Structural, magnetic, electric and electrochemical studies on zinc doped magnesium ferrite nano particles - Sol-gel method

The sol-gel process was used to prepare zinc doped magnesium ferrite (Mg1-xZnxFe2O4) nanopowders obtained from the nitrates of magnesium, zinc and ferrous is precursor materials, maintain the pH value which were then studied for sensing purposes. The crystallite size and phase of the ferrite samples studied by X-ray diffraction (XRD) revealed a pure spinel phase (Mg1-xZnxFe2O4) with a cubic spinel structure and higher crystallite size and etc. The functional groups with possible stretching analysis were taken from Fourier transform infrared spectroscopy (FTIR). The surface features and morphology and the purity of the samples were analysed through a Scanning electron microscope (SEM) and energy dispersive X-ray (EDAX) spectrum respectively. Through the vibrating sample magnetometer (VSM), the magnetic behaviour was studied from relevant parameters such as saturation magnetization (Ms), coercivity (Hc) and retentivity (Mr). The larger Ms in 0.8 has ferromagnetic nature were observed. The dielectric constants (ε'& ε''), dielectric loss (tan δ) with AC conductivity (σAC) determined through the LCR metre, and electrochemical behaviour of the samples were found through cyclic voltametery. The possible polarizations at lower and higher frequencies are studied The obtained data are extensively examined and understood.

Comparing 90-Day Post-Operative Mortality after Neoadjuvant Proton-Based vs. Photon-Based Chemoradiotherapy for Esophageal Cancer

PURPOSE/OBJECTIVE(S)

Standard of treatment for locally advanced esophageal cancer consists of chemoradiotherapy (CRT) followed by surgery. Evidence suggests that proton beam therapy (PBT) results in lower toxicity and fewer post-operative complications compared to photon-based radiotherapy (RT). Mortality in the first 90 days after surgery is a rare event occurring in 2-8% of patients, with higher reported rates (of up to 17%) in older patients. This 90-day mortality (90DM) rate is an important measure of post-operative (non-oncologic) mortality as a proxy of quality of care. We hypothesize that PBT could reduce the incidence of 90DM compared to photon-based RT.

MATERIALS/METHODS

From a single-center retrospectively acquired database patients with esophageal cancer treated with neoadjuvant CRT and esophagectomy in 1998-2022 were selected. Univariable logistic regression analyses were used to study the associations of RT modality and other patient- and treatment-related characteristics with 90DM. Subsequently, 3 separate methods were applied to adjust for confounding bias. These included multivariable logistic regression, 1:1 nearest-neighbor propensity score matching (PSM), and inverse probability of treatment weighting (IPTW). Finally, stratified analyses for patient groups aged ≥67 vs. <67 years were performed.

RESULTS

A total of 894 eligible patients were included (PBT, n = 202; photon-based RT, n = 692). PBT patients had a significantly higher age, better performance score, and a higher number of comorbidities. The 90DM rate was 5 (2.5%) in the PBT group and 29 (4.2%) in the photon-based RT group (p = 0.262). Significant univariable predictors of 90DM included higher age and tumor location. After multivariable adjustment, PBT vs. photon therapy was not significantly associated with 90DM (OR 0.49, 95% CI 0.18-1.31). The 90DM rates in the PSM cohort (n = 181 vs. n = 181) were 2.8% for PBT and 3.3% for photon-based RT (p = 0.379). The 90DM rates in the IPTW cohort were 2.8% for PBT and 4.1% for photon-based RT (p = 0.427). In the full cohort, stratified analysis for age groups revealed that in patients aged ≥67 years, PBT was associated with a decreased risk of 90DM compared to photon-based RT (1.3% vs. 8.8%; p = 0.046), which was not the case in patients aged <67 years. In the PSM cohort, a comparable (but non-significant) difference was observed in favor of PBT in patients aged ≥67 years (i.e., 1.5% vs. 7.5%; p = 0.099). Within-group analyses in the original cohort demonstrated that a higher age significantly increased the risk of 90DM within the photon-based RT group (8.8% vs. 2.7% for age ≥67 vs. <67 years; p = 0.001), but not within the PBT group (1.3% vs. 3.2%; p = 0.398).

CONCLUSION

Post-operative 90DM after esophagectomy for cancer was not significantly different between PBT and photon-based neoadjuvant CRT. However, among older patients we observed a signal that PBT may reduce the risk of 90DM. Higher age increased the risk of 90DM in patients who underwent photon-based RT, but not in patients who underwent PBT.

Outcomes and complications of Titanium elastic nailing for forearm bones fracture in children: our experience in a district general hospital in the United Kingdom

Intramedullary Titanium elastic nailing (TENS) is successfully used for irreducible and displaced forearm bone fractures in children. The purpose of this study was to report the potential complications and functional outcomes associated with paediatric forearm fractures treated with TENS nails. We retrospectively reviewed 65 children with displaced forearm bone fractures treated by TENS nailing with a mean follow-up of 5.84 months (4-12). Data detailing patient demographics, fracture characteristics, associated fractures, injury surgery interval, grade of the operating surgeon, methods of fixation, time to union, the timing of removal of the nail, and complications were collected and analysed. The mean age in our study was 9.13 years. 92% had fractures of both radius and ulna, 83.3% had fixation of both bones, and 16.7% had single bone fixation only. Open reduction was required in 38.5% of cases. The average time to fracture union was 10.34 weeks (6-20). The average time of implant removal was 20.12 weeks (9-32). We observed an overall complication rate of 41.5%. We noted a higher (56% vs 32.5%, p=0.059) complication rate in open reduction cases. According to the Price criteria, we had excellent to good results in over 98% of patients despite a slightly higher complication rate. Titanium elastic nailing is a safe, reliable method of internal fixation for irreducible or unstable fractures of both bones of the forearm in children. Open reduction of fracture was associated with higher complications. Despite higher overall complications, we noted excellent functional results in most cases.

Total knee replacement survivorship by Design Philosophy: are we ignoring medial pivot design? Analysis based on the UK National Joint Registry

The UK National Joint Registry(NJR) has not reported total knee replacement (TKR) survivorship based on design phi- losophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design phi- losophy using data from NJR's 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot (MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves. 1,144,384 TKRs were included. CR is the most popular design philosophy (67.4%), followed by PS(23.1%), MB (6.9%) and least commonly MP (2.6%). MP and CR implants showed the best survivorship (95.7% and 95.6% respectively) at 15 years which is statistically significant at, and beyond, 10 years. Observed survivorship was lower at all time points with the PS and MB implants (94.5% for both designs at 15 years). While all design philosophies considered in this study survive well, CR and MP designs offer statistically superior survivorship at and beyond 10 years. MP design performs better than CR beyond 13 years yet, remain the least popular design philosophy used. Publishing data based on knee arthroplasty design phi- losophy would help surgeons when making decisions on implant choice.

Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey

BACKGROUND

Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies.

METHODS

A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies.

RESULTS

Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites.

CONCLUSION

Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

Phthalate migration and its effects on poly(vinyl chloride)-based footwear: pathways, influence of environmental conditions, and the possibility of human exposure

The study of phthalate migration in footwear is important from an environmental viewpoint and the consumer health perspective as it remains in direct contact with the user for a long time. In this research article, the migration of phthalate, specifically di-(2-ethylhexyl) phthalate (DEHP), from the poly(vinyl chloride) (PVC) shoe sole to the attached leather insole has been studied for six months under different environmental conditions. After one month, the DEHP concentration in the PVC sole decreased by 45-58%, and that in the leather insole increased from 0.35 mg g^-1 to 38-58 mg g^-1. After six months, about 90% of the DEHP has been lost from the PVC sole, and that in the leather insole reached close to its initial value (value before the experiment). The migration rate depends on the environmental conditions and the presence of phthalate soluble solvents in the sole-adhesive-insole system of the footwear. The influence of DEHP migration on the physicochemical characteristics of the PVC sole and leather insole has been studied by Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR), thermo-gravimetric analysis (TGA), and differential scanning calorimetry (DSC). The migration and emission pathways of DEHP, the influence of environmental conditions, and the possibility of human exposure to phthalate through footwear are discussed.

Computational Fluid Dynamics Simulation on Thermal Performance of Al/Al2O3/SWCNT Nanocoolants for Turning Operations

The objective of this study is to numerically investigate the thermal performance of cutting fluids dispersed with nanoparticles for effective heat removal during turning operations. The simulations are performed using Ansys Fluent software, and the problem is modelled as a three-dimensional turbulent incompressible single-phase flow. The computational domain consists of a heated cutting tool and work piece, and nanocoolants are sprayed from a nozzle located above the machining zone. The nanocoolants are prepared by mixing mineral oil with nanoparticles of Al₂O₃ (Aluminium Oxide), Al (Aluminium) and SWCNT (Single Walled Carbon Nanotube). The heat transfer performances of different nanocoolants are compared by varying the nanoparticle volume fraction (φ) and coolant velocity (U_c) in the range of 2% ≤ φ ≤ 8% and 1 m/s ≤ U_c ≤ 15 m/s, respectively. The results indicated a drastic drop in the cutting tool temperature with an increase in the volume fraction of dispersed nanoparticles and coolant velocity. The increase in volume fraction decreases the average cutting tool temperature by 25.65% and also enhances the average heat transfer rate by 25.43%. It is additionally observed that SWCNT nanocoolants exhibited a superior thermal performance and heat removal rate compared with Al and Al₂O₃ nanocoolants. The analysed numerical results are validated and are in good accordance with the benchmark results validated from literature.

Retrospective analysis of anti-inflammatory therapies during the first wave of COVID-19 at a community hospital

BACKGROUND

Our understanding of the severe acute respiratory syndrome coronavirus 2 has evolved since the first reported cases in December 2019, and a greater emphasis has been placed on the hyper-inflammatory response in severely ill patients. The purpose of this study was to determine risk factors for mortality and the impact of anti-inflammatory therapies on survival.

AIM

To determine the impact of various therapies on outcomes in severe coronavirus disease 2019 patients with a focus on anti-inflammatory and immune-modulating agents.

METHODS

A retrospective analysis was conducted on 261 patients admitted or transferred to the intensive care unit in two community hospitals between March 12, 2020 and June 17, 2020. Totally 167 patients received glucocorticoid (GC) therapy. Seventy-three patients received GC alone, 94 received GC and tocilizumab, 28 received tocilizumab monotherapy, and 66 received no anti-inflammatory therapy.

RESULTS

Patient survival was associated with GC use, either alone or with tocilizumab, and decreased vasopressor requirements. Delayed administration of GC was found to decrease the survival benefit of GC therapy. No difference in survival was found with varying anticoagulant doses, convalescent plasma, tocilizumab monotherapy; prone ventilation, hydroxychloroquine, azithromycin, or intravenous ascorbic acid use.

CONCLUSION

This analysis demonstrated the survival benefit associated with anti-inflammatory therapy of GC, with or without tocilizumab, with the combination providing the most benefit. More studies are needed to assess the optimal timing of anti-inflammatory therapy initiation.

Short communication: Molecular markers for epithelial cells across gastrointestinal tissues and fecal RNA in preweaning dairy calves

The objective of this study was to compare the transcription of gene markers for gastrointestinal (GI) epithelial cells, including fatty acid binding protein 2 (FABP2) and cytokeratin 8 (KRT8), and tight junction complex genes (TJP1, CLDN1, CLDN4) in fecal RNA against several GI tract tissue sections in dairy calves. Eight healthy Jersey calves were euthanized at 5 wk of age, and postmortem samples were collected from rumen, duodenum, jejunum, ileum, large intestine, cecum, and feces for total RNA isolation. Tissues and fecal samples were immediately frozen in liquid nitrogen until RNA isolation. A real-time quantitative PCR analysis was performed using a single standard curve composited of equal amounts of all samples, including cDNA from fecal and GI tract tissues. The mRNA expression of the tight junctions TJP1, CLDN1, and CLDN4 was greater in fecal RNA compared with lower GI tract tissues (i.e., duodenum, jejunum, ileum, large intestine, and cecum). Similar to fecal RNA, rumen tissue had greater expression of tight junctions CLDN1 and CLDN4 than lower GI tract tissues. Similarly, rumen tissue had greater expression of TPJ1 than all lower GI tract tissues except duodenum. The expression of TJP1 and CLDN4 was greater in fecal RNA than in rumen tissue; in contrast, CLDN1 mRNA expression was greater in rumen tissue than in the fecal RNA. The expression of FABP2 was greater in duodenum in comparison to all tissue except ileum. The mRNA expression of FABP2 in fecal samples was similar to jejunum and ileum. The expression of KRT8 in fecal samples was similar to duodenum, large intestine, and cecum. The fecal RNA had a greater expression of KRT8 in comparison to jejunum and ileum. The rumen tissue had the lowest mRNA expression of KRT8. The expression levels of FABP2, KRT8, and tight junction genes observed in fecal transcripts suggest that a considerable amount of RNA derived from GI tract epithelial cells can be detected in fecal RNA, which is in agreement with previous data in neonatal dairy calves and other biological models including humans, rodents, and primates. The greater expression of tight junctions in fecal RNA in comparison to sections of the low GI remains to be understood, and due to the importance of tight junctions in GI physiology, further clarification of this effect is warranted. The similarities in mRNA expression of FABP2 and KRT8 between fecal RNA and intestinal sections add up to the accumulating evidence that fecal RNA can be used to investigate molecular alterations in the GI tract of neonatal dairy calves. Further research in this area should include high-throughput transcriptomic analysis via RNA-seq to uncover novel molecular markers for specific sections of the GI tract of neonates.

Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients

OBJECTIVE

End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.

METHODS

The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category.

RESULTS

There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50.

CONCLUSION

Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.

Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.

Selectively arranged single-wire based nanosensor array systems for gas monitoring

Gas nanosensors, comprised of arrays of nanoelectrodes with finger-widths of ∼100 nm developed by electron beam lithography and aerosol assisted chemical vapor deposited non-functionalized and Pt-functionalized tungsten oxide nanowires (<100 nm) subsequently integrated across the pairs of electrodes via the dielectrophoresis method, are developed in this work. The functionality of these devices is validated towards various concentrations of NO2 and C2H5OH. The results demonstrate reproducible and consistent responses with better sensitivity and partial selectivity for the non-functionalized systems to NO2, as opposed to the Pt-functionalized systems, which display better sensing properties towards C2H5OH with a loss of response to NO2. These results are explained on the basis of the additional chemical and electronic interactions at the Pt/tungsten oxide interface, which increase the pre-adsorption of oxygen species and make the functionalized surface rather more sensitive to C2H5OH than to NO2, in contrast to the non-functionalized surface.