Early diagnosis of oesophageal cancer.

Squamous cell carcinoma and adenocarcinoma of the oesophagus are cancers that develop from distinct epithelial sub-types; however, they are both related to chronic inflammation of differing aetiologies. Inflammation leads to somatically inherited genetic mutations altering control of the cell cycle, DNA replication and apoptosis, which together result in autonomous and uncontrolled proliferation. These cancers have often metastasised to lymph nodes and distant organs before symptomatic presentation and therefore carry a poor prognosis. It is therefore vital to diagnose oesophageal cancer at an early stage, before the development of symptoms, when treatment can dramatically improve prognosis. Understanding the pathogenesis of these cancers is vital to guide early diagnostic strategies

Diagnosis and treatment of bacterial meningitis in the newborn

Background: Bacterial meningitis in the newborn is globally renowned for high mortality. The associated morbidities also include audiologic, motor, visual and mental deficits.Objective: To highlight the peculiarities in the current diagnostic andmanagement strategies in newborn meningitis.Methods: Relevant literature on the subject published only in Englishlanguage or translated to English language was searched manually and electronically. The Medline, PUBMED and HINARI were searched for the period between 1966 and 2012. The following key words were used during the search: newborn/neonatal , bacter ial / pyogenic meningitis, central nervous system infections, antibiotics, dexamethasone and fluidrestriction.Results: The pattern of bacterial aetiology and mortality differ betweenthe developed and developing world. The usefulness of bacteriologic culture in the diagnosis of meningitis can be improved with serologic method like polymerase chain reaction. Widespread resistance of pathogens may be threatening the use of penicillins and gentamicinfor empirical treatment of newborn meningitis. No sufficient evidence presently supports the current practices of fluid restriction, prolonged duration of antibiotic treatment and non-use of adjuvant steroid therapies in the newborn.Conclusion: Efforts to reduce the incidence of newborn meningitis cannot be separated from the prevention of newborn sepsis generally. In addition, more controlled trials are required in the developing world with respect to the various aspects of management of newborn meningitis, particularly fluid management and the use of adjuvant steroids

Incidence and prognosis of vascular complications after transcatheter aortic valve implantation

ObjectiveTranscatheter aortic valve implantation (TAVI) has gained increasing global popularity as a minimally invasive option for high-risk cardiac patients. However, this operation is not without risk, particularly of significant vascular complications that increase the morbidity, mortality, and overall cost of the procedure. We aim to present our experience of TAVI-related vascular complications, including the morbidity and cost impacts of these events.MethodsA case-series study was performed for all patients undergoing TAVI at our center. Vascular complications were defined according to the 2011 Valve Academic Research Consortium standardized end points. The data were prospectively collected from February 2009 to April 2012, and the outcomes were entered into a database and cross-checked with the hospital notes.ResultsTAVI was performed on 100 patients in our center during the study period, and the 30-day mortality was 6%. Access approaches included 81 transfemoral, 18 transapical, and one trans-subclavian access. The average patient age was 84.9 years, and 65% of the patients were male. Among the transfemoral procedures, there were 16 vascular access-related complications (VAC), including nine major and seven minor complications. The major complications included aortic dissection, iliac arterial rupture, femoral dissection, false aneurysms, and distal embolization, all of which required surgical or endovascular repair. An apical false aneurysm and an apical tear were major VAC of the transapical group, with the latter resulting in death. Patients with VAC had higher blood transfusion requirements (4.1 ± 4.5 units vs 0.9 ± 2.2 units; P = .004), greater length of hospital stay (16.4 ± 10.7 days vs 6.5 ± 5.1 days; P = .001), and increased cost (A$93,448 ± 21,435 vs A$69,932 ± 15,007; P = .002) compared with the non-VAC group. The predictors of vascular complications using multivariate analysis included European System for Cardiac Operative Risk Evaluation (odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P = .001) and diabetes mellitus (odds ratio, 5.07; 95% confidence interval, 1.17-21.88; P = .03). Occurrence of major VAC did not affect in-hospital or 30-day mortality rates and was not associated with poorer survival.ConclusionsVascular complications affect perioperative management and outcomes following TAVI. Our findings show that these complications often require urgent surgical or endovascular repair and result in increased blood transfusions, greater length of hospital stay, and significantly increased costs. Diabetes mellitus and logistic European System for Cardiac Operative Risk Evaluation may be predictive of VAC and should be considered during TAVI patient selection

Linguistic Analysis of Natural Language Engineering Requirements

In engineering design, the needs of the customer are expressed through engineering requirement statements. These requirement statements are often expressed using natural language because they are easily created and read. However, there are several problems associated with natural language requirements including but not limited to ambiguity, incompleteness, understandability, testability and over specificity. Several representation and analysis tools have been proposed to address these problems within a requirement statement. These tools include formal languages, such as UML and SysML, requirement management tools, such as IBM Telelogic Doors, and natural language processors such as QuARS. These tools assist in the systematic elicitation and creation of requirements, improve requirement visibility and traceability, and provide a central repository for shared access. However, these tools do not prescribe a formal representation of a requirement and its elements. The effectiveness of these tools can be greatly improved with a formalized syntax for expressing engineering requirements. The research presented in this thesis examines engineering requirements from a linguistic viewpoint and leads to a formalized syntax based on parts of speech, grammatical functions, and sentence structure. Specifically, a requirement statement is decomposed into four syntactical elements: artifact, necessity, function, and condition. Further, grammar and linguistics provide the basis for requirements classification into functional or non-functional and qualitative or quantitative requirements. Finally, the deficiencies in current natural language requirements such as incompleteness, understandability, ambiguity, and specificity, are identified through the formal syntax and grammatical rules. The requirements syntax and analysis method are demonstrated on 110 requirements from the Family of Medium Tactical Vehicles (FMTV). Using the syntax and analysis method proposed, the count of incomplete requirements, percentages of function and non-functional requirements, and specificity of the requirement statements in the document were determined. Identifying such requirement measures will help to improve the expressiveness of requirement statements and help to identify if appropriate requirements are being authored for the different stages of design (i.e. conceptual, embodiment, detailed). To further improve the analysis method proposed, more quality attributes of requirement statements have to be addressed such as ambiguity and traceability. The end goal is to develop a syntax and analysis method that addresses all quality attributes of a requirement statement that is not empirically based but rule based

COPYRIGHTS, COMPETITION AND DEVELOPMENT: THE CASE OF THE MUSIC INDUSTRY

The economic importance of copyright industries in developed market economies has been well documented. Although less important in developing countries, this is likely to change with the growing weight of the service sector in these economies and its importance for their closer integration into the global market economy. This paper analyses the relationship between the copyright and income generation in the audio-visual sector, in particular music, and argues that the appropriate copyright administration is essential in creating the conditions for a viable music industry in developing countries. However, an effective copyright regime is not, by itself, sufficient to guarantee a flourishing music industry, and other institutional arrangements will be needed in countries looking to better exploit their musical resources.

Incidence of carcinoma of esophagus in cases of dysphagia undergoing upper GI endoscopy in Coimbatore Medical College and Hospital

BACKGROUND: In India, squamous cell carcinoma of the esophagus was common and it commonly found in males in the age group of >50 years. Dysphagia was the commonest complaint. AIM F THE STUDY: Aim of this study was to determine the presence of carcinoma in patients with complaints of dysphagia, and also to find out common location, histological types and grading. METHOD: A prospective study in patient with complaints of dysphagia who were undergoing upper GI endoscopy in Coimbatore medical college and hospital (department of General surgery) conducted over a period of 12 months from November 2012 to October 2013. Biopsy specimen processed and reported in pathology department and histopathological confirmation done. RESULTS: out of 50 patients of dysphagia who were undergone upper GI endoscopy in Coimbatore medical college Hospital, 16 patients found to be having carcinoma of esophagus Squamous cell carcinoma was the most common histological type, seen in 15 (93.75%) out of 16 cases. 1 patients (6.25%) had adenocarcinoma. Most of them (12/16) are with moderately differentiated histological grading of tumor. In our study series, out of 16 cases of carcinoma of esophagus 12 (75%) were male and 4(25%) were females. Carcinoma of esophagus commonly presented in middle one third of esophagus. It was about 9 (56.25) out of 16 cases were found in middle one third. Most common age groups involved were more than 50 years of age. 13(81.25%) out of 16 cases were above 50 years. CONCLUSION: carcinoma of esophagus is the most important cause of dysphagia which should be diagnosed earlier. Males are more commonly affected than females, because of smoking, alcoholism and GERD. Patients with age of more than 50 are found to be affected by carcinoma of esophagus. Squamous cell carcinoma is more common than adenocarcinoma in our study and middle third of esophagus is commonly involved. Regarding histological grading moderately differentiated tumors are common

Lassa virus persistence in body fluids after recovery from acute Lassa fever: a 2-year interim analysis of a prospective longitudinal cohort study

Background: There is anecdotal evidence for Lassa virus persistence in body fluids. We investigated various body fluids after recovery from acute Lassa fever and describe the dynamics of Lassa virus RNA load in seminal fluid. The primary objective of this study was to quantitatively describe virus persistence and clearance and assess the infectivity of seminal fluid. Methodology: In this prospective, longitudinal, cohort study, we collected plasma, urine, saliva, lacrimal, vaginal and seminal fluids from Lassa fever survivors at Irrua Specialist Teaching Hospital in Edo State, Nigeria. Inclusion criteria for participants were RT-PCR-confirmed Lassa fever diagnosis and age 18 years and above. Samples were taken at discharge from hospital (month 0) and at months 0·5, 1, 3, 6, 9, 12, 18, and 24 after discharge. Lassa virus RNA was detected using real-time RT-PCR. Infectivity was tested in cell culture and immunosuppressed mice. We used a linear mixed-effect model to analyse the dynamics of virus persistence in seminal fluid over time. Results: Between Jan 31, 2018, and Dec 11, 2019, 165 participants were enrolled in the study, of whom 159 were eligible for analysis (49 women and 110 men). Low amounts of Lassa virus RNA were detected at month 0 in plasma (45%, n=49/110), urine (34%, 37/110), saliva (5%, 5/110), lacrimal fluid (9%, 10/110), and vaginal fluid (21%, n=7/33 female participants). Virus RNA was cleared from these body fluids by month 3. However, 35 (80%) of 44 male participants had viral RNA in seminal fluid at month 0 with a median cycle threshold of 26·5. Lassa virus RNA remained detectable up to month 12 in seminal fluid. Biostatistical modelling estimated a clearance rate of 1·19 log₁₀ viral RNA copies per month and predicted that 50% of male survivors remain Lassa virus RNA-positive in seminal fluid for 83 days after hospital discharge, and 10% remain positive in seminal fluid for 193 days after discharge. Viral RNA persistence in seminal fluid for 3 months or more was associated with higher viraemia (p=0·006), more severe disease (p=0·0075), and longer hospitalisation during the acute phase of Lassa fever (p=0·0014). Infectious virus was isolated from 48 (52%) of 93 virus RNA-positive seminal fluid samples collected between month 0 and 12. Conclusion: Lassa virus RNA is shed in various body fluids after recovery from acute disease. The persistence of infectious virus in seminal fluid implies a risk of sexual transmission of Lassa fever