Single stage oncologic resection and reconstruction: A step toward development of sarcoma service in resource constrained country

Tumor free-margin surgical resection remains the single most important treatment in the curative therapy of musculoskeletal tumor of limbs. Refinements in surgical techniques have led to increased function preservation and limb salvage. Patients and Methods: The records of patients (n = 24) who underwent microsurgical soft tissue reconstruction subsequent to resection of limb tumour during the period 2006 to 2011 were reviewed. Primary outcome i.e. uptake of the flap was evaluated. Perioperative morbidities were also noted including donor as well as recipient site complications. Assessment of Functional outcome (Musculoskeletal Tumor Society score, MSTS) local recurrence, free survival, and disease-specific survival was also made. Results: Twenty four patients (age range: 7 - 72 years) who have undergone tumor resection followed by flap coverage were identified. Lower limb reconstruction outnumbered upper limb by 6:1. Complications included, one complete failure of free vascularized iliac crest flap done for reconstruction of a heel defect. One of the patients had secondary hemorrhage 10 days after surgery. Another patient with internal hemipelvectomy for Ewing’s sarcoma had a dura puncture during resection of sacrum. Partial epidermal necrosis was evident in four cases. Eighty three percent of the patients remained alive (n = 20), 19 of whom currently have no evidence of disease (NED) Disease recurrence was noted in three patients. Overall MSTS score was 73.5%. Conclusion: The microsurgical repair of defects is a reliable option that, though not free of complications, is necessary in selected cases. The procedure enables both adequate oncosurgical resection and function preservation

Complex biological reconstruction after wide excision of osteogenic sarcoma in lower extremities

Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each with mid tibia, mid femur, proximal femur, and heel bone. Locking compression plate was used in 7 patients including six with periarticular disease. Eight out of ten patients underwent biologic reconstruction using autograft; endoprosthetic reconstruction and hindquarter amputation were done in the remaining two patients. Vascularized fibula was done in five patients, sural artery flap which was primarily done in three patients, spare part fillet flap, free iliac crest flap, and Gastrocnemius flap was done in one patient each. Secondary hemorrhage, infection, nonunion, wound dehiscence, and flap failure were notable complications in four patients. The Average Musculoskeletal Tumor Society score was 89%. Conclusion. Combined surgical approach results in cosmetically acceptable and functional limb

Renoprotection, renin inhibition, and blood pressure control: the impact of aliskiren on integrated blood pressure control

Hypertension (HTN) is an important factor in progressive loss of renal function. The kidney can be both a contributor to and a target of HTN. The functional integrity of the kidney is vital for the maintenance of cardiovascular homeostasis. Chronic activation of the renin system causes HTN and, ultimately, end-organ damage. Direct renin inhibitors (DRIs) inhibit plasma renin activity (PRA), thereby preventing the conversion of angiotensinogen to angiotensin I; consequently, the levels of both Ang I and Ang II are reduced. There is no compensatory increase in PRA activity with DRIs as seen with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). There are reasons to speculate that renin inhibition might prove to be a superior strategy for blocking the renin–angiotensin–aldosterone system compared with ACEIs or ARBs. Evidence for the efficacy of aliskiren (a DRI) is considered to be relatively strong, based on published, short-term, double-blind, randomized, controlled trials showing that aliskiren is as effective as other antihypertensive agents in reducing blood pressure (BP), with no rebound effects on BP after treatment withdrawal. When combined with diuretics, fully additive BP reduction is seen. When given with an ACEI or ARB, aliskiren produces significant additional BP reduction indicative of complimentary pharmacology and more complete renin–angiotensin system blockade

Predictors of length of hospital stay after total hip replacement

Purpose: To identify variables affecting length of hospital stay after total hip replacement (THR) while controlling for potential confounders. Methods: Records of 199 consecutive elective unilateral THRs were reviewed. Clinical and demographic data including age, gender, body mass index, comorbidities, surgical factors (surgical approach, type of prosthesis, use of cement, operating time), anaesthetic factors (type of anaesthesia, ASA physical status), and length of hospital stay were recorded. Results: 64% of Patients left hospital within 12 days, 28% within 3 weeks, and 8% after 3 weeks. The median length of hospital stay was longer in women than men (11.5 vs. 9 days, p=0.009), in Patients aged \u3e65 years than those younger (13 vs. 9 days, p65 years than those younger (61% vs. 37% or 24%, p65 years (pConclusions: Prolonged hospital stay after THR is largely predetermined by case mix. Our study helps to identify individuals who need longer rehabilitation and more care

Cognitive Experiments and Features for Computing Mental Stress

In this paper, mental stress is computed through cognitive experiments that induce stress. In a controlled laboratory environment, a group of students are involved in a series of mental challenges. While performing the cognitive tasks, stress is induced on the participants. Deep breathing exercise is performed in the start of experiments and then in between each activity to make the conditions normal and a participant feels relaxed. Various physiological features are recorded during experimental activities. Also, cerebral features are recorded that provide improved classification results. The severity of stress is different on each participant but the purpose of experimental protocol is to separate stressful conditions from relaxed environment. Support Vector machine (SVM) is used to identify relax or normal class from a number of stressed classes. It is shown that cerebral features improve the classification accuracy with a satisfactory margin and designed protocol system is able to compute the severity of induced stress

A Phonemic and Acoustic Analysis of Hindko Fricatives

The Hindko language is mainly spoken in the province of Khyber Pukhtunkhaw, Pakistan. It relates to the Indo-Aryan family of languages. This paper focusses on the phonemic and acoustic analysis of Hindko fricatives. The phonemic analysis identifies that Hindko has eight fricatives. The acoustic analysis aims to explore temporal and spectral characteristics of these fricatives. The acoustic analysis discloses that Hindko fricatives are distinguishable on the basis of the temporal properties such as friction duration and spectral cues like turbulence noise

Modelling, implementation and validation of polymeric planar spring mechanisms

This thesis explores, by means of modelling and physical experiments, variant designs for triskelion devices, a type of planar exure mechanism widely considered for use in micro-probe suspensions and, more recently, force transfer artefacts. The accurate measurement of low force is challenging problem that has wide range of force related applications. A lot of attention has been paid worldwide during last decade within and beyond the National Metrology Institutes (NMIs) to measuring low forces. A major concern is how to provide traceability for micro- to nanonewton level forces that is highly reliable and could be used for real machine calibration. The current consensus is that this process requires special secondary standards and novel artefacts to transfer such standards to working systems. The latter provides the motivation for this thesis, which makes the following main contributions. A published linear elastic model has been considerably enhanced and generalised to enable the study of a wide range of variants from the one widely-used design of triskelion device. Triskelion and tetraskelion software programs implement this new model, providing a new tool for computing forces, moments, stress, strain, axial stiffness and torsional stiffness for devices before their fabrication. It has been used to explore widely the sensitivity of the devices to changes in design parameters such as suspension leg geometry and 'elbow' angles. To provide essential physical verification of the practicality of a linear model, a low-cost technique has been developed for making small triskelion test samples. This was used with a new test-rig configuration to measure polymeric triskelion devices under loads in the 1 mN to 1N region with deflections up to around 1 mm. Experiments have determined the onset and characteristics of non-linear spring behaviour in typical devices and have verified the general predictions from the new model. The overall conclusion to be drawn is that at large de ection the spring characteristics follow a cubic law (stiffening). However, during the initial stages of the de ection the linear term dominates over a range that is quite sufficiently wide for practical use as force test artefacts. The polymeric test devices performed well, behaving reasonably closely to predicted values in the linear (model) region. The promising results indicate its prospects for use in low force technology in the future

Compression Techniques for Different Applications of Real-Time Communication.

Real-time communication, is important and its usage is explained with through compression techniques. The application with compression techniques are applied discussed in this article. There is special focus on audio, video and image compression. Matlab is used as a simulation tool image compression is performed. The results are sometimes lossy and sometimes lossless, both types for compression is applied of image. The difference can be seen clearly in results