Progression of asymptomatic carotid stenosis despite optimal medical therapy

BackgroundDespite level 1 evidence in support of carotid endarterectomy vs medical therapy in selected asymptomatic patients, an alternative posture is that optimal medical therapy (OMT) has not been adequately studied and that such OMT has reduced stroke risk in asymptomatic patients to levels wherein carotid endarterectomy is no longer justified. The goal of this study was to determine the natural history of patients with asymptomatic moderate (50%-69%) carotid artery stenosis (AMCAS) in a contemporary cohort as a function of their associated medical therapy.MethodsPatients with AMCAS determined by duplex ultrasound (DUS) from 2005-2006 were identified in our hospital database. Patients were included in the cohort if they had at least one additional DUS during the 6-year follow-up interval. Patient characteristics including medication history and lipid levels were collected. Patients were considered to have OMT if they were on aspirin and a statin with a low-density lipoprotein level that was always <100 mg/dL. Study end points included progression of carotid disease by DUS to severe stenosis (70%-100%), development of ipsilateral neurologic symptoms (INS) such as stroke or transient ischemic attack, and death.ResultsThere were 900 carotid arteries in 794 patients in the study cohort. The average age was 72.5 years, 77.2% had hypertension, 59.6% had coronary artery disease, and 87.1% were on a statin throughout the study. The low-density lipoprotein cholesterol level was always normal (<100 mg/dL) in 37.8% and accordingly, 241 (30.3%) had OMT as defined above. The 5-year actuarial survival was 81.9% ± 1.3% with no advantage seen with OMT. Multivariate analysis of survival showed statins were protective (hazard ratio [HR], 0.50; confidence interval [CI], 0.34-0.73; P = .0004). The 5-year freedom from plaque progression was 61.2% ± 2.1% with no benefit from OMT vs the control group. Multivariate predictors of plaque progression were chronic kidney disease (HR, 2.1; CI, 1.2-3.7; P = .009), aspirin use (HR, 1.9; CI, 1.2-3.0; P = .01), and the use of calcium channel blockers (HR, 1.4; CI, 1.1-1.8; P = .007). There were 90 (11.3%) patients who developed INS during follow-up (58% of these were strokes), and the 5-year freedom from INS was 88.4% ± 1.5%. Multivariate predictors of INS were diabetes (HR, 2.3; CI, 1.5-3.6; P = .0002) and warfarin use (HR, 1.9; CI, 1.2-2.9; P = .009); while statin use (HR, 0.37; CI, 0.22-0.65; P = .0005) was protective against symptom development.ConclusionsAt the 5-year of follow-up, OMT failed to prevent carotid disease progression or development of ipsilateral symptoms in 45% of patients with AMCAS

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

Microfilaria in thyroid gland fine needle aspiration cytology - an unusual finding

Involvement of thyroid gland by filariasis is an unusual finding. We report a case in which microfilaria was found in thyroid aspirate smear. Patient did not have any symptoms or signs suggestive of filariasis. The patient was treated with diethylcarbamazine and a later hemithyroidectomy was performed. We reviewed the literature and discussed possible reasons for finding a microfilaria in thyroid gland. KEYWORDS: microfilaria, aspiration cytology, thyroid gland Nigerian Journal of Otorhinolaryngology Vol. 3(1) 2006: 36-3

Multi-criteria decision making approach for the selection of software effort estimation model

Software development with minimum effort has become a challenging task for the software de-velopers. Software effort may be defined as the prediction process of the effort required to de-velop any software. Many software effort estimation models have been developed in the past, but it is observed that none of them can be applied successfully in all kinds of projects in differ-ent environments that raise the problem of the software effort estimation model selection. To se-lect the suitable software effort estimation model, many conflicting selection criteria must be con-sidered in the decision process. The present study emphasizes on the development of a fuzzy multi-criteria decision making approach by integrating Fuzzy Set Theory and Weighted Distance Based Approximation. To show the consistency of the proposed approach, methodology valida-tion is also performed by making comparison with existing methodologies and to check the criti-cality of the selection criterion, sensitivity analysis is also performed

Decoding the Guidelines of Invasive Pulmonary Aspergillosis in Critical Care Setting: Imaging Perspective

Invasive pulmonary aspergillosis (IPA) is a common, life-threatening opportunistic fungal infection seen in susceptible individuals especially those admitted in critical care units. Multiple guidelines have been promulgated for the diagnosis of IPA, some of which are all inclusive, while others cater to specific patient groups. Microbiology forms the crux of the majority of the diagnostic tests/criteria; however, results take a considerable amount of time. Radiology can play an important role by bridging the gap to reach at an early diagnosis. Thus, the role of a radiologist cannot be overemphasized to recognize the typical and atypical imaging manifestations of invasive aspergillosis and aid in the swift management of these cases. This review decodes the terminology and various diagnostic criteria for IPA relevant to imaging studies. Further, the differences in imaging manifestations of IPA in neutropenic and non-neutropenic patients are also discussed

Leaching Kinetics of Sulphates in Acidic Soil

Aims:&nbsp;Present study is concerned about the leaching kinetics of sulphate anions in soil using glass column method. Study Design:&nbsp;we have focused our attention on the mechanism of solute transport via leaching. Place of Study:&nbsp;Soil samples were collected from the barren field located in the industrial area near Hapur district Methodology:&nbsp;The leaching study of sulphate is carried out in the laboratory by using the glass column. During the entire course of study the flow rate of deionised water or salts solution from glass column was maintained at 10±0.2 mL/10 min. Three salts of sulphates Na2SO4, MgSO4&nbsp;and Al2(SO4)3&nbsp;were used to study the leaching&nbsp; kinetics of sulphates in soil. Results:&nbsp;Initial leaching rate profiles are determined for each salt. On increasing [SO42-]i, LRobs&nbsp;values are seen to increase for all sulphate salts. The log-log plots of [SO42-]i and LRobs&nbsp;indicated to be the&nbsp; fractional order in [SO42-]i. The effect of temperature on sulphate leaching was studied in the range 20-50°C. It is clear that total initially leachable content i.e. [SO42-]i increases with the increase in temperature, probably due to the mobilization and leaching of some insoluble sulphate. LRobs&nbsp;values increases with the size of cation. The results can be explained on the basis of covalent character and radii of the hydrated ions. Initial water content or water filled porosity (θ) of the soil column was varied from .33 to .51 cm3&nbsp;cm-3. LRobs&nbsp;calculated values were found to increase only slightly on increasing initial water content of the soil column. Leached concentration were found time dependent and varied with time as the pore volume of effluent increased with time. The first order kinetics and Elovich model has been found to have excellent correlation for the desorption/Leaching of the sulphate confirmed by SEE and high r2&nbsp;values. However there is little correlation for the zero order and parabolic profiles. Conclusion:&nbsp;Present study proves that leaching of sulphate salts can be studied by initial rate method, which can also be applied for monitoring the fate of applied sulphate in agricultural fields and its diffusion into soil solution for plants uptake as well as in calculating the downward transportation of sulphate from polluted site to the underground water

Accuracy of two different apex locators for working length determination during root canal retreatment of mandibular molars using two different retreatment files: An in vitro study

Aim: The aim of this study was to evaluate the accuracy of two different apex locators for working length determination during root canal retreatment of mandibular molars in an in vitro study. Method: Sixty extracted mandibular first molars with separate mesial canals and apical foraminae and one distal canal were selected. The mesiobuccal and distal canals were investigated; the length with the file tip at the major diameter was defined as the tooth length (TL). The canals were prepared with ProTaper files to 1 mm short of this and filled with gutta-percha and AH Plus sealer. One week later, the root fillings were removed using ProTaper and M2 retreatment files. Tooth length was remeasured and recorded as the retreatment tooth length (RTL). Then electronic measurements were taken at the major (electronic apex locator (EAL) major) and minor (EAL minor) foraminae with Root ZX and Apex ID apex locator as suggested by the instrument display. These lengths were compared with RTL and measurements 0.5 and 1 mm short of this distance. Results: For both canals, no significant difference was found between RTL and EAL major, and 0.5 mm short of RTL and EAL minor with Root ZX apex locator and protaper retreatment files. There were significant differences found between Apex ID apex locator with M2 retreatment files readings. Conclusion: Root ZX apex locator was more accurate as compared to Apex ID apex locator in determining the working length in teeth after removing the root canal obturating material

Overview of the KUKA robot language-based intelligent algorithms on industrial robots for multifaced medical and engineering applications: A modern approach to automation

Industrial robots have been in use for about fifty years. Typical applications of industrial robots include biomedical, painting, palletizing, welding, assembly, and material handling. As healthcare robotic systems for diagnostics, surgical treatments, or rehabilitative services: Robotic&nbsp;technologies seem to be very well with a broad array of applications in automation medical advancements. Apart from medical, an algorithm is designed to play electronic musical keyboards with the help of an industrial robot. The algorithm is implemented on the KUKA KR-16 industrial robot. The robot plays an electronic musical keyboard according to the keyboard notes of the desired song. The algorithm is designed to make the input of musical notes simple and easy. The design algorithm is further developed with KRL (KUKA Robot Language). The proposed algorithm results show that the KUKA KR-16 can play the specified notes