and gripping force feedback.

CONCLUSIONS

RMF-2F offers an ergonomic and intuitive interface for intraoperative tissue manipulation in TLM. The device performance, usability, and haptic feedback capability were positively evaluated by users as well as expert surgeons. RMF-2F introduces the benefits of robotic teleoperation including, (i) overcoming hand tremors and wrist excursions, (ii) improved reachability and accuracy, and (iii) tissue gripping feedback for safe tissue manipulation.

Multivariate box spline wavelets in higher-dimensional Sobolev spaces

We construct wavelets and derive a density condition of MRA in a higher-dimensional Sobolev space. We give necessary and sufficient conditions for orthonormality of wavelets in H s ( R d ) . We construct nonseparable orthonormal wavelets in a higher-dimensional Sobolev space by using multivariate box spline.

Homicide concealed strangulation after bobbing reins in sexually sadistic homicide

This case of sexually motivated homicide combined the perpetrator's obliteration of his victim's identity along with his attempt at concealment of the corpse and sexual gratification following ligature strangulation of a young unidentified female from a minority Indian state. Sexual bondage was evident with characteristic body tying in a typical posture to fuel the killer's sexual arousal and gratification before, during and then after strangling his victim with a scarf. The victim's body was left in a sack packed with vegetables and transported from the crime site and found abandoned in a park.

Factors associated with repeat diagnosis of syphilis in genitourinary medicine (GUM) clinic attendees in the North East of England, 2002-2014

This study aimed to identify factors associated with repeat syphilis infection in North East England, in order to inform local prevention and control opportunities. We undertook a case-case study comparing individuals diagnosed with single or multiple episodes of syphilis infection within genitourinary medicine (GUM) clinics in NE England (12 clinics serving a population of 2.5 million). Study cases were verified as having had true re-infection by a GUM clinician (using serological and/or clinical parameters) and control cases (3 per case) frequency matched to cases by age and year of presentation. The odds of exposure to sexual behavioural and clinical factors were compared for cases and control cases using stepwise multivariable logistic regression. We included 66 cases and 235 control cases. The majority of cases (62/66) and control cases (165/235) were men who had sex with men (MSM). Data were missing for 0-64% of cases across different variables. Following multivariable analysis HIV seropositivity (OR 23.3, 95% CI 4.32-125.9), failure to attend follow-up (OR 4.63, 95% CI 1.11-19.31), stage of infection and deprivation were associated with re-infection ( p < 0.001). In this study, HIV seropositivity and failure to attend follow-up were associated with re-infection with syphilis. Actions targeted at these groups may help to reduce ongoing transmission.

Plasmodium falciparum specific helicase 3 is nucleocytoplasmic protein and unwinds DNA duplex in 3' to 5' direction

Plasmodium falciparum is responsible for most dangerous and prevalent form of malaria. The emergence of multi drug resistant parasite hindered the prevention of malaria burden worldwide. Helicases are omnipresent enzymes, which play important role in nucleic acid metabolism and can be used as potential targets for development of novel therapeutics. The genome wide analysis of P. falciparum 3D7 strain revealed some novel parasite specific helicases, which are not present in human host. Here we report the detailed biochemical characterization of P. falciparum parasite specific helicase 3 (PfPSH3). The characteristic ATPase and helicase activities of PfPSH3 reside in its N-terminal region (PfPSH3N) as it contains all the conserved signature motifs whereas the C-terminal does not show any detectable biochemical activity. PfPSH3N also shows DNA helicase activity in the 3′–5′ direction. The immunofluorescence microscopy results show that PSH3 is localized in nucleus as well as in cytoplasm during different stages such as trophozoite and early schizont stages of intraerythrocytic development. This report sets the foundation for further study of parasite specific helicases and will be helpful in understanding the parasite biology.

ATPase activity of Plasmodium falciparum MLH is inhibited by DNA-interacting ligands and dsRNAs of MLH along with UvrD curtail malaria parasite growth

Malaria caused by Plasmodium falciparum is the major disease burden all over the world. Recently, the situation has deteriorated because the malarial parasites are becoming progressively more resistant to numerous commonly used antimalarial drugs. Thus, there is a critical requirement to find other means to restrict and eliminate malaria. The mismatch repair (MMR) machinery of parasite is quite unique in several ways, and it can be exploited for finding new drug targets. MutL homolog (MLH) is one of the major components of MMR machinery, and along with UvrD, it helps in unwinding the DNA. We have screened several DNA-interacting ligands for their effect on intrinsic ATPase activity of PfMLH protein. This screening suggested that several ligands such as daunorubicin, etoposide, ethidium bromide, netropsin, and nogalamycin are inhibitors of the ATPase activity of PfMLH, and their apparent IC₅₀ values range from 2.1 to 9.35 μM. In the presence of nogalamycin and netropsin, the effect was significant because in their presence, the V _max value dropped from 1.024 μM of hydrolyzed ATP/min to 0.596 and 0.643 μM of hydrolyzed ATP/min, respectively. The effect of double-stranded RNAs of PfMLH and PfUvrD on growth of P. falciparum 3D7 strain was studied. The parasite growth was significantly inhibited suggesting that these components belonging to MMR pathway are crucial for the survival of the parasite.

Imaging of current flow in the human head during transcranial electrical therapy

BACKGROUND

It has been assumed that effects caused by tDCS or tACS neuromodulation are due to electric current flow within brain structures. However, to date, direct current density distributions in the brains of human subjects have not been measured. Instead computational models of tDCS or tACS have been used to predict electric current and field distributions for dosimetry and mechanism analysis purposes.

OBJECTIVE/HYPOTHESIS

We present the first in vivo images of electric current density distributions within the brain in four subjects undergoing transcranial electrical stimulation.

METHODS

Magnetic resonance electrical impedance tomography (MREIT) techniques encode current flow in phase images. In four human subjects, we used MREIT to measure magnetic flux density distributions caused by tACS currents, and then calculated current density distributions from these data. Computational models of magnetic flux and current distribution, constructed using contemporaneously collected T₁-weighted structural MRI images, were co-registered to compare predicted and experimental results.

RESULTS

We found consistency between experimental and simulated magnetic flux and current density distributions using transtemporal (T7-T8) and anterior-posterior (Fpz-Oz) electrode montages, and also differences that may indicate a need to improve models to better interpret experimental results. While human subject data agreed with computational model predictions in overall scale, differences may result from factors such as effective electrode surface area and conductivities assumed in models.

CONCLUSIONS

We believe this method may be useful in improving reproducibility, assessing safety, and ultimately aiding understanding of mechanisms of action in electrical and magnetic neuromodulation modalities.

Novel modular 2-DOF microsurgical forceps for transoral laser microsurgeries: Ergonomic design and preliminary evaluation

Transoral Laser Microsurgeries (TLM) demand a great level of control and precision in intraoperative tissue manipulation. The optimal eradication of the diseased tissue is possible only with coordinated control of the laser aiming for incision and the microsurgical tools for orienting and stretching the tissue. However, the traditional microsurgical tools are long, single purpose, one degree-of-freedom (DOF), rigid tools with small range of motion and a normal grasping handle inducing non-ergonomic usage. This paper presents a novel, modular microsurgical tool to overcome the challenges of the traditional tools and improve the surgeon-tool usage experience. The novel design adds a rotational DOF to expand the reach and functionality of the tool. The device is provided with an ergonomic grasping handle that avoids extreme wrist excursions and is capable of adapting to the variety of tools used in TLM within the same design. The performance of the new microsurgical tool was evaluated through a subjective assessment with both medical students and expert surgeons. The evaluation demonstrated a general acceptance of the new forceps tool, with the expert surgeons providing positive appraisals for the improved functionality and user experience with the tool, which indicates towards the potential suitability of the device for TLM. The parameters assessed in the preliminary evaluation not only provide a sense of the advantages of the novel design, but also guide future evolution of the tool design.

Robot-assisted microsurgical forceps with haptic feedback for transoral laser microsurgery

In this paper, a novel, motorized, multi-degrees-of-freedom (DoF), microsurgical forceps tool is presented, which is based on a master-slave teleoperation architecture. The slave device is a 7-DoF manipulator with: (i) 6-DoF positioning and orientation, (ii) 1 open/close gripper DoF; and (iii) an integrated force/torque sensor for tissue grip-force measurement. The master device is a 7-DoF haptic interface which teleoperates the slave device, and provides haptic feedback in its gripper interface. The combination of the device and the surgeon interface replaces the manual, hand-held device providing easy-to-use and ergonomic tissue control, simplifying the surgical tasks. This makes the system suitable to real surgical scenarios in the operating room (OR). The performance of the system was analysed through the evaluation of teleoperation control and characterization of gripping force. The new system offers an overall positioning error of less than 400 μm demonstrating its safety and accuracy. Improved system precision, usability, and ergonomics point to the potential suitability of the device for the OR and its ability to advance haptic-feedback-enhanced transoral laser microsurgeries.

Genome Wide In silico Analysis of the Mismatch Repair Components of Plasmodium falciparum and Their Comparison with Human Host

Malaria a major parasitic infection globally particularly in tropical and sub-tropical regions of the world is responsible for about 198 million cases and estimated deaths due to this disease are about 0.6 million. The emergence of drug resistance in the malaria parasite is alarming and it is necessary to understand its underlying cause and molecular mechanisms. It has been established that drug resistant malaria parasites have defective mismatch repair (MMR) therefore it is essential to study this pathway and its components in detail. Recently a number of non-synonymous Single Nucleotide Polymorphisms have been reported in genes involved in MMR pathways. PfMLH is an endonuclease essential to restore the MMR in drug resistant strains of Plasmodium falciparum. Considering all these facts about the role of MMR in emergence of drug resistant parasite, in this manuscript we report a genome wide analysis of the components of the MMR pathway such as MLH, Pms1, MSH2-1, MSH2-2, MSH6, and UvrD using in silico bioinformatics based approaches. The phylogenetic analysis revealed evolutionary closeness with the MMR components of various organisms. It is noteworthy that P. falciparum contains two homologs of MSH2, which are located on different chromosomes. The structural modeling of these components showed their similarity with the human/yeast MMR components. The docking studies reveal that PfUvrD and PfMLH interact with each other. The in silico identification of interacting partners of the major MMR components identified numerous P. falciparum specific proteins. In line with our previous studies the present study will also contribute significantly to understand the MMR pathway of malaria parasite.

32 NEXT-GENERATION SEQUENCING DISCLOSES DIFFERENCES IN microRNA EXPRESSION PROFILES OF BUFFALO (BUBALUS BUBALIS) EMBRYOS PRODUCED BY HAND-MADE CLONING AND IN VITRO FERTILIZATION

Mammalian embryo development is a complex process with a series of critical events taking place at every stage of development. It is an established fact that the birth rate of animals produced by nuclear transfer (NT) is far less (<2%) than that of IVF embryos (40%) after successful embryo transfers in different farm animal species. Micro(mi)RNAs are small non-coding RNAs of 17 to 25 nucleotides that alter the function of their target genes by either degrading them or inhibiting their expression. MiRNAs play a vital role during mammalian embryo development and may be adding to the extremely low birth rate and abnormalities in cloned animals. The present study was done with an objective of comparing the miRNA expression profiles of pre-implantation buffalo blastocysts produced by handmade cloning (HMC) and IVF. We hypothesised that there may be differences in the profiles of miRNAs expressed between the 2 groups that contribute to higher success rate in IVF group compared with HMC. Next-generation sequencing (NGS) was done to generate and compare the miRNA profiles and further discern the differentially expressed miRNAs between the 2 groups of blastocysts. For this study, NT blastocysts were produced using fibroblast donor cells isolated from ear skin of a buffalo bull. To produce genetically half-identical IVF blastocysts, the semen of the same bull was used. The oocytes used for generation of both HMC and IVF blastocysts were aspirated from buffalo ovaries obtained from abattoir. Total RNA was isolated from HMC and IVF blastocysts in 4 pools of each group. Each pool consisted of 40 blastocysts. A MiRNA cDNA library was prepared which was then subjected to NGS on Illumina HiSEqn 2000 (Illumina Inc., San Diego, CA, USA). Bos taurus genome was taken as reference to align the reads generated. The data from NGS was validated by RT-qPCR, taking 10 miRNAs (mir-15a, mir-23a, mir-128, mir-130a, mir-133a, mir-194, mir-196b, mir-200b, mir-431 and mir-451). The results positively validated the NGS data. Differential expression analysis of miRNAs between the 2 types of blastocysts revealed that the number of differentially expressed miRNAs with fold change of ≥ 2.0 were 74, with 52 miRNAs up-regulated in HMC and 22 miRNAs up-regulated in IVF. At significance level of P < 0.2, there were 2 miRNAs (mir-202 and mir-133a) that were uniquely expressed in IVF blastocysts and 8 miRNAs (mir-219, mir-451, mir-497, mir-33a, mir-2448, mir-592, mir-187, and mir-502a) that were uniquely expressed in HMC blastocysts. According to the gene ontology analysis, mir-202 is involved in negative regulation of apoptosis and positive regulator of cell growth, whereas mir-133a is involved in generating immunity. Absence of mir-202 and mir-133a expression from HMC blastocysts may be contributing to high apoptosis and other abnormalities in them compared with IVF counterparts. The NGS results indicate that the miRNA profiles of HMC and IVF blastocysts show huge differences. Further analysis of these differentially expressed miRNAs may open the door to miRNA therapies for treating the HMC blastocysts by regulating the expression of critical miRNAs in HMC blastocysts, thereby improving the success rate of cloning.

Newborn healthcare in urban India

The rapid population growth in urban India has outpaced the municipal capacity to build essential infrastructures that make life in cities safe and healthy. Local and national governments alike are grappling with the challenges of urbanization with thousands migrating from villages to cities. Thus, urbanization in India has been accompanied by a concentration of poverty and urban public healthcare has emerged as one of the most pressing priorities facing our country. Newborn mortality rates in urban settings are lower than rural areas, early neonatal deaths account for greater proportion than late neonatal deaths. The available evidence suggests that socio-economic inequalities and poor environment pose major challenges for newborn health. Moreover, fragmented and weak public health system, multiplicity of actors and limited capacity of public health planning further constrain the delivery of quality and affordable health care service. Though healthcare is concentrated in urban areas, delay in deciding to seek health care, reaching a source of it and receiving appropriate care affects the health outcomes disproportionately. However, a few city initiatives and innovations piloted in different states and cities have brought forth the evidences of effectiveness of different strategies. Recently launched National Urban Health Mission (NUHM) provides an opportunity for strategic thinking and actions to improve newborn health outcomes in India. There is also an opportunity for coalescence of activities around National Health Mission (NHM) and Reproductive, Maternal, Newborn and Child Health+Adolescent (RMNCH+A) strategy to develop feasible and workable models in different urban settings. Concomitant operational research needs to be carried out so that the obstacles, approaches and response to the program can be understood.