New Family of Generalized Metrics for Comparative Imaging System Evaluation

A family of imaging task-specific metrics designated Relative Object Detectability (ROD) metrics was developed to enable objective, quantitative comparisons of different x-ray systems. Previously, ROD was defined as the integral over spatial frequencies of the Fourier Transform of the object function, weighted by the detector DQE for one detector, divided by the comparable integral for another detector. When effects of scatter and focal spot unsharpness are included, the generalized metric, GDQE, is substituted for the DQE, resulting in the G-ROD metric. The G-ROD was calculated for two different detectors with two focal spot sizes using various-sized simulated objects to quantify the improved performance of new high-resolution CMOS detector systems. When a measured image is used as the object, a Generalized Measured Relative Object Detectability (GM-ROD) value can be generated. A neuro-vascular stent (Wingspan) was imaged with the high-resolution Micro-Angiographic Fluoroscope (MAF) and a standard flat panel detector (FPD) for comparison using the GM-ROD calculation. As the lower integration bound increased from 0 toward the detector Nyquist frequency, increasingly superior performance of the MAF was evidenced. Another new metric, the R-ROD, enables comparing detectors to a reference detector of given imaging ability. R-RODs for the MAF, a new CMOS detector and an FPD will be presented. The ROD family of metrics can provide quantitative more understandable comparisons for different systems where the detector, focal spot, scatter, object, techniques or dose are varied and can be used to optimize system selection for given imaging tasks.

Anti-scatter grid artifact elimination for high resolution x-ray imaging CMOS detectors

Higher resolution in dynamic radiological imaging such as angiography is increasingly being demanded by clinicians; however, when standard anti-scatter grids are used with such new high resolution detectors, grid-line artifacts become more apparent resulting in increased structured noise that may overcome the contrast signal improvement benefits of the scatter-reducing grid. Although grid-lines may in theory be eliminated by dividing the image of a patient taken with the grid by a flat-field image taken with the grid obtained prior to the clinical image, unless the remaining additive scatter contribution is subtracted in real-time from the dynamic clinical image sequence before the division by the reference image, severe grid-line artifacts may remain. To investigate grid-line elimination, a stationary Smit Röntgen X-ray grid (line density: 70 lines/cm, grid ratio 13:1) was used with both a 75 micron-pixel CMOS detector and a standard 194 micron-pixel flat panel detector (FPD) to image an artery block insert placed in a modified uniform frontal head phantom for a 20 × 20cm FOV (approximately). Contrast and contrast-to-noise ratio (CNR) were measured with and without scatter subtraction prior to grid-line correction. The fixed pattern noise caused by the grid was substantially higher for the CMOS detector compared to the FPD and caused a severe reduction of CNR. However, when the scatter subtraction corrective method was used, the removal of the fixed pattern noise (grid artifacts) became evident resulting in images with improved CNR.

Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE)

BACKGROUND

Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, demonstrated efficacy and safety in moderate-to-severe plaque psoriasis when administered via subcutaneous injection. Self-administration by pre-filled syringe (PFS) can offer patients clinical benefits of a drug, with increased convenience.

OBJECTIVES

To assess efficacy, safety and usability of secukinumab administration via PFS in subjects with moderate-to-severe plaque psoriasis.

MATERIALS AND METHODS

Subjects in this phase 3 trial were randomized 1 : 1 : 1 to secukinumab 300 or 150 mg or matching placebo. Results to week 12 are presented here. Each treatment was delivered using a PFS once weekly to week 4, and again at week 8. Co-primary endpoints were secukinumab superiority over placebo for week 12 PASI 75 (≥ 75% reduction in Psoriasis Area and Severity Index) and IGA mod 2011 (2011 modified Investigator's Global Assessment) 0/1 response rates. Secondary endpoints included PFS usability, determined by observer rating of successful, hazard-free self-injection and subject rating of acceptability by the Self-Injection Assessment Questionnaire (SIAQ).

RESULTS

Co-primary endpoints were met, with demonstration of superiority for each secukinumab dose vs. placebo at week 12 (PASI 75: 75·9%, 69·5% and 0% for secukinumab 300 mg, 150 mg and placebo; IGA mod 2011 0/1: 69·0%, 52·5% and 0%, respectively; P < 0·0001 for all comparisons vs. placebo). PFS usability was high: 100% of subjects successfully self-administered treatment at week 1, and subjects reported high SIAQ-assessed acceptability of the PFS throughout the trial. No new/unexpected safety signals were observed.

CONCLUSIONS

Secukinumab administration by PFS was effective, with an acceptable safety profile and high usability. The PFS provides a reliable, convenient form of secukinumab administration in subjects with moderate-to-severe plaque psoriasis.

A rapid and visual loop-mediated isothermal amplification assay to detect Leifsonia xyli subsp. xyli targeting a transposase gene

Leifsonia xyli subsp. xyli (Lxx), causal organism of ratoon stunt (RSD), does not produce any reliable internal or external symptoms on sugarcane. Its detection on a large scale is solely based on microscopic and serological methods. These methods require well-equipped laboratories, are time consuming and are not feasible for near-field detection of Lxx. In this study, we developed a loop-mediated isothermal amplification (LAMP) assay for rapid and sensitive detection of Lxx without the use of sophisticated equipment. To the best of our knowledge, this is the first report on the detection of Lxx in 30 min via an isothermal amplification method at 65°C. A transposase gene, ISLxx5, was used to design a set of six primers specifically targeting eight genomic sequences. The xylem sap was used as template, thus circumventing the need to isolate pure genomic DNA. The positive reactions were visually detected through a colour change of hydroxynaphthol blue (HNB) from violet to light blue, thus, eliminating the need for gel electrophoresis. The LAMP method was 10 times more sensitive than serological detection and as sensitive as immunofluorescence microscopy (IFM). The simplicity and sensitivity of the ISLxx5 LAMP assay makes it suitable for near-field diagnosis of RSD.

SIGNIFICANCE AND IMPACT OF THE STUDY

Detection of Leifsonia xyli subsp. xyli (Lxx) on a large scale is based on serological assays such as evaporative-binding enzyme-linked immunoassay (EB-EIA). These methods are time consuming and require well-equipped laboratories. This study presents the development of a loop-mediated isothermal amplification (LAMP) assay which allows detection of Lxx in 30 min at 65°C, using xylem sap as the template. The assay requires minimal laboratory equipment and could be used at near farm conditions, thus saving time and money required to transfer samples from remote areas to diagnostic laboratories. The LAMP method shows potential as an alternative detection method for RSD.

Optomechanical coupling between a multilayer graphene mechanical resonator and a superconducting microwave cavity

The combination of low mass density, high frequency and high quality factor, Q, of mechanical resonators made of two-dimensional crystals such as graphene make them attractive for applications in force/mass sensing and exploring the quantum regime of mechanical motion. Microwave optomechanics with superconducting cavities offers exquisite position sensitivity and enables the preparation and detection of mechanical systems in the quantum ground state. Here, we demonstrate coupling between a multilayer graphene resonator with quality factors up to 220,000 and a high-Q superconducting cavity. Using thermomechanical noise as calibration, we achieve a displacement sensitivity of 17 fm Hz(-1/2). Optomechanical coupling is demonstrated by optomechanically induced reflection and absorption of microwave photons. We observe 17 dB of mechanical microwave amplification and signatures of strong optomechanical backaction. We quantitatively extract the cooperativity C, a characterization of coupling strength, from the measurement with no free parameters and find C = 8, which is promising for the quantum regime of graphene motion.

A peptide inhibitor of synuclein-γ reduces neovascularization of human endometriotic lesions

Endometriosis is a chronic painful gynecological condition characterized by adherence and growth of endometrium outside of the uterine cavity. Neovascularization is essential to the developing endometriosis lesion to support its growth. Synuclein-γ (SNCG), a protein implicated in cellular proliferation, is associated with a broad range of malignancies as well as endometriosis. We hypothesized that SNCG plays an important role in the neovascularization and growth of endometriosis and blocking of SNCG will interfere with survival of endometriotic lesions in a mouse model. We developed SP012, a novel 12 amino acid peptide inhibitor of SNCG. SP012 inhibited three-dimensional endothelial cell tube formation in a dose-dependent manner. Using intravital microscopy, SP012 was shown to be successfully delivered to human endometriotic lesions in a xenograft mouse model in vivo. Alymphoid (BALB/c-Rag2-/-Il2rγ-/- lacking T, B and NK cells) mice were surgically induced with human endometriotic lesions and treated with SP012 or phosphate-buffered saline control. SP012 treated endometriotic lesions had decreased growth, development and vascularization at the time of necroscopy. Endometriotic lesions treated with SP012 also had fewer isolectin (+) microvessels. These results, using a mouse model, indicate that SNCG plays a role in the neovascularization and subsequent growth of human endometriotic lesions. Targeting SNCG function using peptide inhibitor might provide a potential therapeutic option for the treatment of endometriosis in the future.

Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India

BACKGROUND & OBJECTIVES

There is no national spinal trauma registry available in India at present and the research on epidemiology of these injuries is also very limited. The purpose of this study was to describe the mortality profile of patients with spinal injuries brought to a level I trauma centre in India, and to understand the predictive factors which identify patients at an increased risk of spinal trauma mortality.

METHODS

Retrospective data were collected from computerized patients records and autopsy reports maintained in the department of Forensic Medicine. All the cases with spinal injuries whether in isolation or as a part of polytrauma were reviewed. A total of 341 such cases were identified between January 2008 to December 2011. The demographic data, type of trauma, duration of survival, body areas involved, level of spinal injury and associated injuries if any, were recorded.

RESULTS

There were 288 (84.45%) males and 53 (15.55%) females. Most victims (73%) were between 25 and 64 yr of age, followed by young adults between 16 and 24 yr (19.35%). Male: female ratio was 5.4:1. Fifty five per cent cases had spinal injuries in isolation. Injury to the cervical spine occurred in 259 (75.95%) patients, thoracic spine in 56 (16.42%) and thoraco-lumbar spine in 26 (7.62%) patients. The commonest cause of injury was high energy falls (44.28%), followed by road traffic accidents (41.93%). The majority of deaths (51.6%) occurred in the phase IV (secondary to tertiary complications of trauma, i.e. >1 wk). Forty patients died in phase I (brought dead or surviving <3 h), 55 in phase II (>3 to 24 h) and 70 in phase III (> 24 h to 7 days).

INTERPRETATION & CONCLUSIONS

Our data suggest that there is an urgent need to take steps to prevent major injuries, strengthen the pre-hospital care, transportation network, treatment in specialized trauma care units and to improve injury surveillance and the quality of data collected which can guide prevention efforts to avoid loss of young active lives.

Cold-nuclear-matter effects on heavy-quark production at forward and backward rapidity in d + Au collisions at √sNN = 200 GeV

The PHENIX experiment has measured open heavy-flavor production via semileptonic decay over the transverse momentum range 1 < p(T) < 6  GeV/c at forward and backward rapidity (1.4 < |y| < 2.0) in d+Au and p + p collisions at √sNN = 200  GeV. In central d+Au collisions, relative to the yield in p + p collisions scaled by the number of binary nucleon-nucleon collisions, a suppression is observed at forward rapidity (in the d-going direction) and an enhancement at backward rapidity (in the Au-going direction). Predictions using nuclear-modified-parton-distribution functions, even with additional nuclear-p(T) broadening, cannot simultaneously reproduce the data at both rapidity ranges, which implies that these models are incomplete and suggests the possible importance of final-state interactions in the asymmetric d + Au collision system. These results can be used to probe cold-nuclear-matter effects, which may significantly affect heavy-quark production, in addition to helping constrain the magnitude of charmonia-breakup effects in nuclear matter.

Azimuthal-angle dependence of charged-pion-interferometry measurements with respect to second- and third-order event planes in Au+Au collisions at √[S(NN)]=200 GeV

Charged-pion-interferometry measurements were made with respect to the second- and third-order event plane for Au+Au collisions at sqrt[s_{NN}]=200  GeV. A strong azimuthal-angle dependence of the extracted Gaussian-source radii was observed with respect to both the second- and third-order event planes. The results for the second-order dependence indicate that the initial eccentricity is reduced during the medium evolution, which is consistent with previous results. In contrast, the results for the third-order dependence indicate that the initial triangular shape is significantly reduced and potentially reversed by the end of the medium evolution, and that the third-order oscillations are largely dominated by the dynamical effects from triangular flow.

Role of the QuantiFERON®-TB Gold In-Tube test in the diagnosis of intrathoracic childhood tuberculosis

SETTING

Tertiary care hospitals in India.

OBJECTIVE

To compare the performance of the QuantiFERON®-TB Gold In-Tube test (QFT-GIT) with that of the tuberculin skin test (TST) in the diagnosis of intrathoracic childhood tuberculosis (TB).

METHODS

Children with intrathoracic TB were enrolled in a randomised controlled trial studying micronutrient supplementation in intrathoracic TB. They underwent TST and QFT-GIT before starting daily anti-tuberculosis treatment.

RESULTS

Of 362 children (median age 115.5 months, IQR 73-144, 55% girls) enrolled in the study, microbiological confirmation of TB was obtained in 128 (35%). The TST was positive in 337 (93%, 95%CI 90-95.5) and QFT-GIT in 297 (82%, 95%CI 77.8-85.6). Sensitivity of TST and QFT-GIT in culture-confirmed TB cases was respectively 90.5% (95%CI 84.1-94.5) and 82.6% (95%CI 74.9-88.4). QFT-GIT positivity rate correlated with TST induration (P < 0.001). TST was influenced by the disease spectrum (P = 0.004) and the age of the children (P = 0.002); QFT-GIT remained unaffected by these factors. Bacille Calmette-Guérin immunisation status, weight-for-age Z-scores and microbiological confirmation of Mycobacterium tuberculosis did not influence the performance of either test.

CONCLUSION

In high-burden countries, QFT-GIT is comparable to TST and offers no added advantage in the diagnosis of childhood intrathoracic TB.

Effect of plasmon-enhancement on photophysics in upconverting nanoparticles

Surface plasmon polaritons (SPP) waves have been shown to significantly affect the near-field photophysical phenomenon. In particular, strong Coulombic interactions can enhance nearby non-linear optics and energy transfer process, while SPP waves also affect other photophysical processes like quenching observed in fluorescent and excitonic systems. Here, using different plasmonic substrates, we show the effect of plasmon-enhancement on quenching, phonon-assisted non-radiative decay, weak Purcell effect or electromagnetic field enhancement, and energy transfer rates of upconverting doped-lanthanide nanoparticles. While the resonant plasmons enhance the local electromagnetic field and the rate of energy transfer leading to enhanced upconversion photoluminescence of infrared radiation to visible light, it can also increase the quenching and non-radiative decay rates of photoexcited electron-hole pairs leading to losses and lower efficiency. These results can guide the design of optimized substrate geometry for using surface plasmons to modulate the photophysics in other applications too.

Low cost technology for screening early cancerous lesions of oral cavity in rural settings

BACKGROUND

Low cost technologies are needed in resource poor rural settings for detection of pre-cancer and cancer lesions of the oral cavity.

AIM

The study was undertaken to investigate the feasibility of a low cost technology (Magnivisualizer) for the early detection any lesions of the oral cavity among tobacco users in a resource poor rural field setting.

SUBJECTS AND METHODS

A total of 1329 tobacco users were motivated to come forward for oral examination in the camp organized for this purpose. Their oral cavities were screened with a torch and Magnivisualizer by a Dentist.

RESULTS

With torch light, 104/1329 (7.8%) lesions were identified, though only 62/104 (59.6%) positive lesions could be differentiated into various categories. However, through Magnivisualizer 156/1329 (11.7%) lesions were detected and 153/156 (98.1%) positive lesions were differentiated into different categories.

CONCLUSION

Magnivisualizer offers an alternative instrument for detecting most of the early cancerous and high-grade precancerous lesions and it can be used in the rural field settings.

Limitations of anti-scatter grids when used with high resolution image detectors

Anti-scatter grids are used in fluoroscopic systems to improve image quality by absorbing scattered radiation. A stationary Smit Rontgen X-ray grid (line density: 70 lines/cm, grid ratio: 13:1) was used with a flat panel detector (FPD) of pixel size 194 micron and a high-resolution CMOS detector, the Dexela 1207 with pixel size of 75 microns. To investigate the effectiveness of the grid, a simulated artery block was placed in a modified uniform frontal head phantom and imaged with both the FPD and the Dexela for an approximately 15 × 15 cm field of view (FOV). The contrast improved for both detectors with the grid. The contrast-to-noise ratio (CNR) does not increase as much in the case of the Dexela as it improves in the case of the FPD. Since the total noise in a single frame increases substantially for the Dexela compared to the FPD when the grid is used, the CNR is degraded. The increase in the quantum noise per frame would be similar for both detectors when the grid is used due to the attenuation of radiation, but the fixed pattern noise caused by the grid was substantially higher for the Dexela compared to the FPD and hence caused a severe reduction of CNR. Without further corrective methods this grid should not be used with high-resolution fluoroscopic detectors because the CNR does not improve significantly and the visibility of low contrast details may be reduced. Either an anti-scatter grid of different design or an additional image processing step when using a similar grid would be required to deal with the problem of scatter for high resolution detectors and the structured noise of the grid pattern.

Relative object detectability (ROD): a new metric for comparing x-ray image detector performance for a specified object of interest

Relative object detectability (ROD) quantifies the relative performance of two image detectors for a specified object of interest by taking the following ratio: the integral of detective quantum efficiency of a detector weighted by the frequency spectrum of the object divided by that for a second detector. Four different detectors, namely the micro-angiographic fluoroscope (MAF), the Dexela Model 1207 (Dex) and Hamamatsu Model C10901D-40 (Ham) CMOS x-ray detectors, and a flat-panel detector (FPD) were compared. The ROD was calculated for six pairs of detectors: (1) Dex/FPD, (2) MAF/FPD, (3) Ham/FPD, (4) Dex/Ham, (5) MAF/Ham and (6) MAF/Dex for wires of 5 mm fixed length, solid spheres ranging in diameter from 50 to 600 microns, and four simulated iodine-filled blood vessels of outer diameters 0.4 and 0.5 mm, each with wall thicknesses of 0.1 and 0.15 mm. Marked variation of ROD for the wires and spheres is demonstrated as a function of object size for the various detector pairs. The ROD of all other detectors relative to the FPD was much greater than one for small features and approached 1.0 as the diameter increased. The relative detectability of simulated small iodine-filled blood vessels for all detector pairs was seen to be independent of the vessel wall thickness for the same inner diameter. In this study, the ROD is shown to have the potential to be a useful figure of merit to evaluate the relative performance of two detectors for a given imaging task.

Pediatric lupus: varied haematological picture and presentation

Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease characterized by periods of increased disease activity caused by inflammation of blood vessels and connective tissue. Pediatric patients with SLE have a more severe clinical course when compared with adults. Patients commonly present with rash, fever, and arthritis, although the presentation may be unpredictable. Hematological findings are more predominant in children than adults. Thirty-nine percent of children with SLE will develop hematological abnormalities, one of the American Rheumatic Association criteria for classifying the disease. In our case series we found varied hematological picture and presentation. We present here four case reports of SLE cases with interesting hematological features. Our first case is a 13 month old female child who was initially diagnosed as Evans syndrome and 2 years later diagnosed as SLE. Second case is a 3 year old male child who had SLE with warm antibody AIHA. Third case is a 6 year old female child who presented with AIHA and was diagnosed with SLE 6 years later. Fourth case is a 6 year old female child diagnosed as SLE with aplastic anemia. Hematological findings should be carefully assessed and treated in order to decrease disease related morbidity.

Process integration for simultaneous saccharification, fermentation, and recovery (SSFR): production of butanol from corn stover using Clostridium beijerinckii P260

A simultaneous saccharification, fermentation, and recovery (SSFR) process was developed for the production of acetone-butanol-ethanol (AB or ABE), of which butanol is the main product, from corn stover employing Clostridium beijerinckii P260. Of the 86 g L(-1) corn stover provided, over 97% of the sugars were released during hydrolysis and these were fermented completely with an ABE productivity of 0.34 g L(-1)h(-1) and yield of 0.39. This productivity is higher than 0.31 g L(-1)h(-1) when using glucose as a substrate demonstrating that AB could be produced efficiently from lignocellulosic biomass. Acetic acid that was released from the biomass during pretreatment and hydrolysis was also used by the culture to produce AB. An average rate of generation of sugars during corn stover hydrolysis was 0.98 g L(-1)h(-1). In this system AB was recovered using vacuum, and as a result of this (simultaneous product recovery), 100% sugars were used by the culture.

An in vitro study on catecholamine modulation of ovarian steroidogenic activity in the catfish Heteropneustes fossilis

In the present study, α-methylparatyrosine (α-MPT), a tyrosine hydroxylase inhibitor was used to impair ovarian catecholaminergic activity in vitro. The consequent effects on catecholamine (CA) levels were correlated with follicular steroid production. l-dihdroxyphenylalanine (l-DOPA, the precursor of CA) and human gonadotropin (hCG) were supplemented to reverse the effect of α-MPT. The experiments were conducted in two reproductive phases, namely preparatory and pre-spawning phases in female catfish Heteropneustes fossilis. The incubation with α-MPT inhibited ovarian l-DOPA, dopamine (DA), norepinephrine (NE) and epinephrine (EP) levels and the l-DOPA supplementation compensated the inhibitory effect. The level of tyramine (TR) was increased by the α-MPT treatment but inhibited by the l-DOPA supplementation. α-MPT produced stage-specific (seasonal) effects on ovarian estradiol-17β (E2); in the preparatory phase, E2 was decreased significantly at both 12 and 24h and in the pre-spawning phase, the level was stimulated over the respective control groups. The changes were higher at 24h in both phases. l-DOPA and hCG increased the E2 level significantly in the preparatory phase and reversed the inhibitory effect of α-MPT in the co-incubation groups. In the pre-spawning phase, α-MPT-stimulated the E2 level compared to the control groups, which was reversed by l-DOPA, hCG, or by both, in co-incubations. In contrast, the α-MPT treatment decreased progesterone (P4), 17-hydroxyprogesterone and 17,20β-dihydroxy-4-prenen-3-one (17,20β-DP) in a duration-dependent manner while the co-incubations with l-DOPA, hCG, or by both, significantly reversed the inhibitory effect. These results suggest that ovarian CAs (DA, NE and EP) may exert differential and stage-specific effects on E2, inhibition in the preparative phase and stimulation in the pre-spawning phase. The progestin steroids appear to be stimulated by CAs. In conclusion, this study highlights a possible direct/causal functional interaction between CA activity and gonadotropin on steroidogenic activity, and that CAs may be involved in regulating temporal secretion of the hormones through causing the shift in steroidogenic pattern.

Effect of micronutrient deficiency on QuantiFERON-TB Gold In-Tube test and tuberculin skin test in diagnosis of childhood intrathoracic tuberculosis

BACKGROUND/OBJECTIVES

Data on performance of QuantiFERON-TB Gold In-Tube test (QFT) and tuberculin skin test (TST) in children with active tuberculosis from high burden countries in the context of micronutrient deficiency are scarce. The objective of this study was to evaluate the effect of micronutrient deficiency on the performance of TST and QFT in children with intrathoracic tuberculosis.

SUBJECTS/METHODS

Children with probable intrathoracic tuberculosis underwent TST, QFT, gastric lavages and induced sputum examination for AFB (Acid-Fast Bacilli) smear and culture. Zinc, copper, ferritin and vitamin D were measured on stored serum samples. The study used cross-sectional data at initiation of anti-tubercular therapy.

RESULTS

Three hundred and sixty-two children (median age 115.5 months (interquartile range: 73, 144), 200 (55.3%) girls) were enrolled in the study. Microbiological confirmation of tuberculosis could be obtained in 128 patients. TST and QFT were positive in 337 (93%) and 297 (82%) children, respectively. Performance of both the tests was unaffected by weight-for-age and height-for-age 'z-scores' or by serum copper levels. TST was not affected by serum zinc and ferritin levels. Children with negative QFT results had lower mean serum zinc level (P=0.01) and higher ferritin levels (P=0.007) as compared to those with positive test. Higher proportion of children with positive TST were vitamin D deficient/insufficient (P=0.003).

CONCLUSION

Micronutrient status, especially serum levels of zinc, may influence the performance of QFT in children with intrathoracic tuberculosis. Considering the high prevalence of zinc deficiency in developing countries, QFT should be used cautiously for diagnosing tuberculosis.

Swelling equilibrium of dentin adhesive polymers formed on the water-adhesive phase boundary: experiments and micromechanical model

During their application to the wet, oral environment, dentin adhesives can experience phase separation and composition change, which can compromise the quality of the hybrid layer formed at the dentin-adhesive interface. The chemical composition of polymer phases formed in the hybrid layer can be represented using a ternary water-adhesive phase diagram. In this paper, these polymer phases are characterized using a suite of mechanical tests and swelling experiments. The experimental results were evaluated using a granular micromechanics-based model incorporating poro-mechanical effects and polymer-solvent thermodynamics. The variation in the model parameters and model-predicted polymer properties was studied as a function of composition along the phase boundary. The resulting structure-property correlations provide insight into interactions occurring at the molecular level in the saturated polymer system. These correlations can be used for modeling the mechanical behavior of the hybrid layer, and are expected to aid in the design and improvement of water-compatible dentin adhesive polymers.

Cardioversion in late pregnancy: a case report

About 1% of all pregnancies are complicated by maternal cardiac diseases. Among the various cardiac pathologies complicating pregnancy, arrhythmias are the most common. Most of them are diagnosed for the first time during pregnancy. Tachyarrhythmias are the commonest form of arrhythmias reported during pregnancy. Risk factors for this are the presence of organic heart disease, various hormonal and hemodynamic changes during pregnancy. Fortunately most of these arrhythmias are benign and require no intervention. Treatment options must take into consideration hemodynamic status of mother, gestational age and the possible teratogenic effect of medications on the fetus. We are hereby reporting a case of successful electrical cardioversion performed in a woman at 37th week of gestation due to resistant symptomatic atrial fibrillation.

Quadrupole anisotropy in dihadron azimuthal correlations in central d+Au collisions at √(s(NN))=200 GeV

The PHENIX collaboration at the Relativistic Heavy Ion Collider (RHIC) reports measurements of azimuthal dihadron correlations near midrapidity in d+Au collisions at √(s(NN))=200 GeV. These measurements complement recent analyses by experiments at the Large Hadron Collider (LHC) involving central p+Pb collisions at √(s(NN))=5.02 TeV, which have indicated strong anisotropic long-range correlations in angular distributions of hadron pairs. The origin of these anisotropies is currently unknown. Various competing explanations include parton saturation and hydrodynamic flow. We observe qualitatively similar, but larger, anisotropies in d+Au collisions at RHIC compared to those seen in p+Pb collisions at the LHC. The larger extracted v2 values in d+Au are consistent with expectations from hydrodynamic calculations owing to the larger expected initial-state eccentricity compared with that from p+Pb collisions. When both are divided by an estimate of the initial-state eccentricity the scaled anisotropies follow a common trend with multiplicity that may extend to heavy ion data at RHIC and the LHC, where the anisotropies are widely thought to arise from hydrodynamic flow.

Nuclear modification of ψ', χc, and J/ψ production in d+Au collisions at sqrt[s(NN)]=200 GeV

We present results for three charmonia states (ψ', χc, and J/ψ) in d+Au collisions at |y|<0.35 and sqrt[s(NN)]=200  GeV. We find that the modification of the ψ' yield relative to that of the J/ψ scales approximately with charged particle multiplicity at midrapidity across p+A, d+Au, and A+A results from the Super Proton Synchrotron and the Relativistic Heavy Ion Collider. In large-impact-parameter collisions we observe a similar suppression for the ψ' and J/ψ, while in small-impact-parameter collisions the more weakly bound ψ' is more strongly suppressed. Owing to the short time spent traversing the Au nucleus, the larger ψ' suppression in central events is not explained by an increase of the nuclear absorption owing to meson formation time effects.

VIA screening for cervical cancer in developing countries: potential role of the light source

A total of 385 symptomatic patients presenting to the gynaecology and obstetrics outpatient department were screened by two sources of light: the yellow light of the tungsten bulb and the white light of the halogen bulb (100 Watt, 12 Volt), fitted with KODAK 80B filter and diffuser in an instrument called a 'Magnivisualizer' (developed by our Institute). Colposcopic examination was the gold standard for visualisation of the cervix. This study clearly brings out the significance of visual examination of the cervix using white light; as, in addition to having perfect correlation with colposcopy (0.86 for white vs 0.53 for yellow light), white light enables us to select the correct site of biopsy. Most of the rural clinics use torch or ordinary tungsten bulb, thus missing many significant lesions. In the light of our research findings, we strongly recommend the use of white light (complete spectrum of light) for screening purposes.

Comparison between limbal (von Noorden) and para limbal (Santiago) conjunctival incisions for adjustable recessions of horizontal recti

INTRODUCTION

Both limbal and para limbal conjunctival incisions are routinely used in strabismus surgery with comparable results however their outcome has not been compared while using adjustable sutures.

OBJECTIVE

To compare limbal (von Noorden) and para limbal (Santiago) conjunctival incisions for adjustable recessions of horizontal recti.

SUBJECTS AND METHODS

Uniocular adjustable recessions (with conventional non adjustable resection) in 24 appropriate patients were performed according to standard slip knot technique. The patients were assigned to the two groups after obtaining an informed consent using systematmic randomization. Twelve patients in first group received the von Noorden incision with bare sclera closure and 12 in the second group received the Santiago's modification of Swan incision with deferred closure. The surgeries were performed by a single surgeon and the adjustments performed after 24 hours. The incisions were studied on the established subjective (pain) and objective (hyperaemia, chemosis, discharge and gap in incision) variables at follow ups of 1st day post adjustment, 2 weeks and 12 weeks.

STATISTICS

'Repeated Measures Anova' test was used for statistical analysis. A p value Less than 0.05 was considered statistically significant.

RESULTS

The limbal incision was superior to the paralimbal incision on both objective and subjective criteria by 'Repeated Measures Anova' test.

CONCLUSION

We recommend using limbal incision and avoiding para limbal incisions while performing adjustable recessions.

Presence or absence of intestinal metaplasia but not its burden is associated with prevalent high-grade dysplasia and cancer in Barrett's esophagus

Universal agreement on the inclusion of intestinal metaplasia to diagnose Barrett's esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64±12 vs. 60±11 years, P=0.001; whites 92% vs. 82%, P=0.001; males 99.7% vs. 99.3%, P=NS; CLE length 3.4±3.2 vears 1.4±0.4 cm, P=0.001 and hiatus hernia 64% vs. 56%, P=0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P=0.007) and 4.2-fold (95% CI 1.4-13, P=0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P=0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE.

Management of temporomandibular joint ankylosis type III: lateral arthroplasty as a treatment of choice

Many surgical techniques for the management of temporomandibular joint (TMJ) ankylosis have been described in the literature. The purpose of this study was to report our experience using a lateral arthroplasty technique in the management of type III ankylosis. The records of 15 patients treated for TMJ ankylosis at our institution between 2007 and 2011 were reviewed. Pre- and postoperative information collected included age, gender, aetiology, ankylosis type/classification, existing facial asymmetry, maximum pre- and postoperative mouth opening, complications, and recurrence of ankylosis. The mean maximum inter-incisal opening in the preoperative period was 12.9 mm and in the postoperative period was 36.2mm. No major complication was observed in any patient. No recurrence was noted in any patient. Our working hypothesis was that for patients with ankylosis type III, the medially displaced condyle and disc can fulfil their role in mandibular function and growth after extirpation of the ankylozed mass. Although they are located in an awkward medial position, they should function exactly as they would after a properly treated, displaced condylar fracture.