Audit of Gastroesophageal Junction Tumors

INTRODUCTION: Gastroesophageal junction tumors are considered to be those tumors whose epicenter lies within the 5 cm range (totally-10cm) on either side of anatomic gastro-esophageal junction. A cancer in the stomach with its epicenter 5cm beyond the gastroesophageal junction aborally, and also those within 5 cm but not encroaching the gastroesophageal junction, are considered as proximal gastric cancer. Endoscopically the gastro esophageal junction is defined as the place where distal end of esophageal longitudinal vessels meet the proximal ends of gastric mucosal folds. Histological confirmation of the esophagus is needed by identifying the distal end of esophageal squamous mucosa, its multilayered epithelium and the deep esophageal sub mucosal glands or ducts. Identification of the proximal end of gastric oxyntic mucosa is also useful. In hiatus hernia the squamocolumnar junction is not a reliable marker of gastro esophageal junction. The most common tumors to arise in this area is the adenocarcinoma and the squamous cell carcinoma. This is a heterogeneous group comprising both, esophageal and gastric carcinoma and the true junctional type tumors. AIM OF THE STUDY: To study the epidemiology, clinical presentation, age group affected, sex ratio, resectability, type of surgical procedure, margin status, pathological type of tumors, complications occurring post surgery including death in the patients presenting to our department (Surgical Gastroenterology and proctology) during the study period from August 2010 to February 2013. MATERIALS AND METHODS All the patients presenting to our department (surgical gastroenterology) at Rajiv Gandhi Government General hospital from august 2010 to February2013 with gastroesophageal junction tumors or those presenting with dysphagia and regurgitation and on evaluation by upper gastrointestinal endoscopy and imaging studies, found to have gastroesophageal junction tumors and distant metastasis ruled out by a CECT were studied. Age, gender, chief complaints, co-morbid illness, nature of diet, personal habits like smoking and alcohol consumption were noted. Complete physical examination findings of the patients like presence or absence of jaundice, pallor, pedal edema and bilateral supraclavicular lymphadenopathy if any were noted. Abdominal examination was done to look for any palpable mass, hepatomegaly and free fluid. Rectal examination was done in all patients to rule out pelvic deposits. Lab investigations including a complete hemogram, liver function tests and renal function tests were done. Inclusion criteria: All patients with gastroesophageal junction tumors who have resectable disease by imaging and in whom surgery is planned. Exclusion criteria: Patients with carcinoma lower third of esophagus not encroaching the anatomic gastro esophageal junction, Carcinoma esophagus with epicenter beyond 5cm on the oral side of the anatomic gastroesophageal junction. Carcinoma arising in the cardia of stomach but not involving gastroesophageal junction and those with epicenter 5cm beyond GEJ aborally. Carcinoma of GEJ with distant metastasis identified preoperatively. RESULTS: Of all the patients with gastroesophageal junction tumors, those patients who were found to have distant metastasis or locally advanced disease by imaging were referred to palliative chemotherapy, chemoradiotherapy or palliative supportive care and were excluded from the study. Also patients with proximal gastric cancer within 5cm of gastroesophageal junction but not involving the gastroesophageal junction and those with esophageal carcinoma 5cm proximal to gastroesophageal junction and those not involving the gastroesophageal junction were excluded from the study. 81 patients who had resectable disease on imaging in whom surgery was planned were studied. CONCLUSION: GE junction cancers represent an emerging health problem. The incidence of adenocarcinoma in this part of the world is on the rise similar to the west probably due to changing life styles and adaptation of western culture. The AJCC 7th edition staging manual for esophageal carcinoma includes the gastroesophageal junction and harmonizes the esophageal and gastric cancer staging system. Surgical resection for cure remains the mainstay of treatment at present. Tailoring the surgical approach in accordance with the histological type, and siewert type gives the optimal outcome to the patient

Stiffness of Contacts Between Rough Surfaces

The effect of self-affine roughness on solid contact is examined with molecular dynamics and continuum calculations. The contact area and normal and lateral stiffnesses rise linearly with the applied load, and the load rises exponentially with decreasing separation between surfaces. Results for a wide range of roughnesses, system sizes and Poisson ratios can be collapsed using Persson's contact theory for continuous elastic media. The atomic scale response at the interface between solids has little affect on the area or normal stiffness, but can greatly reduce the lateral stiffness. The scaling of this effect with system size and roughness is discussed.Comment: 4 pages, 3 figure

FORMULATION DEVELOPMENT AND IN VITRO EVALUATION OF SUSTAINED RELEASE MATRIX TABLETS OF BOSENTAN BY USING SYNTHETIC POLYMERS

Objective: Bosentan is an endothelin receptor antagonist (ERA) indicated for the treatment of Pulmonary arterial hypertension (PAH). The aim of the present study involves the development of sustained release matrix tablets of bosentan in order to release the drug in sustained and predictable manner. Methods: Bosentan SR Matrix tablets were prepared by Wet granulation method. The tablets were evaluated for Hardness, Thickness, Friability and Drug content and were subjected to a 12 hours in vitro drug release studies. Results: The amount of Bosentan released from the tablet formulations at different time intervals was estimated using a UV Spectroscopy method. Among all the formulations are prepared by using different polymers like HPMC K 4 M, HPMC K15 M at different ratios. Conclusion: We Can Conclude that Among the Ten formulations, F-2 formulation containing drug to HPMC K 4 M in ratio 1:0.5 is optimized based on its ability to sustain drug release till 12 hours of dissolution study, The results of the study clearly demonstrated that HPMC matrix tablet formulation is an effective and promising drug delivery system for once daily administration of Bosentan

Bulk viscosity in hyperonic star and r-mode instability

We consider a rotating neutron star with the presence of hyperons in its core, using an equation of state in an effective chiral model within the relativistic mean field approximation. We calculate the hyperonic bulk viscosity coefficient due to nonleptonic weak interactions. By estimating the damping timescales of the dissipative processes, we investigate its role in the suppression of gravitationally driven instabilities in the $r$-mode. We observe that $r$-mode instability remains very much significant for hyperon core temperature of around $10^8$K, resulting in a comparatively larger instability window. We find that such instability can reduce the angular velocity of the rapidly rotating star considerably upto $\sim0.04 \Omega_K$, with $\Omega_K$ as the Keplerian angular velocity.Comment: 10 pages including 7 figure

Photon emission from out of equilibrium dissipative parton plasma

Using the second order Israel-Stewart hydrodynamics we discuss the effect of viscosity on photon production in a parton plasma created in relativistic heavy ion collisions. We find that photon production rates can enhance by several factors due to the viscous effect in a chemically nonequilibrated plasma.Comment: 6 pages + 4 figure

HAND GESTURE BASED SURVELLIANCE ROBOT USING RASPBERRY PI3

In modern days robots have become an integral part of human life. Now a day’s humans and robots need to coincide, it is important to evolve more natural and easy communication mechanisms for human machine interaction. The communication mechanism needs to be easier for humans than machines. Hence a mechanism has been developed that operates by processing the gesture commands signal. The prototype uses object tracking algorithm to understand the gesture commands. The Spybot is programmed to understand the gesture command signals and make route according to hand gestures, sensed by video camera operating within a short range. The gesture commands can be used for controlling the Spybot functions such as movement of the robot or other operations of robot silently that can be implemented by raspberry pi unit. By means of application, a Spybot that captures images from target places silently and sends the capture data to the host computer

On attributes of a Rotating Neutron star with a Hyperon core

We study the effect of rotation on global properties of neutron star with a hyperon core in an effective chiral model with varying nucleon effective mass within a mean field approach. The resulting gross properties of the rotating compact star sequences are then compared and analyzed with other theoretical predictions and observations from neutron stars. The maximum mass of the compact star predicted by the model lies in the range $(1.4-2.4) ~M_{\odot}$ at Kepler frequency $\Omega_K$, which is consistant with recent observation of high mass stars thereby reflecting the sensitivity of the underlying nucleon effective mass in the dense matter EoS. We also discuss the implications of the experimental constraints from the flow data from heavy-ion collisions on the global properties of the rotating neutron stars.Comment: 11 Pages, 10 Figures and 2 Table

Use of spatiotemporal characteristics of ambient PM2.5 in rural South India to infer local versus regional contributions

This study uses spatiotemporal patterns in ambient concentrations to infer the contribution of regional versus local sources. We collected 12 months of monitoring data for outdoor fine particulate matter (PM2.5) in rural southern India. Rural India includes more than one-tenth of the global population and annually accounts for around half a million air pollution deaths, yet little is known about the relative contribution of local sources to outdoor air pollution. We measured 1-min averaged outdoor PM2.5 concentrations during June 2015-May 2016 in three villages, which varied in population size, socioeconomic status, and type and usage of domestic fuel. The daily geometric-mean PM2.5 concentration was approximately 30mugm(-3) (geometric standard deviation: approximately 1.5). Concentrations exceeded the Indian National Ambient Air Quality standards (60mugm(-3)) during 2-5% of observation days. Average concentrations were approximately 25mugm(-3) higher during winter than during monsoon and approximately 8mugm(-3) higher during morning hours than the diurnal average. A moving average subtraction method based on 1-min average PM2.5 concentrations indicated that local contributions (e.g., nearby biomass combustion, brick kilns) were greater in the most populated village, and that overall the majority of ambient PM2.5 in our study was regional, implying that local air pollution control strategies alone may have limited influence on local ambient concentrations. We compared the relatively new moving average subtraction method against a more established approach. Both methods broadly agree on the relative contribution of local sources across the three sites. The moving average subtraction method has broad applicability across locations