Modalities of Reconstruction in Oral Malignancy: A prospective study

INTRODUCTION: Carcinoma oral cavity affects 10 million people annually. It is the sixth commonest carcinoma in the world. According to National cancer registry program, Thanjavur district stands at the 11th place for oral cavity carcinoma in males in India. In spite of the easy accessibility for physical examination and biopsy, majority of the patient still remain a challenge for the treating physician. Surgery forms the mainstay of treatment and in most cases with addition of radiotherapy as an adjuvant therapy. The cosmetic, functional and psychosocial results of oral cancer may combine to produce devastating effect on the patient in view of wide range of functions of oral cavity including speech, deglutition, mastication and competence. These patients require a well-planned and well executed reconstructive strategies and extensive rehabilitative management. With the advent of the newer technique like microvascular free tissue transfer and availability of improved biomaterials like Osseointegrated implants, simultaneous reconstruction of defect and ensuring a near normal quality of life has become the standard care instead of previous concept of providing a skin coverage alone. A descriptive study of 40 patients with oral cavity malignancy and reconstructive strategies employed from October 2007 to April 2010 are discussed. AIMS AND OBJECTIVES: 1. To study the demographics of oral cavity reconstruction in our department during the period October 2007- April 2010. 2. To identify the various factors that influences the choice of reconstruction. 3. To analyse the various methods of reconstruction and their outcomes in terms of functionality and aesthetics. MATERIALS AND METHODS: This study is the prospective non randomized descriptive study conducted in the Department of Plastic Surgery, Thanjavur medical college and hospital. • A total of 40 Patients with oral malignancy who were treated in our department from October 2007 to April 2010 were included in the study. • Detailed History, Physical Examination & appropriate investigations were done to arrive at a clinical diagnosis. • Patients with prior histopathological diagnosis were included in the study. Co morbid conditions were thoroughly assessed. • Patients were clinically staged with the help of clinical examinations and staging investigations. • Based on the clinical stage of the disease, treatment and reconstruction was planned for each case in our departmental planning session. Inclusion Criteria: All patients diagnosed with oral malignancy during the study period. Exclusion Criteria: Patients with metastasis, Lesions involving retromolar trigone, Recurrent malignancy, Patients with N3 nodal status were excluded in the study. CONCLUSION: Oral cancer is a national problem. • It remains the challenge as a surgery forms the mainstay of treatment but the reconstruction of post excisional defect as the post excisional defect are complex wound which often requires replacement of lining, skin cover and bone. • With the multimodality management emerging as the treatment of choice, the reconstructive surgeon has to be the part of a team which includes oncosurgeon, radio therapist and oncopathologist. • Commonest age group affected were 50 – 60 years, because of easy accessibility of lesion, a rigorous screening program in these age groups especially those who are at high risk will enable early detection of lesion which would provide better curative and easier reconstructive options. • Tobacco in any form is the major predisposing factor, health education through mass media and posters in health centers in a large scale by Government and Non- Government organizations will create awareness and help in prevention

Thai Pongal in the life of the Vellalars of Karimangalam Area

In the early days when the Tamil people lived in groups, they followed certain guidelines for the betterment of their lives. Its expression can still be seen today in the works of Sangam literature. It would not be an exaggeration to say that this is the way our forefathers followed then to understand the Tamil people as civilized people today. Thus, the Velala Gounder living in the Karimangalam area of ​​the Dharmapuri district, a Tamil tribe, are still celebrating Pongal. A few days before the commencement of the festival in the Karimangalam area, all the people of Urgudi unanimously decided to collect firewood for Pongal, to boil the door, to roll the clay, to set the stove, to provide the other community with the customs of Thaipongal, and to preserve the Pongal on the day of Poki. Feasting, sharing of food with others, worshiping with cow dung, embracing the dead, bringing a plant from the river to worship the dead, and worshiping the cow, which helps to improve their lives. Making people feel the pain of bullfighting and making people feel the pain of bullfighting and celebrating the festival at the beginning of the festival are just as important as the honor of sharing a bouquet so that no one can return home empty-handed after the festival

Structure models for the hydrated and dehydrated nitrate-intercalated layered double hydroxide of Li and Al

Imbibition of LiNO3 into gibbsite results in the formation of a single phase layered double hydroxide of the composition LiAl2(OH)6(NO3)·1.2H2O. This phase undergoes reversible dehydration along with the compression of the basal spacing accompanied by the reorientation of the nitrate in the interlayer gallery. The hydrated phase is a solid solution of two lattices: (i) a hexagonal lattice defining the ordering of atoms within the metal hydroxide layer, and (ii) a lattice of orthorhombic symmetry defining the ordering of atoms within the interlayer. DFT calculations of the hydration behaviour show that there is no registry between the two sublattices. In the dehydrated phase, the nitrate ion is intercalated with its molecular plane parallel to the metal hydroxide layer and the crystal adopts a structure of hexagonal symmetry

Density functional theoretical studies on photoswitching and charge migration dynamics of thio and selenoureidopeptides

Density functional theoretical calculations have been performed to investigate the changes in electronic structure at ground and excited states of ureidopeptides on substitution with higher chalcogens like sulphur and selenium for oxygen. This replacement results in a reduced preference towards the intramolecular hydrogen bonding interaction, thus linear conformers are found to be stable at both states. Nevertheless, conformational switching observed during this process is mainly due to n to �* transition that leads to the dihedral angle � change from trans to cis with a rotational barrier of 10 to 17 kcal mol-1. The computed barrier is lesser than that reported for oxopeptides (20 kcal mol-1). And, the hole migration dynamics after immediate ionization illustrates that the hole originated at ureido end evolves in time (2�4 fs) while the hole generated at the carboxylate end will not evolve as reported for ureidopeptides. The usage of these candidates as photoswitches has also been explored. Copyright © 2017 John Wiley & Sons, Ltd

Electronic-Structure Calculations of Cation-Ordered II-III Layered Double Hydroxides: Origin of the Distortion of the Metal-Coordination Symmetry

Cation ordering brings down the crystal symmetry and introduces distortion into the coordination polyhedra around the divalent cations. In particular, edge sharing of the differently sized M(OH)6 polyhedra causes a non-uniform distension of the array of hydroxy ions. The question arises as to whether this distortion has its origin in the Jahn�Teller distortion of metal coordination or a 2D �Peierls�-type distortion of the array of hydroxy ions. To address this question, DFT calculations were performed on the sulfate-intercalated Cu�Cr, Zn�Cr, and Zn�Al layered double hydroxides (LDHs). An analysis of the density of states shows that the distortion of the Cu2+ coordination polyhedron is due to the Jahn�Teller effect, whereas the Zn2+ coordination polyhedron in Zn�Al LDH likely suffers a �Peierls�-type distortion. In the Zn�Cr LDH, electronic-structure calculations do not predict any distortion in the metal coordination, which is in agreement with experimental results that show only a slight departure from ideal symmetry. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinhei

Bilateral cadaveric variations of musculocutaneous nerve and median nerve in the anterior brachium: a case report

Formation of the brachial plexus is by the union of ventral rami of C5-T1 spinal nerves. The musculocutaneous nerve is a continuation of the lateral cord, pierces the coracobrachialis and supplies the flexor compartment of the arm. Our case report presents a unique bilateral cadaveric variation in the musculocutaneous nerve and median nerve branching patterns, in the flexor compartment of the arm. A case report of bilateral variations of musculocutaneous nerve and median nerve (R-Right, L-Left) was found during the routine dissection in the Department of Anatomy, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru. From the right lateral cord, separation of few nerve fibres forming the lateral root of the median nerve was appreciated. The lateral root joins the medial root of the medial cord, after emerging out of the ulnar nerve and forms the initial segment of median nerve. Before the union of lateral and medial roots of initial segment of median nerve, ulnar nerve, medial cutaneous nerve of arm and medial cutaneous nerve of forearm descends along the medial aspect of the right arm. From the left lateral cord musculocutaneous nerve pierces the coracobrachialis. Before piercing the muscle, it gives one vascular branch and a motor branch. After piercing, the musculocutaneous nerve runs downwards and gives a motor branch to left biceps brachii. Variations of brachial plexus are frequently subjected to compression neuropathy. During surgical approaches to the brachium region, awareness about the anatomical variations of lateral and medial cords is mandatory for diagnosing the peripheral nerve entrapment syndrome. An integrated understanding of these branches prevent iatrogenic injuries during surgical procedures

Association of fibroblast growth factor 21 with oxidative stress and lipid profile in type 2 diabetes

Background: Cardiovascular disease is the most prevalent cause of morbidity and mortality in diabetic patients. Fibroblast growth factor 21 (FBG 21) is an endocrine factor that regulates glucose and lipid metabolism, insulin resistance, and obesity. Blood levels of FGF21 are elevated in patients with atherosclerosis, macrovascular, and microvascular complications of diabetes, possibly due to a compensatory up regulation. Studies reported that FGF21 is an important regulator of mitochondrial and oxidative stress. The role of FGF21 in chronic diseases and the diminished oxidative stress observed with anti-diabetic therapy has been the target of new studies. Current study aimed to evaluate serum FGF21 levels and its association with oxidative stress and lipid profile levels in type 2 diabetic patients.Methods: 100 controls and 100 diabetic patients on oral hypoglycemic drugs between 35-55 years of age without any cardiac, renal, liver, and thyroid dysfunction were selected for this study. Oxidative stress (MDA), total antioxidant status (FRAP), and FGF21 were measured. FGF21 was analyzed by ELISA methods. Serum MDA was assessed by the method of Yagi  serum total antioxidant status was measured by the method of Benzie et al.Results: FGF21 level was increased in diabetic patients compared with controls. There was a significant positive correlation of FGF21 with MDA (r=0.875, p<0.01) and negative correlation with FRAP observed (r= -0.867 p<0.01). There was also positive correlation of FGF21 with total cholesterol (r=0.499, p<0.01), triglycerides (r=0.648, p<0.01), LDL-cholesterol (r=0.337, p<0.01) and negative correlation with HDL-cholesterol (r= -0.172, p<0.05) were observed.Conclusions: Increased oxidative stress and decreased antioxidant status were observed in diabetics. This could be due to dyslipidemia and increased generation of free radicals. High levels of FGF21 observed in our study might represent its resistant state and the compensatory response to maintain metabolic homeostasis. Further studies are needed to explore the role of FGF21 as a novel marker in predicting cardiovascular risk in diabetic patients

Pacemakers and Implantable Cardioverter Defibrillator

The history of cardiac pacing therapy must be viewed within the broader framework of electro-diagnosis and electro-therapy. Electro-therapy has a simple core concept: the use of an outside source of electricity to stimulate human tissue in various ways to produce a beneficial therapeutic effect. This has shown a prolonged, halting development through the ages, sometimes being looked upon as mysterious magic produced by complex machines. The field of paediatric open heart surgery gave a major impetus to the development of pacemakers since heart block often accompanied impeccably performed intra-cardiac repairs of congenital defects. This review deals various of aspects of pacemaker functioning, indications, contraindications and complications

Viewpoint-based testing of concurrent components

The use of multiple partial viewpoints is recommended for specification. We believe they also can be useful for devising strategies for testing. In this paper, we use Object-Z to formally specify concurrent Java components from viewpoints based on the separation of application and synchronisation concerns inherent in Java monitors. We then use the Test-Template Framework on the Object-Z viewpoints to devise a strategy for testing the components. When combining the test templates for the different viewpoints we focus on the observable behaviour of the application to systematically derive a practical testing strategy. The Producer-Consumer and Readers-Writers problems are considered as case studies