Diabetic foot: vasculopathy assessment and analysis of risk factors of amputation

Background:Diabetes is a major contributing factor in up to 70% of lower limb amputations. In majority of diabetic patients, the underlying factor contributing to eventual amputation is diabetic foot disease and diabetic foot ulcer. The burden of diabetic foot disease and ulceration is set to increase further due to the co-existence of contributory co morbidities including peripheral vascular disease and peripheral neuropathy.  Methods:An observational study was designed to assess the vascular status of diabetic foot patients and the risk factors of lower limb amputation.Results:Diabetic foot ulcers was recorded mostly among males and found to increase with age. Smoking was noted in 87% of the male patients who had diabetic foot ulcers. Gangrene was the major and most common mode of presentation in diabetic foot ulcer patients. The angiopathy should be considered as the major risk factor which leads to major limb amputation, which can be easily detected at the earliest stage by simple clinical examination of peripheral pulses and by arterial Doppler study which is non-invasive.Conclusion:Present study was carried out to assess the vascular status of diabetic foot patients and to assess the prevalence of risk factors due to the lower limb amputation like Ray amputation, below knee amputation, wound debridement. Arterial Doppler, radiography, fundoscopy and neuropathy were done. Based on a study of these results, it was found that vascular status plays a major role in majority of the diabetic patients. Thus, angiopathy in diabetics must be taken into serious considerations and it is suggested that arterial Doppler can be done as a part of clinical examination to combat the major limb amputations.

Appendicectomy: to do or not

Background: This study is to evaluate the reliability of modified Alvarado scoring system for diagnosis of acute appendicitis and correlate it with acute diagnostic modality. It helps to assess the discrimination and calibration performance of the Alvarado score. It is also useful in evaluating the importance of modified Alvarado scoring system in reducing the percentage of negative appendicitis.Methods: The scoring system is based on three symptoms, three signs and one laboratory finding. The decision to operate is made independently by surgeon. All operated appendices are to be sent for histopathological examination. Then the MAS score is compared with pathology results.Results: In our study we have divided the modified Alvarado scoring system into three groups. The persons with score from 7-10 are more likely to have appendicitis and they are termed as modified Alvarado score positive and other two groups are considered to be modified Alvarado score negative. Out of 50 patients, 32 were considered positive and they underwent appendicectomy irrespective of ultrasonographic findings. Histopathological results were obtained for these patients.Conclusion: From present study, it is concluded that modified Alvarado score is better diagnostic tool than ultrasonography alone in diagnosis of acute appendicitis. It is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis. The overall modified Alvarado scoring system showed high sensitivity and specificity rate, high accuracy rate, high positive predictive value and low appendicectomy rate.

The Role of Higher Education Institutions in Promoting Innovativeness and Passion towards Entrepreneurship among Students – A Meta-Analytic Review

With the growing importance of entrepreneurship education, entrepreneurship programs established within higher education institutions are thriving hard to achieve entrepreneurship educational outcomes in recent years. Several studies reported the role of higher education institutions in promoting entrepreneurship education and enhancing students\u27 skill sets in various ways. To extend this knowledge, this paper aims to analyse the role of higher education institutions in promoting innovativeness and passion among students pursuing entrepreneurship education. A meta-analytic review is conducted by combining the results from empirical analysis of 24 related studies. The influence of higher education institutions on entrepreneurship educational outcomes and individual transformations is examined and their relationships are exposed. The results of the review show that various components of higher education institutions are positively related to individual transformations (rc=0.579) and entrepreneurship educational outcomes (rc=0.331). It is also found that the passion (rc = 0.31) and innovativeness (rc = 0.2771) are positively correlated with entrepreneurship educational outcome. Moreover, institutional environment has a greater impact on passion (rc = 0.531). Thus, the results indicate that higher education institutions play an important role in promoting passion and innovativeness among students

Modelling the student journey using customer journey mapping: moments of truth in the educational journey

Nations widely acknowledge the potential of education in shaping both the individual and society. There is a constant effort to develop a model to understand students’ journeys which includes understanding what they go through during the whole process of education. This study creates a basic model to understand students’ experiences before, during and after study periods of formal education at the University of Technology and Applied Sciences, Muscat. An interactive discussion in the form of a semi-structured interview with final-year students was conducted to collect in-depth information related to the six phases of a student’s journey. It concludes with an examination of six moments of truth, each of which is defined and explained using various touchpoints. The sample was students in training who had completed all courses before receiving their Bachelor’s degree (N=156) across the Business Studies, Engineering and Applied Sciences departments, including on-the-job training students pursuing. The semi-structured interview method was used as the method of data collection. The objective of this paper was to assess the application of the concept of customer journey mapping to design a methodology to map students’ journeys from their points of view and develop a system that delivers a better experience for students. The user-centred design (UCD) was used for summarising the outcome of students’ responses. The analysis is an effort to highlight the touchpoints which need to be taken improved on and also the touchpoints which are well appreciated by the students

Spatial modelling of the tumor microenvironment from multiplex immunofluorescence images: methods and applications

Spatial modelling methods have gained prominence with developments in high throughput imaging platforms. Multiplex immunofluorescence (mIF) provides the scope to examine interactions between tumor and immune compartment at single cell resolution using a panel of antibodies that can be chosen based on the cancer type or the clinical interest of the study. The markers can be used to identify the phenotypes and to examine cellular interactions at global and local scales. Several translational studies rely on key understanding of the tumor microenvironment (TME) to identify drivers of immune response in immunotherapy based clinical trials. To improve the success of ongoing trials, a number of retrospective approaches can be adopted to understand differences in response, recurrence and progression by examining the patient’s TME from tissue samples obtained at baseline and at various time points along the treatment. The multiplex immunofluorescence (mIF) technique provides insight on patient specific cell populations and their relative spatial distribution as qualitative measures of a favorable treatment outcome. Spatial analysis of these images provides an understanding of the intratumoral heterogeneity and clustering among cell populations in the TME. A number of mathematical models, which establish clustering as a measure of deviation from complete spatial randomness, can be applied to the mIF images represented as spatial point patterns. These mathematical models, developed for landscape ecology and geographic information studies, can be applied to the TME after careful consideration of the tumor type (cold vs. hot) and the tumor immune landscape. The spatial modelling of mIF images can show observable engagement of T cells expressing immune checkpoint molecules and this can then be correlated with single-cell RNA sequencing data

Simultaneous development of adenocarcinoma and gastrointestinal stromal tumor (GIST) in the stomach: case report

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors (GISTs) and adenocarcinoma are distinct neoplasms originating from different cell layers. Approximately 20% of patients with GIST develop other cancers.</p> <p>Case presentation</p> <p>We report a case of the coexistence of adenocarcinoma and gastrointestinal stromal tumor (GIST). Gastric endoscopy showed the ulcerated tumor with bleeding along the lesser curvature of the proximal stomach and a submucosal nodule that measured about 3 cm in diameter in the lower part of the stomach body. Their pathological examination showed gastric cancer (poorly differentiated diffuse adenocarcinoma) and GIST (low-risk category). Further, immunohistochemical staining for C-kit and CD34 was positive, while that for SMA and S-100 was negative.</p> <p>Conclusion</p> <p>Although it is not easy to speculate on the coexistence of adenocarcinoma and GIST, pre-and post-operative diagnoses may be essential, and such cancer development is not considered to be unusual.</p

Survival of gastrointestinal and stromal tumor patients at UT M.D. Anderson Cancer Center

Objective. Gastrointestinal Stromal Tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal (GI) tract with spindled cell, epithelioid, or occasionally pleomorphic morphology. The primary objective of this paper is to describe the demographic and clinical characteristics and survival among GIST patients registered at the University of Texas M.D. Anderson Cancer Center (MDACC). Methods. This cohort study includes 783 consecutive patients diagnosed with GIST from 1995 to 2007. Demographic, clinical and survival information were obtained from the MDACC cancer registry. Statistical Analysis. Kaplan-Meier survival curves, univariate and multivariate Cox proportional hazards analysis were conducted to estimate survival and identify prognostic clinical factors associated with survival. Results. The age at diagnosis of MDACC GIST cases ranged from 17 to 91 with a mean of 57 years and a male-to-female ratio of 1.3:1. The racial distribution was whites 77%, African-Americans 9.5%, Hispanics 9.3% and other races 4.2%. Fifty per cent of the GISTs arose from stomach, 35% small intestine, 7% retroperitoneal space, 6% colorectal and 2% were omentum and mesentery. About half of the tumors were less than 10 cm in size. Fifty eight per cent of the tumors were localized whereas 36% were metastatic. MDACC GIST patients were generally comparable to SEER patients, but, on the average, were 7 years younger than SEER patients and were predominantly whites. Stratification of 783 GIST cases by year of diagnosis based on the introduction of imatinib treatment in 2000 revealed that 60% of the GIST cases were first diagnosed between 2000 and 2007 whereas, 40% were first diagnosed between 1995 and 1999. There was a significant difference between the two cohorts in the distribution of race, GIST symptom, tumor size, tumor site, and stage of the tumor at diagnosis. The 1- and 5-year survival was 93% and 59% in the 1995–2007 cohort. Multivariate Cox regression analysis identified age at diagnosis (p\u3c0.001), female sex (p=0.047), tumor size (p=0.07), multiple cancers (p=0.002), and GIST diagnosed between 2000 and 2007 (p\u3c0.001) were significantly associated with survival. Approximately, 58% of the cases were treated with imatinib whereas 42% did not receive imatinib in 2000–2005 cohort. There was a significant difference in survival between imatinib and non-imatinib groups and in the distribution of tumor size categories, stage of the tumor at diagnosis and cancers before the diagnosis of GIST. The 1- and 5-year survival for imatinib patients was 99% and 73% and was 91% and 63% for non-imatinib patients. Multivariate Cox regression analysis of the 2000–2007 cohort identified, age at diagnosis and tumor stage as possible prognostic factors associated with survival