Intelligent-reflecting-surfaces-assisted hybrid FSO/RF communication with diversity combining: a performance analysis

Free space optics (FSO) and radio frequency (RF) communication systems exhibit complementary characteristics, with FSO being susceptible to fog, turbulence, and pointing errors, whereas RF is susceptible to rain and small scale fading. These inherent complementary characteristics between FSO and RF communication systems enable the hybrid configuration to effectively alleviate the impact of environmental impediments. This paper presents the performance analysis of an intelligent reflecting surfaces (IRSs)-assisted hybrid FSO/RF system under atmospheric turbulence (AT), pointing errors (PE), small scale fading effects, and attenuation due to climatic conditions such as fog, rain, etc. To characterize the AT, gamma-gamma distribution is used, and the multipath fading in the RF link is modeled using Nakagami-m distribution. At the receiver, signals from both the FSO and RF links are combined using either the selection combining (SC) or maximal-ratio combining (MRC) technique. We derive the exact closed-form expressions for outage probability and average symbol error rate (ASER) for both diversity combining schemes. The proposed system is compared with the direct link (DL) FSO system, IRSs-assisted FSO system, and hybrid FSO/RF system with diversity combining schemes. Further, the performance comparison between the SC and MRC schemes is also reported. Finally, the accuracy of the analytical expressions is verified by utilizing Monte Carlo simulations.

An assessment of childhood cancer care services in India - gaps, challenges and the way forward

Background

Childhood cancers are emerging as an essential concern in India where there is lack of a specific programme component or policy to address childhood cancer control. There is limited information on the status and quality of childhood cancer care services in India. This paper describes the childhood cancer care services available at secondary and tertiary-level hospitals in India through a cross sectional study design.

Methods

The survey was conducted in 137 tertiary-level and 92 secondary-level hospitals in 26 states and 4 Union Territories (UTs), ensuring a uniform representation of public and private care hospitals. The study tool collected data on the organisational infrastructure, type of oncology services, health workforce, equipment, treatment and referral protocols, and treatment guidelines. Descriptive statistics was used to primarily present the health service status and data on childhood cancer care services in proportions and mean.

Findings

A dedicated pediatric oncology department was available in 41.6% of the public, 48.6% of private, and 64% Non Government Organization (NGO) managed tertiary-level hospitals. In 36 (39%) of the 92 hospitals providing secondary care, childhood cancer care was provided. The availability of bone (41.5%) and positron emission tomography (PET) scans (25.9%) was lower in public tertiary hospitals, whereas histopathology, computerised tomography (CT scan), and magnetic resonance imaging (MRI) were lower in public secondary hospitals than private and NGO managed hospitals for the corresponding level of care. Most tertiary hospitals had the required supportive care facilities except for play therapy and hospice care. Less than 50% of the public tertiary hospitals had stocks of the four categories of cancer-treating drugs and essential infrastructure for radiotherapy and chemotherapy. Most secondary-level hospitals not treating childhood cancer had referral linkages with tertiary hospitals.

Interpretation

The situational analysis of childhood cancer care services in India showed the concentration of availability of childhood cancer care services at the tertiary level of health care. There were gaps in the availability of specialised pediatric oncology care in all the tertiary hospitals. The availability of childhood cancer care services was higher in private and NGO-managed hospitals than in public hospitals. Integration of childhood cancer as a part of the national cancer control response should be taken up as a matter of priority. The need of the hour is to formulate a childhood cancer policy that will enable timely access to care universally.

Funding

World Health Organization, India provided funding and technical support.

A systematic review on efficacy, safety and cost-effectiveness of office-based laryngeal biopsy

OBJECTIVE

Laryngeal cancer is the second most prevalent head and neck malignancy in the USA. With recent advances in technology, this procedure is increasingly performed under local anaesthesia. This study aimed to identify the efficacy, safety and cost-effectiveness of laryngeal biopsy in out-patients by conducting a systematic review.

METHOD

A literature search was conducted using PubMed, Medline, Google Scholar and Embase over a 20-year period. Inclusion criteria were: studies performed on out-patient diagnostic biopsy procedures of the larynx. Exclusion criteria included all therapeutic procedures. The outcome measures were sensitivity and specificity, complication rate and cost-savings.

RESULTS

Thirty-five studies were included in the analysis. The sensitivity and specificity varied from 60 to 100 per cent with a low complication rate and cost savings.

CONCLUSION

Office-based laryngeal biopsies are increasingly used in the diagnosis of laryngeal cancers, resulting in earlier diagnosis and commencement of treatment. The barrier to undertaking this procedure is low sensitivity.

Multihop IRS-assisted free space optics communication with DF relaying: a performance analysis

Free space optics communication (FSO) offers several advantages over its counterpart radio frequency (RF) systems in terms of bandwidth, data rates, and cost efficiency. However, FSO, being a line-of-sight (LoS) communication system, is hindered by various environmental factors. In this paper, we propose a multihop decode-and-forward (DF) relaying-based intelligent reflecting surface (IRS)-assisted FSO system with an aim to deal with the impediments in FSO communication, and it is assumed that each IRS consists of multiple reflecting elements. Specifically, we derive end-to-end expressions for cumulative distribution function (CDF) of output instantaneous signal-to-noise ratio (SNR). Furthermore, with the aid of the CDF statistics, we study the performance of the proposed system by obtaining the expressions for outage probability (OP) and average symbol error rate (ASER) in terms of multivariate Fox's H-function. Moreover, we have quantified the system performance by numerical results. The numerical results show that the multihop IRS-assisted FSO system provides better performance when compared to a single-hop IRS-assisted FSO system and multihop FSO system without IRS. Finally, the derived expressions of OP and ASER are validated using Monte-Carlo simulations.

Dynamics of oral human papillomavirus infection in healthy population and head and neck cancer

The recent increase in high-risk human papillomavirus (HR-HPV)-associated oral and oropharyngeal cancers has gained considerable importance due to their distinct clinical and molecular characteristics. However, the natural history of oral HPV from acquisition to persistence and malignant transformation is still unclear. The global prevalence of oral HPV infection in healthy individuals ranges from 0.67% to 35%, while 31%-38.5% in head and neck cancer (HNC). The persistence rate of oral HR-HPV infection is 5.5% -12.8% globally. India has the highest HNC burden due to apparent differences in predisposing factors compared with the West. The prevalence of oral HPV in healthy individuals and its contribution to HNC is less evident in Indian studies. HR-HPV-associated HNC in this region accounts for 26%, with an active infection in 8%-15% of these tumors. There is a lack of concordance in the expression of p16 as a surrogate marker for HPV detection in HNC because of differences in behavioral risk factors. Due to a lack of evidence, treatment de-escalation cannot be implemented despite the improved outcome of HPV-associated oropharyngeal cancers. This review critically analyzes the existing literature on the dynamics of oral HPV infection and HPV-associated HNC, identifying potential avenues for future research. A better understanding of the oncogenic role of HR-HPV in HNC will help to formulate novel therapeutic approaches and is expected to have a significant public health impact as preventive strategies can be implemented.

Assessment of Registry-Based Surveillance Statistics Used for Cancer Control in the Dindigul District in South India

Background

Cancer incidence rates from the Dindigul district were lower by 50% than Chennai in Tamil Nadu for most cancers. This study describes the cancer surveillance statistics and provides an assessment of missing cases from routine registration in the Dindigul Ambilikkai Cancer Registry (DACR), covering a predominantly rural population in the Dindigul district.

Method

A total of 21,214 incident cancers in the DACR during 2003-2017 were examined for this study. Cancer registration was carried out by active case-finding following standard international norms. A total of 12,541 incident cancers registered during 2003-2012 and followed through 2014 were used to estimate survival. Data on follow-up were obtained through a mixture of active and passive methods. Survival probability was estimated by actuarial methods. A random survey carried out independently was used to assess the quality of case ascertainment.

Results

The age-standardized rate (ASR) per 100,000 population was higher among women (76.2) than men (61) in 2013-2017, with both sexes reporting a 17% increase compared to 2003-2007. The most common cancers were cervix (ASR,18.5) and female breast (ASR,17.1), with percentage changes of -19% and +46.1%, respectively. Lung cancer (ASR, 5.5) was top among men with an increasing trend (+57.1%). The percent change in ASR of mouth cancer showed opposite trends among men (+24.3%) and women (- 21.4%). The ASR of colorectal cancers almost doubled among men between 2003-2007 and 2013-2017 (3.9; +94.7%). The 5- and 10-year absolute survival for all cancers were 31% and 20%, respectively. Out of 365 incident cancers that occurred during 2003-2010 in the surveyed areas, 310 (84.9%) were already registered in the DACR, while 55 were newly identified from the survey (15.1%). Inadequate coverage of sources outside the Dindigul district was significant (P = .002), with the highest number of missed cases from hospitals under nongovernment sectors (58.3%). Underascertainment was higher among cancer patients living in hilly regions (60%) and border areas (47.4%) than in core regions (P = .05).

Conclusion

Because of an enacted government order making cancer a notifiable disease, the registry-based cancer surveillance could be extended, covering a population of 80 million in a cost-effective manner with enhanced coverage and systematic evaluation of cancer-screening programs.

Assessment of Mental Workload by Visual Motor Activity among Control Group and Patient Suffering from Depressive Disorder

Major depressive disorder (MDD) is a mood state that is not usually associated with vision problems. Recent research has found that the inhibitory neurotransmitter GABA levels in the occipital brain have dropped. Aim. The aim of the research is to evaluate mental workload by single channel electroencephalogram (EEG) approach through visual-motor activity and comparison of parameter among depressive disorder patient and in control group. Method. Two tests of a visual-motor task similar to reflect drawings were performed in this study to compare the visual information processing of patients with depression to that of a placebo group. The current study looks into the accuracy of monitoring cognitive burden with single-channel portable EEG equipment. Results. The alteration of frontal brain movement in reaction to fluctuations in cognitive burden stages generated through various vasomotor function was examined. By applying a computerised oculomotor activity analogous to reflector image diagram, we found that the complexity of the path to be drawn was more important than the real time required accomplishing the job in determining perceived difficulty in depressive disorder patients. The overall perceived difficulty of the exercise is positively linked with EEG activity measured from the motor cortex region at the start of every experiment test. The average rating for task completion for depression patients and in control group observed and no statistical significance association reported between rating scale and time spent on each trial (p=1.43) for control group while the normalised perceived difficulty rating had 0.512, 0.623, and 0.821 correlations with the length of the pathway, the integer of inclination in the pathway, and the time spent to complete every experiment test, respectively (p < 0.0001) among depression patients. The findings imply that alterations in comparative cognitive burden levels during an oculomotor activity considerably modify frontal EEG spectrum. Conclusion. Patients with depression perceived the optical illusion in the arrays as weaker, resulting in a little bigger disparity than individuals who were not diagnosed with depression. This discovery provided light on the prospect of adopting a user-friendly mobile EEG technology to assess mental workload in everyday life.

Cold atmospheric plasma driven self-assembly in serum proteins: insights into the protein aggregation to biomaterials

The self-assembly of proteins is crucial in many biomedical applications. This work deals with understanding the role of cold atmospheric plasma (CAP) on the self-assembly of two different proteins present in the serum – BSA and hemoglobin and to elucidate the process associated with the direct application of physical plasma on or in the human (or animal) body, which has implications in therapeutics. The work has been corroborated by several spectroscopic studies such as fluorescence spectroscopy, circular dichroism spectroscopy, and SEM analysis. Through steady-state fluorescence spectroscopy and by following the tryptophan fluorescence, we observed that the emission intensity was quenched for the protein when treated with plasma radiation. Circular dichroism spectroscopy revealed that the structure of the protein was altered both in the case of BSA and hemoglobin. N-Acetyl tryptophanamide (NATA), which resembles the tryptophan in the protein, was treated with CAP and we observed the similar quenching of fluorescence as in the proteins, indicating that the protein underwent self-assembly. Time-resolved fluorescence spectroscopy with a decrease in the lifetime revealed that the protein self-assembly was promoted with CAP treatment, which was also substantiated by SEM micrographs. The ROS/RNS produced in the CAP has been correlated with the protein self-assembly. This work will help to design protein self-assembled systems, and in the future, may bring possibilities of creating novel biomaterials with the help of plasma radiation.

Self-assembly of proteins after CAP treatment.

Karanjin

Karanjin [IUPAC: 3-methoxy-2-phenylfuro-(2,3-h-chrome-4-ol)], a bioactive furanoflavonoid and a potent biomolecule, was first isolated from Pongamia pinnata (L.). The crude extracts from root, leaf and seed having active constituent karanjin is highly valued in both traditional and modern knowledge systems. This review highlights, critically assesses, and presents the probable biosynthetic pathways of karanjin and its isolation methodologies with a view to actualizing its full potential. Karanjin exhibits multiple health benefits and applications, with evident anti-diabetic, anti-cancer, anti-inflammatory, anti-hyperglycemic, antioxidant, anti-colitis, anti-ulcer, and anti-Alzheimer properties. Consequently, the physiochemical properties and biological effects of karanjin have been detailed and analyzed. The efficacy of karanjin has been attenuated by toxicological studies that have proven karanjin to be non-toxic at physiological conditions as substantiated by in vitro and in vivo studies. In addition, the multiple insect repellent/insecticidal properties of karanjin and its availability as an acaricide/bio-insecticide have been reviewed. This review article underscores and endorses the immense potential for novel drug leads in various medicinal and industrial applications, suggesting a deeper insight into its metabolic fate, bioavailability, and cellular effects that await further investigations.

Comparison of gait, functional activities, and patient-reported outcome measures in patients with knee osteoarthritis and healthy adults using 3D motion analysis and activity monitoring: an exploratory case-control analysis

Objective

To examine functional performance differences using kinematic and kinetic analysis between participants with and without knee osteoarthritis (OA) to determine which outcomes best characterize persons with and without knee OA.

Methods

Participants with unilateral moderate knee OA (Kellgren–Lawrence grades 2 or 3) and controls without knee pain were matched for age, gender, and body mass index. Primary outcomes included temporal parameters, joint rotations and moments, and ground reaction forces assessed via 3D motion capture during walking and ascending/descending stairs. Secondary outcomes included timed functional activities (sit to stand; tying shoelaces), 48 hrs lower limb activity monitoring, and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, European Quality of Life–5 Dimensions).

Results

Eight matched pairs were analyzed. Compared with controls, OA participants exhibited significant reductions in peak frontal hip and sagittal knee moments, and decreased peak anterior ground reaction force with the affected limb while walking. Ascending stairs, OA participants had slower speed, fewer strides per minute, longer cycle and stance times, and increased trunk range of motion (ROM) in assessments of both limbs; longer swing time and reduced ankle ROM in the affected limb; and increased knee frontal ROM in the unaffected limb. Descending stairs, OA participants had fewer strides per minute and decreased trunk transverse ROM in assessments of both limbs; increased knee frontal ROM in the affected limb; and longer strides, shorter stance and cycle times, increased trunk sagittal and decreased knee transverse ROMs in the unaffected limbs vs controls. Compared with controls, OA participants had slower walking cadence (120–130 vs 100–110 steps/min, respectively), took significantly longer on timed functional measures, and had significantly worse scores in patient-reported outcomes.

Conclusion

Several objectives and patient-reported measures examined in this study could potentially be considered as outcomes in pharmacologic or physical therapy OA trials.

Evaluation of Cytogenetic Abnormalities in Patients with Acute Lymphoblastic Leukemia

Acute lymphoblastic leukemia (ALL) accounts for 20% of all adult leukemias and is the most common leukemia during childhood (80%). We present data on cytogenetics of ALL from a tertiary centre in India correlating it with clinical factors. Karyotyping of bone marrow samples of 204 patients with newly diagnosed ALL was performed with standard G-banding technique. Clinical data of patients was obtained from case records. Survival was estimated using Kaplan-Meir curves and compared by the log-rank test. Univariate and multivariate analysis was done for survival with age, sex, immunophenotype, hyperleukocytosis, risk type, remission status and cytogenetics. The most common karyotypes observed were normal in 39.7% (N = 81), hyperdiploidy in 12.7% (N = 26), t(9;22) in 4.4% (N = 9), t(1;19) in 3.9% (N = 8). Adults with ALL had worse survival compared with pediatric patients (HR 3.62; 2.03-6.45 95% CI, p < 0.001). Patients not in morphologic remission after induction chemotherapy fared poorly (HR 4.86; 2.67-8.84 95% CI, p < 0.001). Patients with favourable cytogenetics had better overall survival (HR 0.36; 0.12-1.05 95% CI, p < 0.05). On multivariate analysis, achievement of morphologic remission emerged as single most significant predictor of survival (p < 0.001). MLL gene rearrangement and t(12;21) were seen less commonly as compared to Western data. However, incidence rates of various cytogenetic abnormalities were similar to that reported from other centres from India. Age, morphologic remission at end of induction chemotherapy and favourable cytogenetics correlated significantly with survival.

Mismatch of long Gamma intramedullary nail with bow of the femur: Does radius of curvature of the nail increase risk of distal femoral complications?

INTRODUCTION

Anterior cortical penetration of the distal nail tip is a recognized complication of intra-medullary nailing of the femur particularly in the geriatric population. This has been attributed to a mismatch between the femoral bow and the radius of curvature (ROC) of the femoral nail. We wanted to see if there was a reduction of this risk comparing cephalomedullary nails with ROC of 200 cm and 150 cm.

METHODS

52 patients were split into 2 groups similar with respect to age, sex and comorbidities. Group A with 25 patients used a nail with a ROC of 200 cm and Group B with 27 patients used a 150 cm ROC nail. Lateral radiographs of the distal femur were evaluated to note the position of the nail tip in relation to the femoral canal. The diameter of the femur at the tip of the nail was divided into 3 equal zones. The anterior one-third was designated as Zone1, the middle one-third as Zone 2 and the posterior one-third as Zone 3.

RESULTS

80% of the cases with a 200 cm ROC nail had the tip of the nail in the anterior one-third of the canal (zone 1). Fracture of the anterior femoral cortex distally by the nail tip was seen in 2 patients.Only 18.5% of cases with a 150 cm ROC nail had the tip of the nail in anterior one-third of the canal (zone 1). There were no incidences of complications such as fractures and anterior cortical perforation.

CONCLUSIONS

A cephalomedullary nail with a ROC of 150 cm had its distal tip more towards the center of the femoral canal when compared to a nail with ROC of 200 cm. No case of anterior femoral penetration was seen when using a nail with an ROC of 150 cm.

Feasibility and Results of Cancer Registry and Noncommunicable Disease Cohort Data Linkages in India

Background: Cancer registries worldwide are vital to determine cancer burden, plan cancer control measures, and facilitate research. Population-based cancer registries are a priority for LMICs by the UICC; the National Cancer Registry Program (NCRP) of India oversees 28 such registries. A primary function of registries is to combine data for the same individual from multiple sources. For other disease cohorts where cancer is an outcome of interest, registries can potentially connect information by linking datasets together. Barriers to successful registration and linkages include systems in which cancer is not a notifiable disease, no universal unique individual identifier exists, and lack of trained personnel. This study utilizes technology and infrastructure to develop better linkages, surveillance, and outcomes. Aim: To assess the feasibility of linking large cohorts designed for cardio-metabolic disease research with cancer registries in New Delhi and Chennai; determine additional steps required for linkage accuracy and completeness; and develop detailed protocols for future applications. Methods: A pilot protocol for linkage between a large diabetes cohort and cancer registries in Delhi and Chennai was developed using MatchPro, a probabilistic record linkage program developed for cancer registries. Probabilistic software links datasets together in the presence of uncertainty (eg misspelled or abbreviated names) to identify record pairs with high probability of representing the same individual. For this study, algorithms were developed to address unique aspects of names and demographics in India. The software and algorithms focused on: detecting duplicates in cancer registries; and linking registries with external files from diabetes cohorts. In Delhi, 3 1-year datasets covering 3 years (2010, 2011, 2012) were linked with the diabetes cohort; in Chennai, the linkage included 3 5-year datasets covering 15 years (2000-04, '05-'09, '10-'14). The unique ID (Aadhaar) is not collected or linked systematically between different systems at this point in time. Results: Linkage attempts yielded potential matches ranked according to probabilistic scores; highest scores were reviewed to determine true matches. In Chennai, this process yielded: (2010-2014) 21% self-reported (SR) cases matching perfectly, 36% requiring follow-up, 13 nonreported (NR) cases found; 2005-2009: 33% SR cases matched perfectly, 1 NR case found; 2000-2004: 1 NR case. Also, 2 training workshops on data linkages and software were held. Conclusion: Linkages between cancer registries and other data sources are feasible in LMICs using probabilistic record linkage software augmented by manual matching. Future efforts to use existing epidemiologic resources (cohorts) and cancer research infrastructure (registries and clinical centers) can enhance research including understanding shared risk factors and pathophysiologic mechanisms e.g., between cancer and other NCD.

Rare case of atypical femoral fracture with blocked medullary canal associated with bisphosphonate therapy

Bisphosphonates are widely used for treatment of osteoporosis and its use is increasing in geriatric population. Atypical femoral fractures are associated with bisphosphonate therapy. We report an unusual case of femoral shaft fracture following bisphosphonate therapy where the femoral canal of the proximal and distal fracture fragments was blocked and its management.

Vasoactive Pressure Hormones during and after Cardiopulmonary Bypass

The differences in the pattern of the vasoactive hormone release in response to the stress of surgery and cardiopulmonary bypass (CPB) (pulsatile n = 15 and non pulsatile n = 23) were studied in the adult patients with mitral valve disease (MVD), aortic valve disease (AVD), and the coronary artery disease (CAD). A differential stimulation of the osmoreceptors, baroceptors, renin-angiotensin and the sympathetico-adrenal systems in these patients, resulted in the variations in the pattern of hormone release. Patients with MVD showed a greater stimulation of osmoreceptors, baroceptors and release of Arginine vasopressin (AVP). Renin-angiotensin system was more easily triggered in patients with AVD or CAD; and sympathetico-adrenal system in patients with CAD. The renin-angiotensin-aldosterone axis was better preserved in patients with CAD (r = 0.49, p < 0.001) than in the patients with MVD (r = 0.38, p < 0.02). Plasma renin release showed a significant correlation with noradrenaline release in the patients with MVD (r = 0.47, p < 0.01); but this relationship was lost in the patients with the CAD, due to an excessive noradrenaline release. Pulsatile bypass reduced but did not abolish this response. Under unfavourable conditions, the stress response may persist in the early post-operative period.

Ultrafiltration by Hemofilter - A new Therapeutic Measure in Intractable Ascites

The clinical efficacy of ultrafiltration (UF) of ascitic fluid with hemofilter in the treatment of intractable ascites associated with chronic liver disease or intraabdominal malignancy was studied in fifteen patients. The ascitic fluid was reinfused into the peritoneal cavity after ultrafiltration.

An average of 6.2 liters of fluid was removed during 4.4 hours of ultrafiltration with no significant change in blood pressure, central venous pressure, hemoglobin, platelets or plasma creatinine. Ascitic fluid albumin rose significantly immediately after the procedure (from 5.2 ± 4.3 gm/L to 31.9 ± 30.0 gm/L, P < 0.01). The plasma albumin concentration increased significantly at the end of UF (P < 0.001). Also there was a significant increase in urine output (P < 0.001), urinary sodium excretion (P < 0.001), and endogenous creatinine clearance (P < 0.01) during the 48 hours following UF. There was no evidence of hemodynamic, renal or hematological dysfunction, and other complications, including encephalopathy, peritonitis and variceal bleeding were not experienced. Ultrafiltration of ascitic fluid with hemofilter may be safely used in the temporary relief of refractory ascites due to cirrhosis or intra-abdominal malignancy.

First report of the genus <i>Tettigonia</i> Linnaeus (Orthoptera: Tettigoniidae: Tettigoniinae) and record of <i>Tettigonia</i> <i>caudata</i> <i>caudata</i> (Charpentier, 1842) from India

The genus Tettigonia Linnaeus (Tettigoniidae; Tettigoniinae) with the type species, Gryllus (Tettigonia) viridissima Linnaeus, 1758 belongs to the tribe Tettigoniini, which is represented by 15 genera and 27 species worldwide (Cigliano et al., 2017). According to the annotated checklist, the subfamily Tettigoniinae includes the only tribe Platycleidini Brunner von Wattenwyl, 1893 with 2 genera and 3 species as reported from India by Shishodia et al. (2010). In a review of Orthoptera from the Eastern Palearctic region, the genus Tettigonia Linnaeus was reported by Storozhenko (1994); additionally, some new species of Tettigonia have been described by Ogawa (2003), Greenwalt and Rust (2014), Chobanov et al. (2014), Sultan et al. (2015) and Storozhenko et al. (2015). The sub-family Tettigoniinae is represented by many species endemic to the Asian part of the Palearctic region. In 1971, Kaltenbach studied the Decticinae of the Palearctic, a subfamily now considered part of Tettigoniinae, comprising 65 genera with 407 species; later, Rentz and Colless (1990) estimated 500 species for Tettigoniinae. Further, Rentz (1985) clarified that these species do not occur in tropical rainforests, but are found in grassland and mixed heath habitats. The shape of pronotum, with a distinct angulated shoulder incision, with the clarities and locations of its transversal sulci, and its short, compressed and depressed structure happens to be a common character for the members of the tribe Tettigoniini. The type genus Tettigonia is long winged; however, considerable variability in the wing length has been reported. Nevertheless, the short tegmina reaching to the end of hind knee is a character often used to separate T. caudata and T. viridissima from T. cantans and T. hispina (Haz, 1969).

First description of the female <i>Elimaea</i> <i>melanocantha</i> (Walker, 1869) (Orthoptera: Tettigoniidae: Phaneropterinae) from India

The genus Elimaea Stal, 1874 was established for the type species Phaneroptera subcarinata Stal 1861 (Hongkong), the type genus of the Phaneropterinae. These insects are poorly known from India. Relevant important work on the taxonomy and distribution of Tettigoniidae of northeastern India include those of Barman & Srivastava (1976), Shishodia (2000), Shishodia & Tandon (2000), Barman (2003), Shishodia et al. (2003 & 2010) and, recently, Nagar et al. (2014, 2015a-b) have reported new and additional species of Phaneropterinae from India. The tribe Elimaeini Yakobson, 1905 (group Elimaeae Brunner, 1878) is known to comprise three Oriental genera, Elimaea Stal, 1874; Hemielimaea Brunner, 1878; and Ectadia Brunner, 1878. Karny (1926) divided the genus into three subgenera: Orthelimaea, Rhaebelimaea and Elimaea s. str., based on the shape of the anterior femora and the branching in the radius sector of the tegmen. Of these, Elimaea is most speciose and quite widespread in the Indian sub-continent. Gorochov (2013) reported two species, Elimaea melanocantha (Walker, 1869) and Elimaea nigrosignata Bolivar, 1900 in the group Neoelimaea. The terminology used is that of Ingrisch (1998) and Rentz and Colless (1990).

Real time molecular detection of Chikungunya and dengue virus in the female Aedes mosquitoes collected in Chennai, Tamilnadu, India

Monsoon favors the breeding sites of many mosquito borne viral vectors resulting in increased outbreaks of vector borne infections, such as Chikungunya and dengue infections in the post monsoon period. Hence a pre-monsoon surveillance study of competent vectors carrying Chikungunya and dengue virus would help in better management of vectors and infections. Thus a surveillance study was carried out in Chennai before the onset of monsoon to study the distribution of competent vectors and detection of Chikungunya and dengue virus in female Aedes mosquitoes. Mosquitoes were collected from north, south, east and west zone of Chennai during March to July 2014. Chikungunya (CHIKV) and Dengue virus (DENV) were detected from the collected mosquitoes by Reverse Transcription Real time PCR (RT-PCR) followed by virus isolation in Vero cells. The most predominant species was Culex quinquefasciatis followed by Culex pipiens in the premonsoon period in our study. Viral infection rate during March to July (Premonsoon period) with respect to CHIKV and DENV virus were 0.456. The central zones of Chennai were highly found to inhabit the Aedes species in comparison to other zones surveyed during the premonsoon period. Viral infection rate of CHIKV and DENV were very low in female Aedes mosquitoes during the Pre-Monsoon period in Chennai.

The increasing challenge of never smokers with adenocarcinoma lung: Need to look beyond tobacco exposure

BACKGROUND

Lung cancer continues to remain as one of the leading causes of morbidity and mortality worldwide, despite the decreasing trends in smoking prevalence worldwide. An earlier study from the authors' institute reported the increasing trends of "Nonsmoking associated lung cancers."

MATERIALS AND METHODS

All consecutive histologically confirmed patients with lung cancer who presented to the outpatient department over a year (November 2014-October 2015) were included in this current prospective study.

RESULTS

Seven hundred and thirteen patients presented with clinicoradiologically suspicious findings of lung cancer in the said period. A pathological confirmation of lung cancer could be ascertained in 495 patients, and this cohort was further analyzed. The mean age of presentation was 57.76 years; the male to female ratio was approximately 2.5:1. Interestingly, 55.35% of the patients were nonsmokers. Adenocarcinoma (63%) was the predominant histology. Never smokers, both among men (P = 0.02) and women (P = 0.001), presented more frequently with adenocarcinoma histology. Further, 84.9% (45/53) of rural and 76.1% (19/25) of urban women who were never smokers reported exposure to indoor air pollution (secondhand smoke/fuel used for cooking purposes) which was significantly associated with adenocarcinoma histology.

CONCLUSION

Our study confirmed our initial observation of the changing epidemiology of lung cancer in the Indian subcontinent, paralleling the global trends of rise in adenocarcinoma. Lung cancer in never smokers outnumbering that among smokers was another interesting observation. The take-home message for both the clinicians as well as the policymakers is to study factors beyond tobacco exposure to understand the direction of the current lung cancer epidemic.

Effect of albumin concentration on serum cortisol measured by the Bayer Advia Centaur assay

Introduction: A poor comparison was seen between the Bayer Advia Centaur and the Roche Elecsys cortisol methods using samples sent to the laboratory for cortisol analysis. They were predominantly from patients attending the Endocrine outpatients clinic or patients in the intensive therapy unit. We investigated the effect of albumin concentration on the performance of both assays.

Methods: For the samples used in the patient comparison, the laboratory database was searched for any concomitant albumin concentrations (Beckman LX20 BCP method). A series of recovery experiments were performed combining samples with normal albumin and undetectable cortisol concentrations with samples with detectable cortisol but low albumin concentrations.

Results: Albumin concentration accounts for almost 50% of the variation in the difference between the two methods. The Bayer Advia Centaur method shows significant under-recovery at albumin concentrations lower than 24 g/L.

Conclusion: This under-recovery will significantly affect the diagnosis of adrenal insufficiency in critically ill patients with low albumin concentrations.

Notes on the genus Conocephalus (Orthoptera: Tettigoniidae; Conocephalinae; Conocephalini) from India and description of two new species

The present paper describes two new species of Conocephalus: Conocephalus decaspinosus sp. nov. and C. kwasiphaiensis sp. nov., as additions to the previously known species of the genus; among these, two species have been reported for the first time from India, viz., C. concolor peneri and C. vaginalis. The key morphological characters of the head, pronotum, cerci, spines on the fore tibiae, hind femora, stridulatory file and the ovipositor have been illustrated with suitable line drawings to distinguish the reported new species. The distribution map of the species in India has been provided with a key to the subgenera.

The prediction of neck extensor force using surface electromyography

BACKGROUND

The relationship between muscular force and electromyography (EMG) has been investigated by numerous researchers. EMG has not previously been used as a means of estimating force in the cervical erector spinae (CES).

OBJECTIVE

Use EMG of the CES musculature to indirectly predict neck extension force.

METHODS

Isometric contractions of the CES muscles were studied at increasing levels of contractile force across all participants (n= 12) to produce an individualised force-EMG relationship. The method of least squares was used to determine the linear regression trend line for the force-EMG relationship. The validity of these individual `correlation curves' was demonstrated through further, blinded, investigation.

RESULTS

A linear relationship was identified for the individualised correlation curves that gained in strength for < 50% maximum voluntary contraction (MVC; R2> 0.8 for 80% of trials). The prediction of muscle force from the correlation curves was found to be statistically similar to the equivalent experimental data (p> 0.05). Given the tendency of EMG to slightly overestimate force in most cases, an adjustment coefficient was calculated to reduce the error in the predicted force data.

CONCLUSIONS

This study reports a validated method using EMG to indirectly acquire CES muscular force, which has application for clinicians and research scientists working in fields including sport and rehabilitation.

Does the new rugby union scrum sequence positively influence the hooker's in situ spinal kinematics?

Background

Scrummaging is unique to rugby union and involves 2 ‘packs’ of 8 players competing to regain ball possession. Intending to serve as a quick and safe method to restart the game, injury prevalence during scrummaging necessitates further evaluation of this environment.

Aims

The aim of this study was to determine the effect of scrummage engagement sequences on spinal kinematics of the hooker. The conditions investigated were: (1) live competitive scrummaging using the new ‘crouch, bind, set’ sequence; (2) live competitive scrummaging using the old ‘crouch touch pause engage’ sequence and (3) training scrummaging using a scrum machine.

Methods

Inertial sensors provided three-dimensional kinematic data across 5 spinal regions. Participants (n=29) were adult, male community club and university-level hookers.

Results

Engagement sequence had no effect on resultant kinematics of any spinal region. Machine scrummaging resulted in lesser magnitudes of motion in the upper spinal regions. Around two-thirds of the total available cervical motion was utilised during live scrummaging.

Conclusions

This study indicates that the most recent laws do not influence the spinal kinematics of the hooker during live scrummaging; however, there may be other benefits from these law changes that fall outside the scope of this investigation.

Occurrence of a new species of Letana (Orthoptera: Tettigoniidae: Phaneropterinae) in India

A new species of the Oriental genus Letana, Walker (Orthoptera: Tettigoniidae: Phaneropterinae), proposed as Letana dentata sp. nov., collected from the North-eastern province, Meghalaya, India (Ri bhoi 90°55'15 to 91°16' latitude and 25°40' to 25°21' longitude, 993 MSL), is described together with the morphological characterization of eight reported species. Of these, Letana rubescens (Stål, 1861) collected from Shalimar, Srinagar, Jammu and Kashmir (India) is being reported for the first time from India. The other species of Letana include: L. atomifera, L. bulbosa, L. inflata, L. infurcata, L. pyrifera and L. rufonatata. Taxonomic and diagnostic characters with illustrations of the head, pronotum, ventral view of left tegmina to show stridulatory file teeth and the genitalia (supra-anal plate and subgenital plate) including the phallus sclerite has been given.

Cancer Incidence in Five Continents: Inclusion criteria, highlights from Volume X and the global status of cancer registration

Cancer Incidence in Five Continents (CI5), a longstanding collaboration between the International Agency for Research on Cancer and the International Association of Cancer Registries, serves as a unique source of cancer incidence data from high-quality population-based cancer registries around the world. The recent publication of Volume X comprises cancer incidence data from 290 registries covering 424 populations in 68 countries for the registration period 2003-2007. In this article, we assess the status of population-based cancer registries worldwide, describe the techniques used in CI5 to evaluate their quality and highlight the notable variation in the incidence rates of selected cancers contained within Volume X of CI5. We also discuss the Global Initiative for Cancer Registry Development as an international partnership that aims to reduce the disparities in availability of cancer incidence data for cancer control action, particularly in economically transitioning countries, already experiencing a rapid rise in the number of cancer patients annually.

Some common and less known Phaneropterinae (Orthoptera: Tettigoniidae; Phaneropterinae) with the description of a new species from India

The present paper deals with the description of eleven katydids of the tettigonid subfamily Phaneropterinae (Tettigoniidae). The katydids of more common occurrence in different parts of India include: Phaneroptera gracilis Burmeister, Ducetia japonica (Thunberg), Himertula pallisignata Ingrisch and Shishodia, Isopsera peducnulata Brunner von Wattenwyl, and Trigonocorypha unicolor Stal; while those lesser known are Phaneroptera myllocerca Ragge, Himertula kinneari (Uvarov), Elimaea melanocantha (Walker), Elimaea carispina (Ingrisch and Shishodia), and Trigonocorypha angustata Uvarov. Record of a new species of the genus Ducetia, named as Ducetia serratus sp. nov., is mentioned. The key diagnostic morphological characters have been supported with photographs and illustrations of the body parts: head, pronotum, stridulatory file and the genitalia (supra-anal plate and sub-genital plate). A key to identify the species of the reported katydids has been provided.

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs

Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario.

A note on the new species of the genus Isopsera (Orthoptera: Phaneropteridae: Phaneropterinae) from India

A new species of the genus, Isopsera: Isopsera arcuata Nagar, Mal, Swaminathan sp. nov. (Orthoptera:Phaneropteridae Burmeister, 1838; Phaneropterinae Burmeister, 1838) is described. The holotype (♂) was collected from South India: Coimbatore (Tamil Nadu). The geographical location had the following specifications: 12⁰58 N 77⁰35E 930MSL South India. The described species differs from the two closely related species, I. caligula Ingrisch and I. spinosa Ingrisch, based on the structure of the male sub-genital plate, cerci and stridulatory file on the left tegmen.

Morphological characterization of some representative species of the genus Loxoblemmus (Orthoptera: Gryllidae; Gryllinae; Gryllini) from India

Morphological characterization of some common species of the genus Loxoblemmus (Gryllidae: Gryllinae) from India is presented. In all, 5 species were identified that included two, Loxoblemmus equestris Saussure and Loxoblemmus haani Saussure, from the sub-humid regions of Rajasthan (South West India) and Madhya Pradesh (Central India); while three species, Loxoblemmus taicoun Saussure, Loxoblemmus jacobsoni Chopard and Loxoblemmus intermedius Chopard from the humid hilly regions of Meghalaya and Assam (North East India). Of the 5 reported species, based on the comparative linear measurements, L. haani is relatively larger than the other species encountered.

New record of Anelytra (Anelytra) eunigrifrons Ingrisch, 1998 (Orthoptera, Tettigoniidae: Conocephalinae, Agraeciini) from India

The record of Anelytra (Anelytra) eunigrifrons Ingrisch, 1998 (Conocephlinae: Agraeciini) collected from Umiam in the North-east province, Meghalaya (India) is reported for the first time. Previously, the species was reported from Indo-China, Myanmar Burma, and Shan province, Carin Ghecu (Ingrisch, February 01, 1888 to March 31, 1888 and 1998). From India only one species, Anelytra (Anelytra) concolor  Redtenbacher, 1891 has been recorded from Maharashtra, Mumbai. The paper includes the morphological characterization of the male of this species collected from North-east India.

When thoracic organ recipients become abdominal organ donors: sharing the risks and benefits of transplantation: a case report

INTRODUCTION

The increasing demand for organ donation has resulted in the use of expanded-criteria donors. Solid organ transplant recipients and potential recipients represent a unique pool of selected organ donors that may help to meet this demand.

CASE REPORT

We present 2 cases, a lung transplant recipient and a patient on the lung transplant waiting list, who became kidney donors to 4 recipients.

CONCLUSIONS

These donations illustrate the interrelated risks and benefits for transplant recipients who themselves can become unintended, but effective donors.

Phosphate homeostasis and disorders

Recent studies of inherited disorders of phosphate metabolism have shed new light on the understanding of phosphate metabolism. Phosphate has important functions in the body and several mechanisms have evolved to regulate phosphate balance including vitamin D, parathyroid hormone and phosphatonins such as fibroblast growth factor-23 (FGF23). Disorders of phosphate homeostasis leading to hypo- and hyperphosphataemia are common and have clinical and biochemical consequences. Notably, recent studies have linked hyperphosphataemia with an increased risk of cardiovascular disease. This review outlines the recent advances in the understanding of phosphate homeostasis and describes the causes, investigation and management of hypo- and hyperphosphataemia.

New record of the bush cricket, Zvenella yunnana Gorochov (Orthoptera: Gryllidae: Podoscirtinae) from India

The first record of a known species of bush cricket, Zvenella yunnana (Gryllidae: Podoscirtinae), collected from the North-eastern province, Meghalaya (India) is reported. Previously, the species was reported from Thailand and the Indo-China region (Gorochov, 1985, 1988). The other congeneric species reported is Zvenella geniculata (Chopard) from Thailand. The morphological characterization of Z. yunnana has been presented with suitable illustrations.

Additions to the reported Elimaea species (Orthoptera: Phaneropteridae: Phaneropterinae) from India

The genus Elimaea (Tettigoniidae: Phaneropterinae) has reportedly been represented in India by eight species. Four species in addition to the existing checklist are described, which were earlier reported from the Malay Peninsula, based on the teeth on stridulatory file (on the underside of male left tegmen) and modifications of the gonangulum of the ovipositor. The morphometric variations in the reported species have been given, which include E. securigera, E. subcarinata, E. thaii, E. chloris, E. nautica and E. subcarinata sp. nov. (that differs from E. subcarinata). 

Laparoscopic kidney transplant by extra peritoneal approach: the safe transition from laboratory to the clinic

The aim of this study is to develop a novel laparoscopic surgery by extra-peritoneal approach for kidney transplant and pave the way of safe transition from laboratory to the clinic. The study was established to explore the feasibility and safety of human laparoscopic kidney transplant. The experiment was first conducted on the deceased animals, then live animals and human cavader before human kidney transplant was approved. The study patient was a 49-year-old male who received the kidney for laparoscopic kidney transplant by extra-peritoneal approach. The control patient received the contralateral kidney for open kidney transplant. The estimated blood loss was minimal during surgery. Both kidneys experienced delayed graft function but the kidneys started function on Day 6 postoperation. The analgesia consumption was significantly less in the study patient. There is no surgical complication during 6-month follow-up. This study has developed a new technique for laparoscopic kidney transplant by extra-peritoneal approach. It has retained the advantages of open kidney transplant, which allows the graft located in the extra-peritoneal space without violating peritoneum. This study has also paved the way of safe transition for a novel laparoscopic surgery from laboratory to the clinic.

Record of Natula matsuurai Sugimoto (Orthoptera: Gryllidae: Trigonidiinae) and other sword-tailed crickets from India

The genus Natula is a new record from the state of Rajasthan, India. Description of the species has been supported with photographs and line drawings leading to its identification. The other common sword-tailed crickets of the sub-family Trigonidiinae have also been described.

Weight in infancy and adult calcium absorption as determinants of bone mineral density in adult men: the Hertfordshire cohort study

Adult bone mass is modified by early life environmental influences, but the mechanism of this association is uncertain. Data support an inverse relationship between intestinal calcium absorption (αCa) and birth weight in women. However, little is known regarding determinants in men. This study examines the association between weight in infancy and adult αCa in healthy men and whether this could be a mechanism by which the early life environment may influence bone mass. Men were recruited from the MRC Hertfordshire Cohort Study, for whom detailed early life records were available. Areal bone mineral density (aBMD) was measured using a Hologic QDR 4500 at the femoral neck (FN) and lumbar spine. We randomly selected 123 men stratified by birth weight and assessed αCa using the stable strontium absorption test. The mean age was 63.6 (SD 2.5) years. αCa was not associated with birth weight or weight at 1 year. FN aBMD was associated with both weight at 1 year (r = 0.20, p = 0.03) and αCa (r = 0.20, p = 0.03). Both of these associations remained statistically significant in a mutually adjusted, multivariable model but would account for only ~4 % variance in BMD. We demonstrated a positive association between weight at 1 year and aBMD and between αCa and FN BMD, but no association was found between birth weight and αCa. This suggests that in men, although αCa is a contributing factor in FN bone density, it is not the main mechanism whereby the early environment modifies adult BMD.