Primary arthroplasty as an option for surgical treatment of unstable intertrochanteric fracture femur in elderly patients: a retrospective study

Background: An unstable intertrochanteric fracture in osteoporotic elderly patients presents a very challenging problem to the surgeons. This category of patients if kept in bed for long tends to have many complications like deep vein thrombosis, pneumonia, bed sores, etc. Surgeon’s worldwide face difficulty in getting a good anatomical reduction and do not allow early mobility to these patients because of risk of loss of reduction and implant cut out. The purpose of our study is to study the usefulness of arthroplasty in these patients in terms of better functional outcomes and no increase in complication rates.Methods: It was a retrospective study involving 25 patients (17 females, 8 males) with mean age of 76±2.3 years having intertrochanteric femur fractures (AO type A 2.2 and above) with osteoporosis operated upon with bipolar hemiarthroplasty at IQ City Medical College and NM Hospital between January 2015 and January 2017.Results: All the patients were followed up for a period of 1 year. We had a mean operative time of 75 min (range 55-125 min) with an average blood loss of 450 ml. 4 of our patients required postoperative blood transfusion. All patients walked on 2nd postoperative day. We had a mean Harris hip score of 82 and mean VAS of 1 at the end of 1 year.Conclusions: Hemiarthroplasty done in cases of unstable intertrochanteric femur fractures in elderly patients with osteoporotic bones allows early weight bearing thus improves the final functional outcomes. Further randomized trials are required before deriving any conclusions

Mass Hierarchy Determination via future Atmospheric Neutrino Detectors

We study the problem of determination of the sign of Delta m^2_{31}, or the neutrino mass hierarchy, through observations of atmospheric neutrinos in future detectors. We consider two proposed detector types : (a) Megaton sized water Cerenkov detectors, which can measure the survival rates of nu_\mu + \bar{\nu}_\mu and nu_e + \bar{\nu}_e and (b) 100 kton sized magnetized iron detectors, which can measure the survival rates of \nu_\mu and \bar{\nu}_\mu. For energies and path-lengths relevant to atmospheric neutrinos, these rates obtain significant matter contributions from P_{\mu e}, P_{\mu \mu} and P_{ee}, leading to an appreciable sensitivity to the hierarchy. We do a binned \chi^2 analysis of simulated data in these two types of detectors which includes the effect of smearing in neutrino energy and direction and incorporates detector efficiencies and relevant statistical, theoretical and systematic errors. We also marginalize the \chi^2 over the allowed ranges of neutrino parameters in order to accurately account for their uncertainties. Finally, we compare the performance of both types of detectors vis a vis the hierarchy determination.Comment: 36 pages, 13 figures, revised version accepted in Physical Review

A Novel Approach for Triggering the Serverless Function in Serverless Environment

Serverless computing has gained significant popularity in recent years due to its scalability, cost efficiency, and simplified development process. In a serverless environment, functions are the basic units of computation that are executed on-demand, without the need for provisioning and managing servers. However, efficiently triggering serverless functions remains a challenge, as traditional methodologies often suffer from latency, Time limit and scalability issues and the efficient execution and management of serverless functions heavily rely on effective triggering mechanisms. This research paper explores various design considerations and proposes a novel approach for designing efficient triggering mechanisms in serverless environments. By leveraging our proposed methodology, developers can efficiently trigger serverless functions in a variety of scenarios, including event-driven architectures, data processing pipelines, and web application backend

Neutrino mass hierarchy determination via atmospheric neutrinos with future detectors

The issue of determining the neutrino mass hierarchy is one of the outstanding questions in neutrino physics. We consider the potential of hierarchy determination using atmospheric neutrinos as the source in three different proposed future detectors: A large Iron Calorimeter detector, a megaton Water Cerenkov detector and a large-mass Liquid Argon detector. If the mixing angle θ13 is about 10° (close to CHOOZ upper bound), the hierarchy sensitivity is essentially determined by resonant matter effects. To maximize the potential of these effects in atmospheric neutrinos, charge discrimination capability in the detector is desirable. Hence, detectors with this capability have an advantage in hierarchy determination. We compare and contrast the performance of the above three detectors in this respect. We perform a realistic analysis of the above future detectors for atmospheric neutrinos and show that it is possible to achieve a significant hierarchy sensitivity if the detector characteristics are favourable

Preliminary experience of fractionated stereotactic radiosurgery with extend system of Gamma Knife

Purpose: The purpose of this study is to present multisession stereotactic radiosurgery with initial experience using custom made extend system (ES) of Gamma Knife.Methods: The ES is comprised of a carbon fiber frame also called extend frame, vacuum head rest cushion, patient surveillance unit and a configurable front piece with dental impression tray. The extend frame is a rigid connection between patient's head and patient positioning system (PPS) of Gamma Knife. A dental impression of patient was created and attached to the frontal piece of extend system. The treatment setup involves positioning the patient within the extend frame using patient specific headrest cushion and front piece. The reference patient’s head position was recorded through measurements of repositioning check tool (RCT) apertures using a high precision digital probe before computed tomography (CT) scan. The RCT measurements taken before treatment were compared with recorded reference position to ensure appropriate patient treatment position. Volumetric magnetic resonance (MR) scan was co-registered with stereotactic CT scan on Leksell Gamma plan. Fused MR to CT images on Gamma Plan was utilized to delineate regions of interest and prepare a precise treatment plan. The presented study includes positional reproducibility check and dosimetric evaluation of ten patients treated with ES.Results: Forty-three fractions on ten patients with prescribed treatment format were delivered successfully. An average tumor volume of 11.26 cm3 (range, 340 mm3 to 59.12 cm3) was treated with ES. The mean tumor coverage of 91.91% (range, 90% to 95%) was able to achieve at 50% prescription isodose without compromising adjacent normal structure radiation dose tolerances. The mean inter-fraction positional variation of 0.69 mm influences an inherent strength of immobilization technique. Follow-up of seven patients at a median interval of 16 months (range, 9 months to 26 months) showed evidence of 100% radiographic control with improved clinical results.Conclusion: Conjugative clinical outcome shows the efficacy of fractionation in various clinical indications

Revisiting Low Resource Status of Indian Languages in Machine Translation

Indian language machine translation performance is hampered due to the lack of large scale multi-lingual sentence aligned corpora and robust benchmarks. Through this paper, we provide and analyse an automated framework to obtain such a corpus for Indian language neural machine translation (NMT) systems. Our pipeline consists of a baseline NMT system, a retrieval module, and an alignment module that is used to work with publicly available websites such as press releases by the government. The main contribution towards this effort is to obtain an incremental method that uses the above pipeline to iteratively improve the size of the corpus as well as improve each of the components of our system. Through our work, we also evaluate the design choices such as the choice of pivoting language and the effect of iterative incremental increase in corpus size. Our work in addition to providing an automated framework also results in generating a relatively larger corpus as compared to existing corpora that are available for Indian languages. This corpus helps us obtain substantially improved results on the publicly available WAT evaluation benchmark and other standard evaluation benchmarks.Comment: 10 pages, few figures, Preprint under revie

Transcultural Diabetes Nutrition Therapy Algorithm: The Asian Indian Application

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India—coupled with a sedentary lifestyle and specific socioeconomic pressures—has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Hepatocellular Carcinoma due to Hemochromatosis in a Young Patient- A Diagnosis Dilemma

Hemochromatosis causes excess iron deposits in multiple organs, leading to various clinical manifestations. C282Y and H63D are the most common mutation. Diagnosing hemochromatosis is based on clinical characteristics, biochemical abnormalities, radiological findings, and genetic testing with liver biopsy. The literature review also showed 13 cases of developed HCC without cirrhosis in hemochromatosis patients. The increased risk of HCC is associated with excess iron deposition that promotes oxidative DNA damage and increases free radical activity. The amount and duration of iron overload are directly proportional to the risk of development of cirrhosis and HCC