Diffusion Weighted MR Imaging in Diffuse Axonal Injury

INTRODUCTION: Head Injury is one of the leading causes of disability and death in Middle Ages in Head Injury and in our country1, about fifty thousand people loose their lives and another 80000 are disabled because of Traumatic Brain Injury. Head injury involves young people in their productive part of their life. Loss of life and rehabilitation of severely disabled victims costs a lot of money and incurs a significant economic burden to the family and country. One of the WHO report mentioned 3.5 million deaths all over the world in a year, due to injury, among them 700,000 were due to road accidents. The same report mentioned that 1.5 million people required medical care. Nakajima et al, reported 5000 billion US dollars being the medical bills and rehabilitation cost. This is a tremendous financial loss due to accidents. India being a developing country increasing accidents not only results in loss of young life, but also damage to the family and financial burden Currently number of deaths due to the road accidents in India are over 60,000 and large number of deaths do occur due to various other injuries. Ramamurthy quoted Rs. 350 cores financial loss per year, due to accidents. The figure is higher at present. AIMS AND OBJECTIVES: 1. To study the usefulness of Diffusion Weighted MR Imaging (DWI) in assessing the prognosis of patients with Diffuse Axonal Injury (DAI). 2. An attempt to understand the significance of various images and signs in DWI MRI of DAI Patients from neurosurgical perspectives. 3. To enable the neurologists and neurosurgeons to understand and correlate the varied clinical manifestations and findings of images and to predict the outcome based on MR sequences. 4. To study about various modes of injuries that are associated with DAI 5. To study about the variations in MRI findings depending on the duration between Time of Injury and Time of MRI. 6. To correlate the duration of LOC, site of lesion, GCS, GOS in DAI with DW sequence of MRI. MATERIALS AND METHODS: The study was done in 48 patients who had been treated for Diffuse Axonal Injuries at Dept .of Neurosurgery, Madras Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between August 2010 and February 2013. This was a prospective study and included only when the relatives had given informed consent for taking part in the study. Inclusion Criteria All patients having recent closed head injury with GCS Score 12 and below with normal CT Scan Brain i.e. -severe and moderate head injury patients irrespective of mode of injury are included. Exclusion Criteria: The following patients were excluded • An inability to stay for one hour for MR imaging, • Contraindications for MR imaging, • Poly trauma, • The time delay between trauma and admission exceeding 48 hours, • Patients who had definite lesion in CT Scan Brain, • Patients who underwent surgery, • Images with significant Motion artifacts. CONCLUSION: Diffuse Axonal Injuries occur with motor vehicle accidents due to acceleration deceleration and rotational forces acting on the brain during impact. Patient with moderate and severe injuries according to GCS Scoring system had poor Glasgow Outcome scale. Brain Stem Lesions has poor outcome either death or persistent vegetative state probably due to shearing of tracts. Corpus Callosum lesions took a longer time to recover from LOC and are associated with lower Glasgow outcome scores In future, when supplemented with Diffusion tensor imaging and tractography, neuronal injuries can be analysed well. • Road Traffic Accidents are more often associated with Diffuse Axonal Injuries than Assaults and Accidental Falls. • Day of Imaging had no correlation with the findings or Outcome. • Lesions in Brain Stem and Corpus Callosum were associated with poor GCS on Admission. • Lesions in Brain Stem and Corpus Callosum were associated with Longer period of Loss of Consciousness. • Lesions in Brain Stem and Corpus Callosum were associated with poor Outcome as per GOS. • DWI is an eye opener for DAI analyzing the DAI

Trends in Cardiac Pacemaker Batteries

Batteries used in Implantable cardiac pacemakers-present unique challenges to their developers and manufacturers in terms of high levels of safety and reliability. In addition, the batteries must have longevity to avoid frequent replacements. Technological advances in leads/electrodes have reduced energy requirements by two orders of magnitude. Micro-electronics advances sharply reduce internal current drain concurrently decreasing size and increasing functionality, reliability, and longevity. It is reported that about 600,000 pacemakers are implanted each year worldwide and the total number of people with various types of implanted pacemaker has already crossed 3 million. A cardiac pacemaker uses half of its battery power for cardiac stimulation and the other half for housekeeping tasks such as monitoring and data logging. The first implanted cardiac pacemaker used nickel-cadmium rechargeable battery, later on zinc-mercury battery was developed and used which lasted for over 2 years. Lithium iodine battery invented and used by Wilson Greatbatch and his team in 1972 made the real impact to implantable cardiac pacemakers. This battery lasts for about 10 years and even today is the power source for many manufacturers of cardiac pacemakers. This paper briefly reviews various developments of battery technologies since the inception of cardiac pacemaker and presents the alternative to lithium iodine battery for the near future

Proneo: Large File Transfer using Webworkers and Cloud Services

Cloud computing is a term, which involves virtualization, distributed computing, networking, and web services. Efficient data transfer among the cloud server and client. Cloud storage enables users to remotely store and retrieve their data. In previous work, the data are stored in the cloud using dynamic data operation with computation which makes the user need to make a copy for further updating and verification of the data loss. The objective of our project is to propose the partitioning method & web workers for the data storage which avoids the local copy at the user side. The cryptography technologies offer encryption and decryption of the data and user authentication information to protect it from the unauthorized user or attacker. MD5 based file encryption system for exchanging information or data is included in this model. This ensures secure authentication system and hiding information from others. The Cloud server allows user to store their data on a cloud without worrying about correctness & integrity of data. DOI: 10.17762/ijritcc2321-8169.15052

Dabrafenib plus trametinib in patients with relapsed/refractory BRAF V600E mutation–positive hairy cell leukemia

BRAF V600E is the key oncogenic driver mutation in hairy cell leukemia (HCL). We report the efficacy and safety of dabrafenib plus trametinib in patients with relapsed/refractory BRAF V600E mutation–positive HCL. This open-label, phase 2 study enrolled patients with BRAF V600E mutation–positive HCL refractory to first-line treatment with a purine analog or relapsed after ≥2 prior lines of treatment. Patients received dabrafenib 150 mg twice daily plus trametinib 2 mg once daily until disease progression, unacceptable toxicity, or death. The primary endpoint was investigator-assessed objective response rate (ORR) per criteria adapted from National Comprehensive Cancer Network-Consensus Resolution guidelines. Secondary endpoints included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Fifty-five patients with BRAF V600E mutation–positive HCL were enrolled. The investigator-assessed ORR was 89.0% (95% confidence interval, 77.8%-95.9%); 65.5% of patients had a complete response (without minimal residual disease [MRD]: 9.1% [negative immunohistochemistry of bone marrow {BM} biopsy], 12.7% [negative BM aspirate flow cytometry {FC}], 16.4% [negative immunohistochemistry and/or FC results]; with MRD, 49.1%), and 23.6% had a partial response. The 24-month DOR was 97.7% with 24-month PFS and OS rates of 94.4% and 94.5%, respectively. The most common treatment-related adverse events were pyrexia (58.2%), chills (47.3%), and hyperglycemia (40.0%). Dabrafenib plus trametinib demonstrated durable responses with a manageable safety profile consistent with previous observations in other indications and should be considered as a rituximab-free therapeutic option for patients with relapsed/refractory BRAF V600E mutation–positive HCL. This trial is registered at www.clinicaltrials.gov as #NCT02034110.</p

Dabrafenib plus trametinib in BRAFV600E-mutated rare cancers:the phase 2 ROAR trial

BRAFV600E alterations are prevalent across multiple tumors. Here we present final efficacy and safety results of a phase 2 basket trial of dabrafenib (BRAF kinase inhibitor) plus trametinib (MEK inhibitor) in eight cohorts of patients with BRAFV600E-mutated advanced rare cancers: anaplastic thyroid carcinoma (n = 36), biliary tract cancer (n = 43), gastrointestinal stromal tumor (n = 1), adenocarcinoma of the small intestine (n = 3), low-grade glioma (n = 13), high-grade glioma (n = 45), hairy cell leukemia (n = 55) and multiple myeloma (n = 19). The primary endpoint of investigator-assessed overall response rate in these cohorts was 56%, 53%, 0%, 67%, 54%, 33%, 89% and 50%, respectively. Secondary endpoints were median duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. Median DoR was 14.4 months, 8.9 months, not reached, 7.7 months, not reached, 31.2 months, not reached and 11.1 months, respectively. Median PFS was 6.7 months, 9.0 months, not reached, not evaluable, 9.5 months, 5.5 months, not evaluable and 6.3 months, respectively. Median OS was 14.5 months, 13.5 months, not reached, 21.8 months, not evaluable, 17.6 months, not evaluable and 33.9 months, respectively. The most frequent (=20% of patients) treatment-related adverse events were pyrexia (40.8%), fatigue (25.7%), chills (25.7%), nausea (23.8%) and rash (20.4%). The encouraging tumor-agnostic activity of dabrafenib plus trametinib suggests that this could be a promising treatment approach for some patients with BRAFV600E-mutated advanced rare cancers. ClinicalTrials.gov registration: .Y

Dabrafenib plus trametinib in BRAFV600E-mutated rare cancers: the phase 2 ROAR trial

BRAFV600E alterations are prevalent across multiple tumors. Here we present final efficacy and safety results of a phase 2 basket trial of dabrafenib (BRAF kinase inhibitor) plus trametinib (MEK inhibitor) in eight cohorts of patients with BRAFV600E-mutated advanced rare cancers: anaplastic thyroid carcinoma (n = 36), biliary tract cancer (n = 43), gastrointestinal stromal tumor (n = 1), adenocarcinoma of the small intestine (n = 3), low-grade glioma (n = 13), high-grade glioma (n = 45), hairy cell leukemia (n = 55) and multiple myeloma (n = 19). The primary endpoint of investigator-assessed overall response rate in these cohorts was 56%, 53%, 0%, 67%, 54%, 33%, 89% and 50%, respectively. Secondary endpoints were median duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. Median DoR was 14.4 months, 8.9 months, not reached, 7.7 months, not reached, 31.2 months, not reached and 11.1 months, respectively. Median PFS was 6.7 months, 9.0 months, not reached, not evaluable, 9.5 months, 5.5 months, not evaluable and 6.3 months, respectively. Median OS was 14.5 months, 13.5 months, not reached, 21.8 months, not evaluable, 17.6 months, not evaluable and 33.9 months, respectively. The most frequent (≥20% of patients) treatment-related adverse events were pyrexia (40.8%), fatigue (25.7%), chills (25.7%), nausea (23.8%) and rash (20.4%). The encouraging tumor-agnostic activity of dabrafenib plus trametinib suggests that this could be a promising treatment approach for some patients with BRAFV600E-mutated advanced rare cancers. ClinicalTrials.gov registration: NCT02034110