Three Level Thoracolumbar Spondylectomy for Recurrent Giant Cell Tumour of the Spine: A Case Report

Giant cell tumour (GCT) is a benign tumour but can be locally aggressive and with the potential to metastasise especially to the lungs. Successful treatments have been reported for long bone lesions; however, optimal surgical and medical treatment for spinal and sacral lesions are not well established. In treating spinal GCTs, the aim is to achieve complete tumour excision, restore spinal stability and decompress the neural tissues. The ideal surgical procedure is an en bloc spondylectomy or vertebrectomy, where all tumour cells are removed as recurrence is closely related to the extent of initial surgical excision. However, such a surgery has a high complication rate, such as dura tear and massive blood loss. We report a patient with a missed pathological fracture of T12 treated initially with a posterior subtraction osteotomy, who had recurrence three years after the index surgery and subsequently underwent a three level vertebrectomy and posterior spinal fusion

Safety behavior and incident experience of worker in gas stations of Suratthani Province, Thailand

Transportation development in Thailand has grown at a rapid pace. LPG is a relatively popular automotive fuel in Thailand. The public have more interest in accident, prevention and reduce incidents in the workplace. Therefore, the aims of this research is to study safety behaviors, incident experience (IE) and investigate the safety behavior among worker who have never had incident experience (IE1) and worker who have had incident experiences (IE2) in gas stations. There were 76 respondents. We carried out an exploratory and descriptive study with respondents 19 LPG stations in Suratthani province, Thailand. The majority of workers have had incident experience in LPG stations. The biggest characteristic of these incidents were in process of filling LPG from the disperser to the customer’s car. There were leakage from the customer’s car and leakage from the equipment in the LPG station. The majority of consequences were the release of gas and collisions resulting in minor, major injury and other results. Besides that, the overall safety behavior of workers was very good. There were some behaviors where the level was moderate and poor. The results showed overall that (IE2) workers had better safety behavior than (IE1) workers. Hence, the companies have to maintain or promote good behaviors. Companies need to provide proper safety training, continually monitor and check to ensure good standards are maintained

Study of Crystal Structure, Lattice Strain, and Elemental Content of Natural Iron Sand Nanoparticles Synthesized by the Coprecipitation Method

This study was conducted to investigate the synthesis of magnetite nanoparticles from iron sand collected from the Bah Bolon River in Indonesia, using the coprecipitation method with NaOH and NH4OH as precipitants. The results showed that based on SEM-EDX (scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy) analysis, the Fe content of the raw iron sand, initially at 34.76%, increased to 45.50% following synthesis with NH4OH, indicating enhanced purity in the final product. SEM observations found average particle sizes of approximately 53 nm for nanoparticles synthesized with NaOH and 20 nm for those synthesized with NH4OH. X-ray diffraction (XRD) analysis confirmed that the synthesized nanoparticles retain the magnetite (Fe3O4) phase with a face-centered cubic (FCC) spinel structure. Crystallite size calculations using the Scherrer equation yielded average crystallite sizes of 80.194 nm for NaOH-synthesized samples and 15.124 nm for NH4OH-synthesized samples, demonstrating that NH4OH favors the formation of smaller crystallites. Lattice strain analysis through the Williamson-Hall method showed positive tensile strain values for all samples, indicating structural tension within the crystal lattice. The NH4OH-synthesized nanoparticles had slightly higher lattice strain, suggesting that synthesis conditions impact both crystallite size and lattice tension. In conclusion, this study demonstrated that NH4OH was more effective than NaOH in producing high-purity, small-crystallite magnetite nanoparticles from natural iron sand, with potential implications for enhanced material properties

Ethnic Differences in Survival after Breast Cancer in South East Asia

Background: The burden of breast cancer in Asia is escalating. We evaluated the impact of ethnicity on survival after breast cancer in the multi-ethnic region of South East Asia. Methodology/Principal Findings Using the Singapore-Malaysia hospital-based breast cancer registry, we analyzed the association between ethnicity and mortality following breast cancer in 5,264 patients diagnosed between 1990 and 2007 (Chinese: 71.6%, Malay: 18.4%, Indian: 10.0%). We compared survival rates between ethnic groups and calculated adjusted hazard ratios (HR) to estimate the independent effect of ethnicity on survival. Malays (n = 968) presented at a significantly younger age, with larger tumors, and at later stages than the Chinese and Indians. Malays were also more likely to have axillary lymph node metastasis at similar tumor sizes and to have hormone receptor negative and poorly differentiated tumors. Five year overall survival was highest in the Chinese women (75.8%; 95%CI: 74.4%–77.3%) followed by Indians (68.0%; 95%CI: 63.8%–72.2%), and Malays (58.5%; 95%CI: 55.2%–61.7%). Compared to the Chinese, Malay ethnicity was associated with significantly higher risk of all-cause mortality (HR: 1.34; 95%CI: 1.19–1.51), independent of age, stage, tumor characteristics and treatment. Indian ethnicity was not significantly associated with risk of mortality after breast cancer compared to the Chinese (HR: 1.14; 95%CI: 0.98–1.34). Conclusion: In South East Asia, Malay ethnicity is independently associated with poorer survival after breast cancer. Research into underlying reasons, potentially including variations in tumor biology, psychosocial factors, treatment responsiveness and lifestyle after diagnosis, is warranted

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND: The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

The performance of extracellular polymeric substance (EPS) on stability of Aerobic granular sludge (AGS)

Various article which indicating the Aerobic granular sludge (AGS) instability, particularly in prolonged phase operating duration become a significant obstacle to its implementation. Generally, prolonged the operation period will lost its stability that can degrade performance effectiveness. As AGS stabilization in hydrodynamic shear force and resisting mass transfer resistance within the reactor generally defined or evaluated by microbial community, bioactivity, extracellular polymeric substance (EPS) structure and granular aspect. The aim of this research in order to illustrate the EPS formation on AGS which is preserved at 4°C in sequencing batch reactor (SBR) by sewage for eight months. The effective of granulation method and redevelopment of AGS stability by particular pressure produced with several hydrodynamic shear force and mass transfer resistance which controlled by low organic loading rate (OLR) between 0.26 and 0.81 kg CODs/m³ d with 1.33 cm/s of superficial air velocity (SAV). The confocal laser scanning microscope (CLSM), Fourier transform infrared (FTIR), and energy dispersive X-ray spectrometer (EDX) were implemented to notice the evolution in composition of EPS that revealed the intermolecular interaction helped the aerobic granule stability as seed to achieved the performance of EPS on stability of AGS

Q-switched in figure of 8 by using graphite flakes as saturable absorber

Abstract In this study, a successful experiment has been reported on pulse compression in the Q-switched fiber laser by utilizing graphite flakes as a saturable absorber (SA). The sputter deposition method was used to deposited graphite flakes as SA, incorporated into the bore of the laser in order to compress the width of the pulse in the operation of Q-switching. The small repetition rate at 29.6 kHz was mentioned as the maximum power of the pump with the single-to-noise ratio (SNR) ∼30dB was required to compress the pulse. Accordingly, graphite flakes have the ability to be utilized as an effective S A in producing pulse compression and Q-switching mode, that will be may fixedly lead to further enhancement in the fiber laser pulsed.</jats:p