Evaluation of juxta-apical radiolucency in cone beam CT images

OBJECTIVES: The aim of this study was to analyse the position and relationship of juxta-apical radiolucency (JAR) to the mandibular canal and buccal and/or lingual cortical plates using cone beam CT (CBCT). METHODS: A retrospective study was carried out to analyse the JAR on CBCT for 27 patients. These findings were compared with 27 age- and sex-matched patients without the presence of JAR, which acted as the control group. The CBCT images were analysed according to a checklist, to evaluate the position of the JAR and its relationship to the mandibular canal. Then, any thinning or perforation of either the buccal or lingual cortical plate due to JAR was noted, and a classification to quantify the thinning of cortical plates was proposed. The findings in the two groups were analysed using a paired comparison by McNemar test. RESULTS: A statistical increased thinning of cortical plates was seen in the JAR group compared with the control group, and most of the cases were in the J3 group. None of the patients in either the JAR or the control group showed perforation of the buccal and/or lingual cortical plate on CBCT images. CONCLUSIONS: A classification to quantify the thinning of cortical plates was proposed, which may be used for objective evaluation of the thinning of the cortical plates in future studies. The present study gives an insight into the relationship of the juxta-apical area with the mandibular canal and cortical plates in the mandible using CBCT.published_or_final_versio

Meigs’ syndrome: how we mistook the diagnosis in a tertiary oncology centre in India; an opinion piece on the surgeon’s responsibility in minimizing the stress of the cancer patient and family

Typical Meigs syndrome may mislead the surgeon as advanced ovarian cancer. CECT can identify the huge ovarian mass, ascites and pleural effusion. Mostly Surgeon’s mind focuses towards the pleural effusion with elevated CA 125 as stage IVa ovarian cancer because of the rarity of this syndrome. But it is Surgeon’s responsibility to diagnosis of Meigs syndrome beforehand to alleviate the pain of the patient and her family. Meigs’ syndrome typically presents with the triad of an ovarian mass, ascites and pleural effusion. The latter two resolved after removal of the mass. As this syndrome is a rare entity, this presentation of an ovarian mass may mislead the surgeon, biasing his or her mind towards advanced ovarian malignancy. Along with these if the CA-125 is also raised, the patient is usually labelled as stage IVa ovarian cancer, causing immense distress to the patient and family. This makes it even more imperative that the surgeon diagnoses this syndrome beforehand to avoid the pain of the patient and family

Methodology for input data modelling in the simulation of manufacturing systems.

Computer simulation is a well-established decision support tool in manufacturing industry. However, factors such as wrong conceptualisation, inefficient input data modelling, inadequate verification and validation, poorly planned experimentation and lengthy model documentation inhibit the rapid development and deployment of simulation models. A serious limitation among the above factors is inefficient data modelling. Typically, more than one third of project time is spent on identification, collection, validation and analysis of input data.This study investigated potential problems which influence inefficient data modelling. On the basis of a detailed analysis of data modelling problems, the study recommends a methodology to address many of these difficulties. The proposed methodology, discussed in this thesis, is called MMOD (Methodology for Modelling Of input Data). An activity module library and a reference data model, both developed using the IDEF family of constructs, are the core elements of the methodology. The methodology provides guidance on the best way of implementation and provide a tool kit to accelerate the data modelling exercise. It assists the modeller to generate a customised data model (entity model), according to the knowledge gained from the conceptualisation phase of the simulation project. The resulting customised data model can then be converted into a relational database which shows how the entities and relationships will be transformed into an actual database implementation. The application of the MMOD through simulation life cycle also enables the modeller to deal with important phases in the simulation project, such as system investigation, problems and objective definitions and the level of detail definitions. A sample production cell with different level of detail has been used to illustrate the use of the methodology. In addition, a number of useful methods of data collection and the benefits of using a MMOD approach to support these methods and data rationalisation which accelerates the data collection exercise are also covered. The aim of data rationalisation is to reduce the volume of input data needed by simulation models. This work develops two useful data rationalisation methods which accelerate the data collection exercise and reduce the model complexity. This work produced a novel approach to support input data modelling in simulation of manufacturing system. This method is particularly useful when the complex systems are modelled

Trends in Epithelial Cell Abnormalities Observed on Cervical Smears over a 21-Year Period in a Tertiary Care Hospital in Kuwait

Objectives: This study aimed to analyse trends in epithelial cell abnormalities (ECAs) in cervical cytology at a tertiary care hospital in Kuwait. Methods: ECAs in 135,766 reports were compared over three seven-year periods between 1992 and 2012. Conventional Papanicolaou (Pap) smear tests were used in the first two periods and ThinPrep (Hologic Corp., Bedford, Massachusetts, USA) tests were used in the third. Results: Significant increases in satisfactory smears, atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance/atypical glandular cells (AGUS/AGCs) were seen in the second and third periods (P <0.001). No significant increases were observed among low-grade squamous intraepithelial lesions (LSILs) or high-grade squamous intraepithelial lesions (HSILs) (P >0.05). An increase was noted in carcinomas between the first and second periods although a significant decline was seen in the third (P <0.014). Conclusion: Satisfactory smears, ASCUS and AGUS/AGC increased during the study period although no significant increases in LSILs, HSILs or carcinomas were observed

Evaluation of pulmonary infiltrates in patients with haematological malignancies using fibreoptic bronchoscopy and bronchoalveolar lavage

Background : Chest infection is the major cause of morbidity and mortality among patients with haematological malignancies. Conventional diagnostic methods - chest x-ray , blood and sputum culture have limited yield . We used fibreoptic bronchoscopy and bronchoalveolar lavage to evaluate nature of pulmonary infiltrates on chest x-ray. Patients and Methods : 25 patients with haematological malignancies with fever and pulmonary infiltrates were studied. Patients median age was 32 years, ranging from 16 to 65 years. There were 21 males and 4 females. Initial evaluation included - detailed physical examination including chest to see for any focus of infection. In all patients , base line blood counts (total and differential), chest x-ray and cultures from blood and other body fluids were taken before starting broad spectrum antibiotics . Those not responding over next 48-72 hours received gram positive coverage followed by amphotericin-B therapy . Patients with persistent fever and pulmonary infiltrates were subjected to fibre-optic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) and samples were collected for bacterial, fungal, AFB and viral studies. The findings were correlated with Chest x-ray and CT scan. Results The median time for FOB and BAL was 16 days (range, 3 to 32 days) after the clinical diagnosis of chest infection.. BAL fluid examination/culture grew microbial isolates in 21 of 25 patients (84%). Of thesebacteria alone were present in 10, fungi alone in 1 and polymicrobial isolates were seen in 10 patients (40%). Later included- a combination of bacteria and fungi - in 2 patients, bacteria and AFB - 6 and a combination of bacteria, AFB and fungi were seen in 2 patients. BAL changed the radiological diagnosis in 14 patients (56% diagnostic utility). Therapy was modified according to BAL results in 6 patients (therapeutic utility of 24 %). Concordance between radiological and BAL findings were found only in 5 patients (20%). FOB procedure was tolerated well, with mild and reversible complications (throat pain, transient hypoxia, tachycardia) in some patients. Conclusions: Infections are the main cause of pulmonary infiltrates in patients with haematological malignancies. Bacterial , fungal and mycobacterium tubercular organisms are the main isolates. Isolation of ESBL positive organisms and polymicrobial isolates suggest inclusion of appropriate initial empirical antibiotics in these patients to prevent development of resistant organisms. Higher frequency of AFB isolates (32%) was the surprising finding and need to be confirmed in future studies

Filariasis of the Axilla in a Patient Returning from Travel Abroad: A Case Report

Background: The term filariasis comprises a group of parasitic infections caused by helminths belonging to different genera in the superfamily Filaroidea. The human parasites occur mainly in tropical and subtropical regions, but filariae are also found in temperate climates, where they can infect wild and domestic animals. Humans are rarely infected by these zoonotic parasites. Patients and Methods: A 55-year-old patient presented with a new-onset, subcutaneous, non-tender palpable mass in the right axilla. Ultrasonography showed a 1.3-cm, solid, singular encapsulated node. Sonography of the breast on both sides, axilla and lymphatic drainage on the left side, lymphatic drainage on the right side, and mammography on both sides were without pathological findings. The node was excised under local anesthesia as the patient refused minimal invasive biopsy. Results: On histopathological examination, the tail of a parasite of the group of filariae was found. The patient revealed that she had stayed in Africa and Malaysia for professional reasons. 6 months before the time of diagnosis, she had also suffered from a fever and poor general condition after a trip abroad. The patient was referred for further treatment to the Institute for Tropical Medicine at the University of Dusseldorf, where a treatment with ivermectin was conducted on the basis of positive staining with antibodies against filariae. Conclusion: Our case demonstrates the importance of interdisciplinary collaboration between breast center, pathology, and other specialties such as microbiology and tropical medicine

Scaling, Propagation, and Kinetic Roughening of Flame Fronts in Random Media

We introduce a model of two coupled reaction-diffusion equations to describe the dynamics and propagation of flame fronts in random media. The model incorporates heat diffusion, its dissipation, and its production through coupling to the background reactant density. We first show analytically and numerically that there is a finite critical value of the background density, below which the front associated with the temperature field stops propagating. The critical exponents associated with this transition are shown to be consistent with mean field theory of percolation. Second, we study the kinetic roughening associated with a moving planar flame front above the critical density. By numerically calculating the time dependent width and equal time height correlation function of the front, we demonstrate that the roughening process belongs to the universality class of the Kardar-Parisi-Zhang interface equation. Finally, we show how this interface equation can be analytically derived from our model in the limit of almost uniform background density.Comment: Standard LaTeX, no figures, 29 pages; (to appear in J. Stat. Phys. vol.81, 1995). Complete file available at http://www.physics.helsinki.fi/tft/tft.html or anonymous ftp at ftp://rock.helsinki.fi/pub/preprints/tft

Parathyroid Hormone Mediates Hematopoietic Cell Expansion through Interleukin-6

Parathyroid hormone (PTH) stimulates hematopoietic cells through mechanisms of action that remain elusive. Interleukin-6 (IL-6) is upregulated by PTH and stimulates hematopoiesis. The purpose of this investigation was to identify actions of PTH and IL-6 in hematopoietic cell expansion. Bone marrow cultures from C57B6 mice were treated with fms-like tyrosine kinase-3 ligand (Flt-3L), PTH, Flt-3L plus PTH, or vehicle control. Flt-3L alone increased adherent and non-adherent cells. PTH did not directly impact hematopoietic or osteoclastic cells but acted in concert with Flt-3L to further increase cell numbers. Flt-3L alone stimulated proliferation, while PTH combined with Flt-3L decreased apoptosis. Flt-3L increased blasts early in culture, and later increased CD45+ and CD11b+ cells. In parallel experiments, IL-6 acted additively with Flt-3L to increase cell numbers and IL-6-deficient bone marrow cultures (compared to wildtype controls) but failed to amplify in response to Flt-3L and PTH, suggesting that IL-6 mediated the PTH effect. In vivo, PTH increased Lin- Sca-1+c-Kit+ (LSK) hematopoietic progenitor cells after PTH treatment in wildtype mice, but failed to increase LSKs in IL-6-deficient mice. In conclusion, PTH acts with Flt-3L to maintain hematopoietic cells by limiting apoptosis. IL-6 is a critical mediator of bone marrow cell expansion and is responsible for PTH actions in hematopoietic cell expansion

Public health professionals' perceptions toward provision of health protection in England: a survey of expectations of Primary Care Trusts and Health Protection Units in the delivery of health protection

BACKGROUND: Effective health protection requires systematised responses with clear accountabilities. In England, Primary Care Trusts and the Health Protection Agency both have statutory responsibilities for health protection. A Memorandum of Understanding identifies responsibilities of both parties, but there is a potential lack of clarity about responsibility for specific health protection functions. We aimed to investigate professionals' perceptions of responsibility for different health protection functions, to inform future guidance for, and organisation of, health protection in England. METHODS: We sent a postal questionnaire to all health protection professionals in England from the following groups: (a) Directors of Public Health in Primary Care Trusts; (b) Directors of Health Protection Units within the Health Protection Agency; (c) Directors of Public Health in Strategic Health Authorities and; (d) Regional Directors of the Health Protection Agency RESULTS: The response rate exceeded 70%. Variations in perceptions of who should be, and who is, delivering health protection functions were observed within, and between, the professional groups (a)-(d). Concordance in views of which organisation should, and which does deliver was high (≥90%) for 6 of 18 health protection functions, but much lower (≤80%) for 6 other functions, including managing the implications of a case of meningitis out of hours, of landfill environmental contamination, vaccination in response to mumps outbreaks, nursing home infection control, monitoring sexually transmitted infections and immunisation training for primary care staff. The proportion of respondents reporting that they felt confident most or all of the time in the safe delivery of a health protection function was strongly correlated with the concordance (r = 0.65, P = 0.0038). CONCLUSION: Whilst we studied professionals' perceptions, rather than actual responses to incidents, our study suggests that there are important areas of health protection where consistent understanding of responsibility for delivery is lacking. There are opportunities to clarify the responsibility for health protection in England, perhaps learning from the approaches used for those health protection functions where we found consistent perceptions of accountability