Demographics of Thoracolumbar Fracture in Indian Population Presenting to a Tertiary Level Trauma Centre

Study DesignProspective, cross-sectional, observational study.PurposeSpine traumata are devastating injuries, which may result in serious disabilities and dire consequences. The current study involves a detailed analysis and description of patients, who were operated at a tertiary care, urban level 1 Spine Centre in India.Overview of LiteratureVarious studies in literature have discussed the epidemiology and patterns of these injuries in trauma patients. However, literature describing the demographic profile and distribution of these traumata in the Indian population is scarce.MethodsThe current study was conducted as a prospective trial involving patients, who were treated at our Spine Centre in India between July 2009 to December 2012. We studied 92 patients with thoraco-lumbar spine fracture, who were operated with short or long segment posterior stabilization. Epidemiological details, pre- and post-hospitalisation care received and other injury pattern factors were studied.ResultsFall from height (46 patients, 50%) was the most common mechanism observed in the patients. Sixty-three percent injuries belonged to AO type A fractures, while 16.2% and 19.4% of the patients had suffered from AO types B and C injuries, respectively.ConclusionsWe identified interesting epidemiological data and prevailing inadequacies in Emergency Spine care management in the study patients. These observations could facilitate implementation of the changes required to improve current standards of patient care

DNA-PKcs-Mediated Transcriptional Regulation Drives Prostate Cancer Progression and Metastasis.

Emerging evidence demonstrates that the DNA repair kinase DNA-PKcs exerts divergent roles in transcriptional regulation of unsolved consequence. Here, in vitro and in vivo interrogation demonstrate that DNA-PKcs functions as a selective modulator of transcriptional networks that induce cell migration, invasion, and metastasis. Accordingly, suppression of DNA-PKcs inhibits tumor metastases. Clinical assessment revealed that DNA-PKcs is significantly elevated in advanced disease and independently predicts for metastases, recurrence, and reduced overall survival. Further investigation demonstrated that DNA-PKcs in advanced tumors is highly activated, independent of DNA damage indicators. Combined, these findings reveal unexpected DNA-PKcs functions, identify DNA-PKcs as a potent driver of tumor progression and metastases, and nominate DNA-PKcs as a therapeutic target for advanced malignancies

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Navier Stokes Solutions for Chemical Laser Flows: Steady and Unsteady Flows

This work consists of an overall effort to apply a detailed and accurate computational fluid dynamic technique to the solution of practical high energy laser flows. In particular, a third generation of super sonic diffusion chemical laser analysis is introduced, namely, the complete solution of the Navier-Stokes equations for the laminar, super sonic mixing flow fields fully coupled with chemical kinetics for both the hot and cold reactions for HF. Multicomponent diffusion is treated in a detailed fashion. Solutions are obtained, firstly, for "cold flows", where the effects of chemical reactions and vibrational relaxation are not included. Although such a situation is purely artificial, the results do isolate some of the fluid dynamic aspects of chemical laser flows, and provide a set of data to be compared later with hot flow calculations. A set of numerical experiments using four different time dependent finite difference schemes show that relatively minor changes in the differencing procedure can lead to major variations in the results. A modification of the well-known Maccormack approach appears to be the best suited for mixing flows associated with chemical lasers. A comparison is next made between cold flows (with fully coupled chemical kinetics). the results show that temperature distributions are affected the most and velocity distributions the least by chemical energy heat release. The results have an impact on the interpretation of cold flow aerodynamic experiments in the laboratory, and their proper extrapolation to the real chemical laser flows. also, comparisons between the present Navier Stokes results and other, more approximate, existing calculations are made. Gradients are calculated as a natural part of the Navier Stokes solutions. Results are given for steady flows with large pressure gradients where advantages of the Navier Stokes solutions are delineated. In addition, the effect of unsteady fluctuations intentionally introduced at the cavity inlet are studied. Specifically, sinusoidal fluctuations in one stream and then both streams (primary and secondary) in various quantities e.g. pressure, density, u velocity and v velocity were simulated. Of these, the oscillations in v velocity with approximate frequency and amplitude produced a remarkable improvement in mixing. Such unsteady fluctuations also yielded peak laser gain which were larger by almost a factor of two compared to the steady case. the flow at which the upstream boundary has so far, in the above mentioned cases been assumed to be uniform with real effects like Boundary Layer and Base Flow having been neglected. For comparison purposes these effects are next included. the boundary layer profile and velocity at the inlet is shown to feed production of gain substantially. Base flow calculations were attempted but were not successfu

Experimental evaluation of anxiolytic and antidepressant activities of methanolic extract of Triticum aestivum (wheatgrass) in albino mice

Background: Anxiety and depression are common psychiatric conditions. The present study was carried out to find antianxiety and antidepressant activity of methanolic extract of Triticum aestivum (wheat grass) in mice. Materials and methods: The methanolic extract of Triticum aestivum (META) was screened for antianxiety activity by elevated plus maze (EPM) and light and dark box (LDB) and for antidepressant activity by forced swim test (FST) and tail suspension test (TST) in mice. Animals were divided into four groups having six animals in each group. Group I served as control and received gum acacia aqueous suspension 10 ml/kg, Groups II and III served as test groups and received META 200 and 400 mg/kg, respectively, Group IV served as standard group and received diazepam 1 mg/kg for antianxiety activity and fluoxetine (20 mg/kg) for antidepressant activity once daily for thirty days. Result: META 200 and 400 mg/kg showed significant (P 0.05) with diazepam 1mg/kg. META 200 and 400 mg/kg also produced dose-dependent significant (P 0.05) with fluoxetine 20 mg/kg. Conclusion: Results of our study suggested that META possess dose-dependent significant antianxiety and antidepressant activities