Dandy-Walker Phenotype with Brainstem Involvement: 2 Distinct Subgroups with Different Prognosis

BACKGROUND AND PURPOSE

Although cardinal imaging features for the diagnostic criteria of the Dandy-Walker phenotype have been recently defined, there is a large range of unreported malformations among these patients. The brainstem, in particular, deserves careful attention because malformations in this region have potentially important implications for clinical outcomes. In this article, we offer detailed information on the association of brainstem dysgenesis in a large, multicentric cohort of patients with the Dandy-Walker phenotype, defining different subtypes of involvement and their potential clinical impact.

MATERIALS AND METHODS

In this established multicenter cohort of 329 patients with the Dandy-Walker phenotype, we include and retrospectively review the MR imaging studies and clinical records of 73 subjects with additional brainstem malformations. Detailed evaluation of the different patterns of brainstem involvement and their potential clinical implications, along with comparisons between posterior fossa measurements for the diagnosis of the Dandy-Walker phenotype, was performed among the different subgroups of patients with brainstem involvement.

RESULTS

There were 2 major forms of brainstem involvement in patients with Dandy-Walker phenotype including the following: 1) the mild form with anteroposterior disproportions of the brainstem structures "only" (57/73; 78%), most frequently with pontine hypoplasia (44/57; 77%), and 2) the severe form with patients with tegmental dysplasia with folding, bumps, and/or clefts (16/73; 22%). Patients with severe forms of brainstem malformation had significantly increased rates of massive ventriculomegaly, additional malformations involving the corpus callosum and gray matter, and interhemispheric cysts. Clinically, patients with the severe form had significantly increased rates of bulbar dysfunction, seizures, and mortality.

CONCLUSIONS

Additional brainstem malformations in patients with the Dandy-Walker phenotype can be divided into 2 major subgroups: mild and severe. The severe form, though less prevalent, has characteristic imaging features, including tegmental folding, bumps, and clefts, and is directly associated with a more severe clinical presentation and increased mortality.

Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study

Aim

The purpose of the study is to compare and evaluate the efficacy of different root canal irrigants-100, 75, 50, and 25% neem extract, 100, 75, 50, and 25% apple cider vinegar (ACV), a combination of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA), and saline on smear layer removal using a scanning electron microscope (SEM).

Materials and methods

A total of 80 freshly extracted single-rooted teeth were collected and divided into 10 groups-group I: normal saline (negative control), group II: NaOCl with EDTA (positive control), group III: 100% neem extract, group IV: 75% neem extract, group V: 50% neem extract, group VI: 25% neem extract, group VII: 100% ACV, group VIII: 75% ACV, group IX: 50% ACV, and group X: 25% ACV. The samples were irrigated with a specific group of irrigants, then split in a longitudinal axis and processed for analysis in an SEM. Microphotographs were obtained and scored according to Torabinejad et al.

Results

Microphotographs were assessed and showed that 100% neem extract was similar to NaOCl with EDTA, followed by 75% neem extract and 100% ACV.

Conclusion

This study showed that 100% neem extract removed the smear layer, similar to the NaOCl with EDTA.

How to cite this article

Sudhakar S, Gupta N, Ghambir N, et al. Comparative Evaluation of Intracanal Smear Layer Removal by Different Root Canal Irrigants: A Scanning Electron Microscope Study. Int J Clin Pediatr Dent 2023;16(4):633-638.

Comparison of the Sevoflurane versus Desflurane Anaesthesia on the Recovery of Airway Reflexes and Cognitive Function: An Original Research

Background and Objectives

Sevoflurane and desflurane virtually equally dissolve in blood gases, yet current research suggests that desflurane helps in a quick return of airway reflex than sevoflurane however the return of cognitive activity fluctuates greatly. In order to compare the lengths of time required to recover after sevoflurane and desflurane anesthesia, the current research was conducted.

Materials and Methods

Current study was randomized that included 100 subjects who were posted for cholecystectomy (elective). Only adult and non-obese subjects were included in the study. The intended anesthetic agents sevoflurane and desflurane were utilized in the study and all the protocols were followed for the surgery. After the end of the surgery, tests for regaining cognitive function and airway reflexes were carried out, and different time intervals were recorded. The values were recorded and compared for the variances while considering the P < 0.05 as significant.

Results

The mean T1 was 8.19 ± 3.28 min for sevoflurane and was 5.82 ± 4.02 min. There was no significant variance between the two agents for the T1, 2 (P = 0.013 and 0.110 respectively). After the inhalation anesthetics ceased at T1, desflurane patients responded to verbal commands more quickly than sevoflurane patients (5.824.02 vs. 8.193.28 min). The SOMCT and swallowing test were similarly completed more quickly by desflurane-treated patients than by sevoflurane-treated patients (T3VST4) (13.693.37 vs. 10.024.86 min, P = 0.008 and (14.094.30 vs. 9.824.50 min, P 0.001, respectively). For the T3, 4-time intervals, there was a significant difference between the sevoflurane and desflurane groups.

Conclusion

Desflurane causes patients to recover more quickly from laparoscopic cholecystectomy under controlled circumstances than sevoflurane does.

Neuroimaging Features of Biotinidase Deficiency

Biotinidase deficiency is an autosomal recessive condition caused by pathogenic variants in the BTD gene. Resultant deficiency of free biotin leads to impaired activity of the enzyme carboxylase and related neurologic, dermatologic, and ocular symptoms. Many of these are reversible on treatment, but early recognition and commencement of biotin supplementation are critical. This practice is especially important in countries where routine neonatal screening for biotinidase deficiency is not performed. In this report comprising 14 patients from multiple centers, we demonstrate the MR imaging patterns of this disorder at various age groups. Knowledge of these patterns in the appropriate clinical context will help guide early diagnosis of this treatable metabolic disorder.

Physiotherapy and Physical Activity: A Cross-Sectional Survey Exploring Physical Activity Promotion and the Physical Activity among Physiotherapists in Bangalore

Introduction: Physical action is a significant viewpoint in our everyday life. In India, around 36.9% of the population is inactive physically. Physical action has a significant medical advantage related to increasingly ideal natural cardiovascular disease hazards considering youngsters and teenagers’ profiles. Healthy habits are progressively significant in physiotherapists as they are future advisors who dismiss embracing a healthy way of life and are bound to neglect to set up well-being advancement and open doors for their patients. Aim of the Study: The study's objective is to identify the physical activity levels among the Physiotherapist in Bangalore. Material and Method: This study involves 100 Physiotherapists between the ages of 22-50 years of male and female genders in Bangalore. A self-reported physical activity assessment was taken using the IPAQ (International Physical Activity Questionnaire) based on inclusion and exclusion criteria. Outcome Measure: Participants self-reported physical activity using the IPAQ Questionnaire, which comprises 4 generic items (Occupation, leisure time, domestic, transport). Analysis: Interpreting the data using the SPSS V. 20 software. Conclusion: This study shows that 50% of physiotherapists are physically active and 36% are moderate, and 14% are low in physical activity in Bangalore.

Expanding the Spectrum of Early Neuroradiologic Findings in β Propeller Protein-Associated Neurodegeneration

BACKGROUND AND PURPOSE

β propeller protein-associated neurodegeneration (BPAN) is the most common neurodegeneration with brain iron accumulation disorder. Typical radiologic findings are T2 hypointensity in the substantia nigra and globus pallidus, as well as a T1 halolike substantia nigra hyperintense signal surrounding a hypointense central area. However, these findings are often subtle or absent on initial scans, risking diagnostic delay. In this study, we sought to investigate radiologic findings that could aid in the early diagnosis of BPAN.

MATERIALS AND METHODS

A retrospective cohort study was performed in a national referral center, including all pediatric patients with confirmed pathogenic WDR45 mutations and consistent clinical semiology. MR imaging findings were independently reported by 2 pediatric neuroradiologists.

RESULTS

Fifteen patients were included in the study, and 27 scans were available for review. The initial neuroimaging study was undertaken at a mean age of 3.2 years. Iron deposition was uncommon in patients younger than 4 years of age. Neuroradiologic features from very early on included dentate, globus pallidus, and substantia nigra swelling, as well as a thin corpus callosum and small pontine volume. Optic nerve thinning was also present in all patients.

CONCLUSIONS

Our study highlights the key early MR imaging features of BPAN. Iron deposition in the globus pallidus and substantia nigra is not common in children younger than 4 years of age; clinicians should not be deterred from suspecting BPAN in the presence of the findings described in this study and the appropriate clinical context.

Refining the Neuroimaging Definition of the Dandy-Walker Phenotype

BACKGROUND AND PURPOSE

The traditionally described Dandy-Walker malformation comprises a range of cerebellar and posterior fossa abnormalities with variable clinical severity. We aimed to establish updated imaging criteria for Dandy-Walker malformation on the basis of cerebellar development.

MATERIALS AND METHODS

In this multicenter study, retrospective MR imaging examinations from fetuses and children previously diagnosed with Dandy-Walker malformation or vermian hypoplasia were re-evaluated, using the choroid plexus/tela choroidea location and the fastigial recess shape to differentiate Dandy-Walker malformation from vermian hypoplasia. Multiple additional measures of the posterior fossa and cerebellum were also obtained and compared between Dandy-Walker malformation and other diagnoses.

RESULTS

Four hundred forty-six examinations were analyzed (174 fetal and 272 postnatal). The most common diagnoses were Dandy-Walker malformation (78%), vermian hypoplasia (14%), vermian hypoplasia with Blake pouch cyst (9%), and Blake pouch cyst (4%). Most measures were significant differentiators of Dandy-Walker malformation from non-Dandy-Walker malformation both pre- and postnatally (P < .01); the tegmentovermian and fastigial recess angles were the most significant quantitative measures. Posterior fossa perimeter and vascular injury evidence were not significant differentiators pre- or postnatally (P > .3). The superior posterior fossa angle, torcular location, and vermian height differentiated groups postnatally (P < .01), but not prenatally (P > .07).

CONCLUSIONS

As confirmed by objective measures, the modern Dandy-Walker malformation phenotype is best defined by inferior predominant vermian hypoplasia, an enlarged tegmentovermian angle, inferolateral displacement of the tela choroidea/choroid plexus, an obtuse fastigial recess, and an unpaired caudal lobule. Posterior fossa size and torcular location should be eliminated from the diagnostic criteria. This refined phenotype may help guide future study of the numerous etiologies and varied clinical outcomes.

Identification, tissue specific expression analysis and functional characterization of arrestin gene (ARRDC) in the earthworm Eudrilus eugeniae: a molecular hypothesis behind worm photoreception

BACKGROUND

The arrestin domain containing proteins (ARRDCs) are crucial adaptor proteins assist in signal transduction and regulation of sensory physiology. The molecular localization of the ARRDC gene has been confined mainly to the mammalian system while in invertebrates the expression pattern was not addressed significantly. The present study reports the identification, tissue specific expression and functional characterization of an ARRDC transcript in earthworm, Eudrilus eugeniae.

METHODS AND RESULTS

The coding region of earthworm ARRDC transcript was 1146 bp in length and encoded a protein of 381 amino acid residues. The worm ARRDC protein consists of conserved N-terminal and C-terminal regions and showed significant homology with the ARRDC3 sequence of other species. The tissue specific expression analysis through whole mount in-situ hybridization denoted the expression of ARRDC transcript in the central nervous system of the worm which includes cerebral ganglion and ventral nerve cord. Besides, the expression of ARRDC gene was observed in the epidermal region of earthworm skin. The functional characterization of ARRDC gene was assessed through siRNA silencing and the gene was found to play key role in the light sensing ability and photophobic movement of the worm.

CONCLUSIONS

The neuronal and dermal expression patterns of ARRDC gene and its functional characterization hypothesized the role of the gene in assisting the photosensory cells to regulate the process of photoreception and phototransduction in the worm.

Spectrum of Neuroradiologic Findings Associated with Monogenic Interferonopathies

The genetic interferonopathies are a heterogeneous group of disorders thought to be caused by the dysregulated expression of interferons and are now commonly considered in the differential diagnosis of children presenting with recurrent or persistent inflammatory phenotypes. With emerging therapeutic options, recognition of these disorders is increasingly important, and neuroimaging plays a vital role. In this article, we discuss the wide spectrum of neuroradiologic features associated with monogenic interferonopathies by reviewing the literature and illustrate these with cases from our institutions. These cases include intracerebral calcifications, white matter T2 hyperintensities, deep WM cysts, cerebral atrophy, large cerebral artery disease, bilateral striatal necrosis, and masslike lesions. A better understanding of the breadth of the neuroimaging phenotypes in conjunction with clinical and laboratory findings will enable earlier diagnosis and direct therapeutic strategies.

Study on Dynamic Balance in College Students with Flat Foot and with Normal Arched Foot using Y- Balance Test

Introduction: Flat foot deformity is mostly found in adults. Talus's average turn and plantar flexion are detailed, as well as calcaneus eversion, a disintegrated average curve, and forefoot snatching. Balance is a basic requirement for performing daily activities, and it plays a critical role in maintaining bodily posture. Lower limb work has included balance as a component. The balance might be affected by a little change in strength or any instability in the muscles or joints of the lower limb. Aim of Study: The purpose of this study is to determine Dynamic balance in college students with flat feet and normal arced feet using Y-Balance test. Materials and Methods: A total of 60 participants were recruited from Bangalore's Krupanidhi College of Physiotherapy who met the inclusion criteria. All of the subjects underwent a Navicular Drop Test and a Y-balance test. Outcome Measures: To distinguish between Flat Foot and Normal Arched Foot, the Navicular Drop Test was utilised. The Dynamic Balance was assessed using the Y-balance test. Statistical Tool: Unpaired t-test. Result: The P-value for the Right foot is 0.0005 and for the Left foot is 0.004, and the Mean difference for the Right side is 6.75033 and for the Left side is 8.6616, indicating that there is a significant difference in dynamic balance stability in students with Flat feet compared to students with Normal feet. Conclusion: The study finds that students with Flat Feet have a deficit in Dynamic Balance when compared to students with Normal Arched Feet.

Multicentric study to evaluate the effectiveness of Thermalytix as compared with standard screening modalities in subjects who show possible symptoms of suspected breast cancer

INTRODUCTION

Machine learning in computer-assisted diagnostics improves sensitivity of image analysis and reduces time and effort for interpretation. Compared to standard mammograms, a thermal scan is easily scalable and is a safer screening tool. We evaluate the performance of Thermalytix (an automated thermographic screening algorithm) compared with other standard breast cancer screening modalities.

METHODS

A prospective multicentre study was conducted to assess the non-inferiority of sensitivity of Thermalytix (test device) to that of standard modalities in detecting malignancy in subjects who show possible symptoms of suspected breast cancer. Standard screening modalities and Thermalytix were obtained and interpreted independently in a blinded fashion. A receiver operating characteristic (ROC) curve was constructed to identify the best cut-off point, non-inferiority margin of ≥10% to demonstrate the non-inferiority.

RESULTS

We recruited 258 symptomatic women who first underwent a thermal scan, followed by mammogram and/or ultrasound. At Youden's Index of ROC curve, the test device had a sensitivity of 82.5% (95% CI 73.2 to 91.9) and specificity of 80.5% (95% CI 75.0 to 86.1) as compared with diagnostic mammogram, which had sensitivity of 92% (95% CI 80.7 to 97.8) and specificity of 45.9% (95% CI 34.3 to 57.9) when BI-RADS 3 (Breast Imaging-Reporting and Data System) was considered as test-positive. The overall area under the curve (AUC) was 0.845. For women aged <45 years, the test device had a sensitivity and specificity of 87.0% (95% CI 66.4 to 97.2) and 80.6% (95% CI 72.9 to 86.9), respectively. For women aged ≥45 years, the sensitivity and specificity were 80.5% (95% CI 65.1 to 91.2) and 86.5% (95% CI 78.0 to 92.6, respectively).

CONCLUSION

We evaluated Thermalytix, a new AI-based modality for detecting breast cancer. The high AUC in both women under 45 years and above 45 years shows the potential of Thermalytix to be a supplemental diagnostic modality for all ages. Further evaluation on larger sample size is needed.

TRIAL REGISTRATION NUMBER

CTRI/2017/10/0 10 115.

A Big Data Analytical Approach for Prediction of Cancer Using Modified K-Nearest Neighbour Algorithm

Today, sensors generate vast amounts of data in different fields such as hospitals, the transport sector, social media, and so on. In hospitals, the use of sensors that are installed in the patient’s body to monitor the pulse rate, heartbeats, head movement, eyes, and other body parts. Every day, these collected data are stored in local data servers and database servers by various sensors that require effective handling of these data. Sensors are primarily used in most of the IoT applications in everyday life from which smart city plays a crucial role. The aim of the work is to address the application of big data in healthcare and life science, including different types of data that involve special attention in processing. This work focuses on the use of large-data analytical techniques to process medical data. A large volume of unstructured cancer database is considered to identify and predict different types of cancer such as breast cancer, lung cancer, blood cancer, and so forth. This research involves the segmentation of thousands of records on cancer forms in a broad cancer database into various segmented databases. Using KNN algorithm this segmentation, classification and prediction will be achieved.

Neuroradiologic Phenotyping of Galactosemia: From the Neonatal Form to the Chronic Stage

Galactosemia is a rare genetic condition caused by mutation of enzymes involved in galactose and glucose metabolism. The varying clinical spectrum reflects the genetic complexity of this entity manifesting as acute neonatal toxicity syndrome, requiring prompt diagnosis and treatment, to more insidious clinical scenarios as observed in the subacute and chronic presentations. The current literature predominantly focuses on the long-standing sequelae of this disease. The purpose of this multicenter clinical report comprising 17 patients with galactosemia is to highlight the MR imaging patterns encompassing the whole spectrum of galactosemia, emphasizing the 3 main clinical subtypes: 1) acute neonatal presentation, with predominant white matter edema; 2) subacute clinical onset with a new finding called the "double cap sign"; and 3) a chronic phase of the disease with heterogeneous imaging findings. The knowledge of these different patterns together with MR spectroscopy and the clinical presentation may help in prioritizing galactosemia over other neonatal metabolic diseases and prevent possible complications.

Earthworms and vermicompost: an eco-friendly approach for repaying nature's debt

The steady increase in the world's population has intensified the need for crop productivity, but the majority of the agricultural practices are associated with adverse effects on the environment. Such undesired environmental outcomes may be mitigated by utilizing biological agents as part of farming practice. The present review article summarizes the analyses of the current status of global agriculture and soil scenarios; a description of the role of earthworms and their products as better biofertilizer; and suggestions for the rejuvenation of such technology despite significant lapses and gaps in research and extension programs. By maintaining a close collaboration with farmers, we have recognized a shift in their attitude and renewed optimism toward nature-based green technology. Based on these relations, it is inferred that the application of earthworm-mediated vermitechnology increases sustainable development by strengthening the underlying economic, social and ecological framework.

Effect of NaCl on the properties of sulphamic acid single crystals

Single crystals of pure and NaCl doped sulphamic acid (SA) were grown by slow evaporation method at room temperature. The lattice parameters and structure were determined by using single crystal and powder X-ray diffraction analyses. The presence of dopant in the SA lattice was affirmed by EDAX analysis. UV-Vis spectra show maximum transmittance in the visible region. The band gap energies were found to be 6.06 eV and 5.70 eV for pure and NaCl doped SA crystals respectively. From the PL specta the emission were observed at 335 and 424 nm for pure and 340 and 428 nm for doped SA crystal. The thermal stability of the grown crystals were analyzed by thermogravimetric and differential thermal analysis (TGA/DTA) and revealed that the grown crystals were thermally stable up to 331 °C and 334 °C for pure and NaCl doped SA. Vickers microhardness study reveals that the hardness of the crystals is increase with increasing load. The photoconductivity study shows that the grown crystals are negative photoconductive nature. The Laser Damage Threshold (LDT) indicates the grown crystals have good resistance to laser radiation than a standard Potassium dihydrogen phosphate (KDP) crystal. The Z-scan technique was employed to determine the nonlinear refractive index, nonlinear optical absorption and third order nonlinear optical (TONLO) susceptibility of the grown crystals using He–Ne laser.

Abstract P6-02-12: Artificial Intelligence over thermal images for radiation-free breast cancer screening

Introduction: Breast cancer is the largest cause of cancer deaths in women today. NIRAMAI has developed a novel solution for detecting early stage breast cancer in women of all age groups. It is low cost, non-contact and portable solution. This radiation-free solution also works on dense breasts and hence is applicable beyond developing countries. The core of the solution is a Computer Aided Diagnostics engine called Thermalytix, which uses Artificial Intelligence algorithms on high resolution thermal images.

In this paper, we present a comparative analysis of Thermalytix solution with Mammography, the standard screening modality, in a retrospective trial that was conducted across 3 reputed cancer hospitals in India.

Aim: To compare the sensitivity, specificity, NPV and PPV of Thermalytix with Mammography.

Methods: A multisite comparative study was performed on 194 patients across 3 reputed cancer hospitals in India with informed consent from subjects and ethics committee approval of respective hospitals. Every person who was going for a mammography test was made to undergo the non-invasive Thermalytix test prior to mammography examination. As per standard of care in India, all women who had a suspicious lesion in Mammo was sent to Ultrasound and then biopsy. 93 of the 194 subjects enrolled were found to be malignant by this standard procedure (9 of them did not have a biopsy report).

Niramai Thermaytix test gave the automated reports detecting patients with suspected malignancy and those results were compared with ground truth derived from mammography, sono-mammography and biopsy. In a similar manner, standalone mammography observation was compared with the above ground truth to compare the two modalities as individual modalities.

Results:

Out of the 194 subjects, 93 positive cases and Niramai accurately detected 91 cases and called out one as boundary case. Sensitivity of Thermalytix was 98% and NPV was 97%, while sensitivity of Mammography was 94% with an NPV of 94%. NIRAMAI Thermalytix detected 4 more malignant patients compared to Mammography. On the other hand, mammography scored over Thermalytix in PPV and Specificity by 10%. These results are tabulated at

Comparing NIRAMAI Thermalytix with Mammography NIRAMAIMammographySensitivity98%94%Specificity76%89%PPV79%89%NPV97%94%Accuracy87%91%Number of subjects = 194 high risk patients

Among the 194 patients, 39 women were found to have dense breasts and 19 with heterogenous dense breasts – on whom ultrasound and elastography was performed by the Radiologist to correlate with mammography results and make the final observations. Niramai test alone was effective in these patients.

The results show that Thermalytix is an emerging, radiation-free diagnostic modality that has comparable accuracy to Mammography. We conclude that NIRAMAI Thermalytix can be complementary modality to mammography as it works well on women of all age groups, including women with dense breasts. Its higher sensitivity and NPV adds to its potential to be the first screening test for early detection of breast cancer.

Citation Format: Manjunath G, Sudhakar S, Kakileti S, Madhu H, Singh A. Artificial Intelligence over thermal images for radiation-free breast cancer screening [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-12.

Efficacy of corrective exercise strategy in subjects with hyperkyphosis

BACKGROUND

Age-related hyperkyphosis causes deleterious effects on health, physical function, and quality of life. Recently, health care providers recognized it as a major health concern.

OBJECTIVE

To identify the effect of corrective exercise strategy on hyperkyphosis and compare it with that of conventional exercise.

METHODS

Subjects were randomly categorized into two groups. Each group comprised 30 subjects. Group A received the corrective exercise strategy, and group B received conventional exercises for 8 weeks of the study duration (15 repetitions of each exercise for three sessions/day for a total duration of 45 min and 4 days/week. Pre- and post-interventional hyperkyphosis were analyzed according to posture number using the Posture Pro 8 postural analysis software. In addition, pectoralis minor flexibility was assessed using the ruler scale method in centimeters.

RESULTS

Both groups showed highly significant postural alteration and changes in pectoralis minor muscle length (p< 0.001)CONCLUSIONS:The corrective exercise strategy seems to promote scapular stability and produce a more upright posture of the upper thoracic spine.

Implication of Posture Analysing Software to Evaluate the Postural Changes after Corrective Exercise Strategy on Subjects with Upper Body Dysfunction-A Randomized Controlled Trial

INTRODUCTION

The postural adaptation is very common now a days in school going children, office desk oriented job, computer users and frequent mobile users, and in all major industrial workers. Several studies have documented a high incidence of postural abnormalities in a given population; however, methods of postural measurement were poorly defined. The implication of postural pro software to analyse the postural imbalance of upper body dysfunction is very rare and literature studies says that the kinematic changes in particular segment will produce pain/discomfort and thereby lesser productivity of subjects.

AIM

To evaluate the postural changes in subjects with upper body dysfunction after a corrective exercise strategy using postural analysis software and pectoralis minor muscle length testing.

MATERIALS AND METHODS

After explaining the procedure and benefits, informed consent was taken from the participating subjects (age 25-55 years). Subjects with upper body dysfunction were randomly allocated into two groups (each group 30 subjects). The Group-A received the corrective exercise strategy and Group-B received the conventional exercise for eight weeks of study duration (15 reps each exercise, total duration of 40 min; four days/week. Pre and Post posture analysis were analysed using posture pro software along with flexibility of pectoralis minor was assessed using ruler scale method.

RESULTS

After interpretation of data, both the group showed the postural alteration and pectoralis minor muscle length changes, p-value (p<0.01) of both group showed highly significant changes. But comparing the both groups, the subjects who received the corrective exercise strategy shown more percentage of improvement in posture alteration (56.25%), pectoralis minor muscle length changes (68.69%) than the conventional exercise received subjects in posture alteration (24.86%) and pectoralis minor muscle length changes (21.9%).

CONCLUSION

Altered postural changes and pectoralis minor muscle flexibility before and after the corrective exercise strategy evaluated by postural analysis software method shown to be a significant tool in clinical practice, which is easier and reproducible method.

Effect of Thoracic Correction Exercises in Upper Body Dysfunction of 94-Year-old Male Participant - A Case Report

The case report has been presented to show the effects of thoracic correction exercises on flexed posture in older men with upper body dysfunction using posture analysis software and pectoralis minor muscle length test. The present case is that of a 94-year-old male. He was guided for a specific thoracic correction exercises for 12 weeks. The program included breathing correction, thorax mobility, scapular stability and passive stretching of Pectoralis major and minor, performed thrice a week, 30 min each session, for 12 weeks. Outcome measures included the upper body dysfunction changes by posture analysis software and pectoralis minor muscle length test. The Pre and Post-test of the patient demonstrated significantly greater improvements in hyperkyphosis (forward head posture) and pectoralis minor muscle length. This case study provides a promising exercise intervention that may improve flexed posture in older men with age-related upper body dysfunction.

Bilateral supplemental maxillary central incisors with double-tooth like appearance

BACKGROUND

Supplemental teeth refer to extra teeth that resemble the normal tooth series. Bilateral supplemental central incisors in a healthy individual are rare and bilateral supplemental incisors with double-tooth like appearance are exceptionally rare and has not been previously reported in the dental literature.

CASE REPORT

This clinical report describes an 8-year old healthy Indian boy referred for the management of delayed eruption of his permanent maxillary incisor teeth. Following clinical and radiographic examination the two supplemental incisors closer to the midline were extracted under local analgesia and both of them exhibited double-tooth like appearance.

CONCLUSIONS

The present case refutes the conventional wisdom that "supplemental teeth are usually smaller than the normal tooth type they resemble and occur distal to the normal tooth series", illustrates that the unusual can occur and that the clinician should be aware of such variations.

Identification of shorter length lamin A protein in mouse ear cartilage tissue

Lamin A is an intermediate filament protein which is cleaved by the enzyme, FACE 1 at VTRSY↓L. The cleavage is the final step in the production of the mature lamin A protein. The mature lamin A protein localizes in the inner membrane of the nucleus. The mutation in the lamin A gene causes many diseases, including accelerated aging. It is known that the protein is not expressed in neuronal cells of the brain. Many splicing variants of the lamin A gene have been reported. In this study, the amino acid sequence VTRSY (a penta-peptide repeat) was found in three different sites of the C-terminal end of the lamin A protein, the protein expressed in cells of ear cartilage tissues is shorter than the protein expressed in cells of the skin tissues. Using two lamin A antibodies, it was found that the amino acid sequence between penta-peptide 2 and 3 is missing in lamin A protein that was expressed in the cells of mouse ear cartilage tissue, besides the RT-PCR data confirmed that the corresponding coding sequence between the penta repeat 2 and 3 is intact. Cleavage may occur at the penta-peptide (VTRSY) at site 3 in the lamin A tail of mouse ear cartilage.

Crystal structure of piperazine-1,4-diium bis-(4-amino-benzene-sulfonate)

The asymmetric unit of the title salt, C4H12N2 (2+)·2C6H6NO3S(-), consists of half a piperazindiium dication, located about an inversion centre, and a 4-amino-benzene-sulfonate anion. The piperazine ring adopts a chair conformation. In the crystal, the cations and anions are linked via N-H⋯O and C-H⋯O hydrogen bonds, forming a three-dimensional framework. Within the framework there are C-H⋯π inter-actions and the N-H⋯O hydrogen bonds result in the formation of R 4 (4)(22) and R 3 (4)(13) ring motifs.

Conserved lamin A protein expression in differentiated cells in the earthworm Eudrilus eugeniae

Lamin A is an intermediate filament protein found in most of the differentiated vertebrate cells but absent in stem cells. It shapes the skeletal frame structure beneath the inner nuclear membrane of the cell nucleus. As there are few studies of the expression of lamin A in invertebrates, in the present work, we have analyzed the sequence, immunochemical conservation and expression pattern of lamin A protein in the earthworm Eudrilus eugeniae, a model organism for tissue regeneration. The expression of lamin A has been confirmed in E. eugeniae by immunoblot. Its localization in the nuclear membrane has been observed by immunohistochemistry using two different rabbit anti-sera raised against human lamin A peptides, which are located at the C-terminus of the lamin A protein. These two antibodies detected 70 kDa lamin A protein in mice and a single 65 kDa protein in the earthworm. The Oct-4 positive undifferentiated blastemal tissues of regenerating earthworm do not express lamin A, while the Oct-4 negative differentiated cells express lamin A. This pattern was also confirmed in the earthworm prostate gland. The present study is the first evidence for the immunochemical identification of lamin A and Oct-4 in the earthworm. Along with the partial sequence obtained from the earthworm genome, the present results suggest that lamin A protein and its expression pattern is conserved from the earthworm to humans.

Alveolar rhabdomyosarcoma on the left maxillary alveolus: a unique presentation

Rhabdomyosarcomas (RMSs) are a group of soft-tissue malignant tumours. They derive from primitive skeletal muscle tissue with head and neck as its principle location. These tumours are extremely rare in adults and it is believed to have a different natural course, treatment response, and prognosis. The invasiveness of tumour, metastasis, lymph node involvement, and the age at diagnosis is a predictor of outcome in patients with RMC. Hence early recognition and histological sub-typing is of critical importance in the therapy of the disease. We report a rare case of RMC in a 50-year-old female patient involving the left maxillary alveolus with a detailed clinical, radiological, histopathological and immunohistochemical findings.

Forecasting Japanese encephalitis incidence from historical morbidity patterns: Statistical analysis with 27 years of observation in Assam, India

BACKGROUND & OBJECTIVES

Japanese encephalitis (JE) is one of the dreaded mosquito-borne viral diseases mostly prevalent in south Asian countries including India. Early warning of the disease in terms of disease intensity is crucial for taking adequate and appropriate intervention measures. The present study was carried out in Dibrugarh district in the state of Assam located in the northeastern region of India to assess the accuracy of selected forecasting methods based on historical morbidity patterns of JE incidence during the past 22 years (1985-2006).

METHODS

Four selected forecasting methods, viz. seasonal average (SA), seasonal adjustment with last three observations (SAT), modified method adjusting long-term and cyclic trend (MSAT), and autoregressive integrated moving average (ARIMA) have been employed to assess the accuracy of each of the forecasting methods. The forecasting methods were validated for five consecutive years from 2007-2012 and accuracy of each method has been assessed.

RESULTS

The forecasting method utilising seasonal adjustment with long-term and cyclic trend emerged as best forecasting method among the four selected forecasting methods and outperformed the even statistically more advanced ARIMA method. Peak of the disease incidence could effectively be predicted with all the methods, but there are significant variations in magnitude of forecast errors among the selected methods. As expected, variation in forecasts at primary health centre (PHC) level is wide as compared to that of district level forecasts.

INTERPRETATION & CONCLUSION

The study showed that adopted forecasting techniques could reasonably forecast the intensity of JE cases at PHC level without considering the external variables. The results indicate that the understanding of long-term and cyclic trend of the disease intensity will improve the accuracy of the forecasts, but there is a need for making the forecast models more robust to explain sudden variation in the disease intensity with detail analysis of parasite and host population dynamics.

Acute ischemic stroke in aortic dissection: case report and review of literature

The estimated incidence of aortic dissection ranges from 5 to 30 cases per million per year. Nearly 38% of cases are missed at an initial presentation due to the wide range of clinical symptoms. We report a survivor of an inadvertent thrombolysis in acute ischemic stroke, secondary to aortic dissection.

Sclerostin: a candidate biomarker of SCI-induced osteoporosis

We assessed several circulating proteins as candidate biomarkers of bone status in men with chronic spinal cord injury. We report that sclerostin is significantly associated with bone mineral content and bone density at all skeletal sites tested. We found no association between bone and any other tested biomarker.

INTRODUCTION

Spinal cord injury results in severe osteoporosis. To date, no circulating biomarker of spinal cord injury (SCI)-induced osteoporosis has been identified. We recently reported that circulating sclerostin is associated with bone density in chronic SCI. In this study, we assessed several circulating proteins as candidate biomarkers of bone in men with chronic SCI.

METHODS

We assessed the relationship between bone mineral content or bone density and the following circulating bone-related proteins: sclerostin, DKK-1, soluble receptor activator of nuclear factor kappa B ligand, osteoprotegerin, osteocalcin, and c-telopeptide in 39 men with chronic SCI and 10 men with no SCI.

RESULTS

After adjusting for age, lower sclerostin levels were significantly associated with lower bone mineral content and bone density at all skeletal sites tested (p = 0.0002-0.03). No other circulating protein was associated with bone mineral content or bone mineral density (p = 0.18-0.99).

CONCLUSION

These findings suggest that circulating sclerostin reflects the severity of bone loss and is a candidate biomarker of osteoporosis severity in chronic SCI.

Diffusion weighted MR imaging versus F18 FDG PETC CT in identifying small hepatic metastases

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Background: This exploratory study assessed the ability of diffusion weighted MRI imaging in identifying small liver metastases as compared to F18- FDG PETCT. Methods: Patients with diagnosis of carcinoma of breast, lung, colorectal, pancreas, neuroendocrine and HCC who were staged for their disease using PET CT and MRI were included in the study. We randomly analyzed and compared PETCT and MRI images of 40 patients with hepatic metastases for sensitivity in detection of metastatic lesions in the liver on PETCT and MRI. Where possible, biopsy was performed if MRI/PET CT showed one or two small lesions in the liver. We performed ANCOVA to detect differences between PETCT and MRI controlling for primary sites of disease as a covariate. Results: The mean number of small lesions detected on PETCT was 0.92 where as it was 3.96 in MRI. There was a significant increase in small (p=0.02) and total number of lesions (p=0.01) seen on MRI compared to PET CT but not in large lesions. MRI was able to detect subcentimeter lesions more accurately than PET CT. Random biopsies done on small lesions found on MRI were positive for disease. MRI was able to detect small subcentimeter lesions three times more accurately than PET CT. Conclusions: MR diffusion is more sensitive in indentifying subcentimeter metastatic deposits in the liver that could help in accurate staging when PET CT is negative for liver metastases or when locoregional treatment for oligometastases is contemplated. However, pixels of DWI MRI (like reduced Signal to noise ratio at high b value, artefacts at liver edges and left lobe due to exaggerated susceptibility weighting and spin dephasing) need to be addressed by using other morphological images.