Radial nerve palsy following plate osteosynthesis of shaft humerus in relation to posterior verses anterolateral approach

Background: Fracture shaft of humerus is a relatively common upper limb injury. Although it can be managed conservatively still surgical management is the recent trend worldwide. Open reduction and plate osteosynthesis is the gold standard and commonly practiced method of management. Iatrogenic radial nerve palsy following fracture fixation is a usual complication. Though most cases recover with time, but the incidence is variable in different approach. We compared two common approaches for fixation of middle 1/3rd of shaft of humerus fracture based on frequency of secondary radial nerve palsy and fracture healing.Methods: A prospective comparative study of management of all middle 1/3rd shaft humerus fracture was undertaken in our institute from Jan 2012 to Nov 2014. Total 42 patients were operated in this period of which six patients lost to follow up, so all total 36 cases were included in the study. Among these 36 patients 16 patients were operated by posterior approach and rest 20 were operated by Anterolateral approach. All patients were followed up at 2nd post-operative day, 2 weeks, 6 weeks, 3 months, 6 month and 1year. Frequency of radial nerve palsy with its outcome and fracture union was accessed in postoperative follow-ups.Results: There were total 3 cases of iatrogenic radial nerve palsy found in patients operated by posterior approach but all these patients recovered by average 5 month (3 to 6 months). There was not a single case of radial nerve palsy seen following humerus fixation by anterolateral approach. All 36 patients had good radiological union by 1 year, of which 2 patients of anterolateral approach and 1 patient from posterior approach required bone grafting to achieve union.Conclusions: Both the approaches had similar outcome in terms of fracture healing but there was significant difference in frequency of secondary radial nerve palsy, commonly seen in posterior approach.

FPGA Design Techniques for Stable Cryogenic Operation

In this paper we show how a deep-submicron FPGA can be modified to operate at extremely low temperatures through modifications in the supporting hardware and in the firmware programming it. Though FPGAs are not designed to operate at a few Kelvin, it is possible to do so on virtue of the extremely high doping levels found in deep-submicron CMOS technology nodes. First, any PCB component, that does not conform with this requirement, is removed. Both the majority of decoupling capacitor types and voltage regulators are not well behaved at cryogenic temperatures, asking for an ad-hoc solution to stabilize the FPGA supply voltage, especially for sensitive applications. Therefore, we have designed a firmware that enforces a constant power consumption, so as to stabilize the supply voltage in the interior of the FPGA chip. The FPGA is powered with a supply at several meters distance, causing significant IR drop and thus fluctuations on the local supply voltage. To achieve the stabilization, the variation in digital logic speed, which directly corresponds to changes in supply voltage, is constantly measured and corrected for through a tunable oscillator farm, implemented on the FPGA. The method is versatile and robust, enabling seamless porting to other FPGA families and configurations.Comment: The following article has been submitted to Review of Scientific Instruments. If it is published, it will be available on http://rsi.aip.or

Patterns of radiation treatment default and its evaluation in a cancer center in the Southern part of Odisha: a retrospective study

Background: The incidence of cancer in India is alarming. However, many patients discontinued their treatment protocols resulting in higher mortality rate. This study aims to find out different patterns of treatment defaults in cancer patients receiving external beam radiation in the radiotherapy department of a cancer center in the southern part of Odisha state.Methods: It is a retrospective epidemiological study carried out in cancer patients receiving external beam radiotherapy for their cancer treatment but had not completed the full course of treatment during the study period from January 2018 to May 2019. Patterns of failure in relation to various demographic and socio-economic statuses were analyzed.Results: One hundred seven defaulter patients were included in this study. The mean age of the patients was 50.93±14.3 years (range 12 to 90 years) and 66(61.7%) were being females. Out of 107 patients, 53.2% patients were receiving treatment in curative intent, 28.0% patients were treated in adjuvant intent and 18.2% in palliative intent. Forty-two (39.2%) patients were from a distance >50 km from the study center, 74.7% of patients belong to low socio-economic status and 60.7% patients were illiterate. Only 33.3% of patients completed more than 15 fractions of radiation excluding the palliative cases. The comparison of various factors such as distance from study center (p=0.759), education (p=0.2428), socio-economic status (p=0.6628) and acute radiation toxicity (p=0.9359) among the groups of patients receiving more or less than 15 fractions of radiation did not showed any statistical significant differences.Conclusions: Radiation induced acute toxicity, distance from study center, education and socio-economic status might be responsible for the treatment discontinuation. There is no particular association of age, disease site and intent of treatment with default among patients

Effect of glutamine supplement on chemo-radiation induced mucositis in head and neck cancer patients: a prospective study

Background: Radiotherapy is one of the primary modalities of cancer treatment but may associated with short and long-term toxicities. Oral mucositis is frequently encountered in head and neck cancer resulting in unplanned treatment breaks. Few studies emphasized that use of oral glutamine may significantly reduce oral mucositis and other acute toxicities. This study aims to assess the effects of glutamine on oral mucositis in head and neck cancer patients receiving chemo-radiation.Methods: It is a prospective study carried out in sixty-four head and neck cancer patients attending radiotherapy department for chemo-radiation from January 2018 to May 2019. Patients were randomly assigned into two arms containing 32 subjects in each. All the patients in arm-A were taking oral glutamine supplement of 15 mg once daily, two hours prior to radiation and arm-B serve as the control group. Dose of radiation fixed at 66 Gy in 33 fractions over a period of 7 weeks along with an infusion of weekly cisplatin (40 mg/m2). Patients were evaluated regarding onset, severity and the recovery period of mucositis.Results: Oral mucositis appeared at around 5th week in arm-A and 3rd week in arm-B (p<0.0001). Number of patients with mucositis is significantly less in arm-A (75%, 24 out of 32) as compared to arm-B (96.8%) (p=0.0310). The time required for healing of mucositis is significantly less than 1 week in arm-A compared to ~2 weeks in the arm-B (p<0.0001).Conclusions: Oral glutamine when given prior to radiation results in delayed onset of oral mucositis with decreased severity and an early healing period.

Fracture union and complication following internal fixation of clavicle by plate and screw

Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws.Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2nd post-operative day 5th post-operative day 14th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications.Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort.Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.

Reasons behind late presentation of cancer patients to radiotherapy department of a tertiary Hospital in Southern Odisha: a cross sectional study

Background: Prevalence of cancer is increasing worldwide. Early diagnosis with appropriate therapeutic interventions is essential for better treatment outcome. Identification and necessary modifications of factors responsible for delayed presentation might increase the life expectancy or quality of living. This study aims to identify the factors responsible for delayed presentation of cancer patients to radiotherapy department.Methods: This is a quantitative descriptive study, done with in a period from August 2018 to October 2019, among 120 cancer patients of different stages presenting to OPD of Radiotherapy department of M.K.C.G Medical College. Data were collected by using pretested semi-structured questionnaires, entered into Microsoft Excel and analyzed by using SPSS version 20.0.Results: A total of 120 cancer patients, 60 from each early and late stage had participated in the study. The mean age of presentation was 53.19 years. The number of male patients were 54 and female were 66. Maximum patients had addiction of chewing tobacco. When the time interval from appearance of symptoms to diagnosis were compared, 1 – 3 months were taken by 45% of early stage and 28.3% of late stage patients. Similarly, &lt;1week time was taken from diagnosis to start of treatment in 25% and 13.3% in respective groups. Comparison of educational status (p=0.001), difference between primary and secondary delay (p&lt;0.05), and socio-economic status (p=0.008) between both the groups were found to be statistically significant.Conclusions: Factors responsible for delayed presentation are related both to patient and system. Educating common people regarding early sign symptoms, emphasizing early detection at grass root level, proper referral and by upgrading existing oncology facilities, we can avoid adverse treatment outcome

Timing of anterior cruciate ligament reconstruction and its effect on associated chondral damage and meniscal injury: a prospective observational study

Background: Following an anterior cruciate ligament (ACL) tear, associated injuries in the knee involving menisci and articular cartilage increase with time. This study was performed to assess the distribution of secondary injuries after an ACL tear with time and identify a suitable timing for the reconstruction surgery. Methods: 74 patients with an ACL tear were divided into three groups based on time since injury- less than six months, six months to one year, and greater than one year. The odds of finding each lesion in every group were calculated and tested for statistical significance. Receiver operating characteristic curves (ROC) were drawn to predict individual lesions with time since injury. The diagnostic performance and statistical significance of these tests were identified. Results: The odds of finding all lesions were greater than one after a year of ACL tear but only chondral damage was statistically significant (p=0.025). Poor diagnostic accuracy was observed for medial meniscal injury even after three years of an ACL tear. Chondral injury showed a good area under the curve (0.817) which predicted chondral damage with a sensitivity of 62% at a cut-off of three years after the ACL injury. Conclusions: After three years of ACL tear, meniscal injuries could not be accurately predicted. However, a significant rise in chondral injuries could be seen and predicted accurately with good sensitivity. There could be a role of MRI or arthroscopy to assess the extent of injury of articular cartilage in patients who do not undergo ACL reconstruction after this time.

CMOS-based cryogenic control of silicon quantum circuits

The most promising quantum algorithms require quantum processors hosting millions of quantum bits when targeting practical applications. A major challenge towards large-scale quantum computation is the interconnect complexity. In current solid-state qubit implementations, a major bottleneck appears between the quantum chip in a dilution refrigerator and the room temperature electronics. Advanced lithography supports the fabrication of both CMOS control electronics and qubits in silicon. When the electronics are designed to operate at cryogenic temperatures, it can ultimately be integrated with the qubits on the same die or package, overcoming the wiring bottleneck. Here we report a cryogenic CMOS control chip operating at 3K, which outputs tailored microwave bursts to drive silicon quantum bits cooled to 20mK. We first benchmark the control chip and find electrical performance consistent with 99.99% fidelity qubit operations, assuming ideal qubits. Next, we use it to coherently control actual silicon spin qubits and find that the cryogenic control chip achieves the same fidelity as commercial instruments. Furthermore, we highlight the extensive capabilities of the control chip by programming a number of benchmarking protocols as well as the Deutsch-Josza algorithm on a two-qubit quantum processor. These results open up the path towards a fully integrated, scalable silicon-based quantum computer

Radial nerve palsy following plate osteosynthesis of shaft humerus in relation to posterior verses anterolateral approach

Background: Fracture shaft of humerus is a relatively common upper limb injury. Although it can be managed conservatively still surgical management is the recent trend worldwide. Open reduction and plate osteosynthesis is the gold standard and commonly practiced method of management. Iatrogenic radial nerve palsy following fracture fixation is a usual complication. Though most cases recover with time, but the incidence is variable in different approach. We compared two common approaches for fixation of middle 1/3rd of shaft of humerus fracture based on frequency of secondary radial nerve palsy and fracture healing.Methods: A prospective comparative study of management of all middle 1/3rd shaft humerus fracture was undertaken in our institute from Jan 2012 to Nov 2014. Total 42 patients were operated in this period of which six patients lost to follow up, so all total 36 cases were included in the study. Among these 36 patients 16 patients were operated by posterior approach and rest 20 were operated by Anterolateral approach. All patients were followed up at 2nd post-operative day, 2 weeks, 6 weeks, 3 months, 6 month and 1year. Frequency of radial nerve palsy with its outcome and fracture union was accessed in postoperative follow-ups.Results: There were total 3 cases of iatrogenic radial nerve palsy found in patients operated by posterior approach but all these patients recovered by average 5 month (3 to 6 months). There was not a single case of radial nerve palsy seen following humerus fixation by anterolateral approach. All 36 patients had good radiological union by 1 year, of which 2 patients of anterolateral approach and 1 patient from posterior approach required bone grafting to achieve union.Conclusions: Both the approaches had similar outcome in terms of fracture healing but there was significant difference in frequency of secondary radial nerve palsy, commonly seen in posterior approach.

Fracture union and complication following internal fixation of clavicle by plate and screw

Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and complications following internal fixation of clavicle with plate and screws.Methods: In a prospective study 50 patients of fracture mid shaft clavicle who were treated with plate and screw were followed for a period of two years. Only adults more than 18 years were included in the study. All patients were followed at 2nd post-operative day 5th post-operative day 14th post-operative day and at 1, 2, 6, 12 and 24 months. Only two parameters were observed i.e. union of fracture and post-operative complications.Results: Of all patients operated with plate and screw 48 patients had good radiological union by six months. Only two patients had non-union and one with implant failure at 12 months. Of complications one had stitch abscess and seven had hardware discomfort.Conclusions: Clavicle fracture in adults has multimodal treatment option. Though conservative management has good results it has high chance of mal-union and non-union. Operative fixation should be opted for adult individuals where chance of non-union is high. Plate and screw fixation has good results in terms of union with least complication.