TO EVALUATE THE MORPHOLOGICAL AND MORPHOMETRIC FEATURES OF ADULT HUMAN CADAVERIC RIGHT LUNG IN NORTH INDIAN POPULATION

Objectives: In the present study, different morphological and morphometric features of adult human cadaveric right lungs were observed and noted on the predesigned pro forma. Not much of such measurements have been done in the past. The mean values and standard deviations are calculated. The data thus obtained were tabulated scrutinized, analyzed, and compared with the earlier studies wherever possible. If any variant from the normal is observed, an attempt has been made to explain the same on ontogenic or phylogenic basis. Methods: The present study has been conducted on 50 adult human cadaveric right lungs obtained from embalmed cadavers, used for dissection in the department of Anatomy, Govt. Medical College, Amritsar, formed the material for the current study. Results: Majority of the lungs (49 [98%]) were spongy in texture while 1 (2%) lung was firm to touch. It is evident that majority of lungs depicted mottling in the form of black, brown or grey in color in 38%, 28%, and 26% of the specimens, respectively. A complete grey, brown, or brownish black color was seen in 2% lungs each. In one lung yellow mottling was seen which could be because of fat deposition. Length of posterior border (19.9cm) was more as compared to anterior border (17.8 cm). Lungs were measured both along lateral and medial surfaces. Along the lateral surface its mean value was 18.52±3.178 cm (Range 12–25 cm) while along medial surface its mean value was 15.11±2.241 cm (Range 9–23 cm). The mean AP width of right lung at center was 11.05±2.864 cm (Range 7–23 cm) and along inferior border was 13.26±2.743 cm (Range 9–20 cm). The mean mediolateral width was found to be 7.536±2.318 cm with range being 4–15.2 cm. Conclusion: Knowledge of normal measurements of lungs and their variations may help cardiothoracic surgeons to avoid undue complications during surgery. Furthermore, it may help radiologist to resolve perplexed radiographic findings

Trial in Progress: Sonoporation for Disrupting the Pancreatic Cancer Microenvironment to Enhance Chemotherapy Delivery and Improve Outcomes

Background Pancreatic ductal adenocarcinoma (PDAC) is 3% of cancers diagnosed in the United States with 62,210 new cases expected in 2022, but it is the fourth leading cause of cancer-related deaths. Hence, there is a considerable clinical need to develop innovative strategies for effective drug delivery and treatment monitoring, resulting in improved outcomes for patients with PDAC. Sonoporation is a novel method that can enhance the therapeutic efficacy of co-administered chemotherapy by localized contrastenhanced ultrasound imaging (CEUS) of gas-filled microbubbles (ultrasound contrast agent UCA), which temporarily changes the tumor vascular microenvironment by increasing leakage from angiogenic vessels through microstreaming, shockwaves and the activation of various intracellular signaling responses [1]. Our Phase I clinical trial of sonoporation in 10 PDAC patients treated with Gemcitabine demonstrated no additional toxicity and an increase in median survival compared to the standard of care treatment (8.9 vs 17.6 months; p = 0.011) [2]. Subsequent, animal studies investigated 4 commercial UCAs under 2 different acoustic regimes and established the optimal UCA (Sonazoid; GE Healthcare, Oslo, Norway) as well as acoustic settings for sonoporation of PDAC [3]. There are two major chemotherapeutic regimens for the treatment of non-resectable PDAC, a combination of Leucovorin, Fluorouracil, Irinotecan and Oxaliplatin (FOLFIRINOX), considered the first line treatment, or a combination of Gemcitabine with a nanoparticle formulation of Paclitaxel (Nab-Paclitaxel), the second line treatment. These regiments results in a median overall survival of approximately 11 and 8-9 months. The Oncological departments at Jefferson and Haukeland will be responsible for the SoC chemotherapeutic treatment. We will use the hospital’s standard recommended treatment protocols of gemcitabine hydrochloride (Gemkabi®) combined with nanoparticle albumin-bound paclitaxel (Nab-Paclitaxel (Abraxane®)), and FOLFIRINOX.https://jdc.jefferson.edu/medoncposters/1013/thumbnail.jp

A Rare Metastatic Mesenteric Malignant PEComa with TSC2 Mutation Treated with Palliative Surgical Resection and Nab-Sirolimus: A Case Report

BACKGROUND: Malignant perivascular epithelioid cell tumors (PEComas) are exceedingly rare malignant mesenchymal neoplasms with characteristic morphological and immunohistochemical (IHC) patterns. However, some malignant PEComas are poorly differentiated with atypical histopathological features, making a definitive diagnosis difficult. PEComas are most commonly found in females and often show either TSC1 or TSC2 alterations, which result in the activation of the mTOR pathway, or TFE3 fusions. Given these molecular characteristics, mTOR inhibitors have recently been approved by the FDA in the treatment of malignant PEComas, particularly in those with TSC1/2 alterations. Therefore, molecular analyses may be helpful for both the diagnostic workup of and predicting response to mTOR inhibitors in cases of malignant PEComas. CASE PRESENTATION: Here, we report a case of an aggressive, 23 cm mesenteric malignant PEComa with multiple peritoneal metastases in a young male patient. Pathological examination of the initial biopsy showed a malignant epithelioid neoplasm with high-grade morphology and atypical immunoprofile, which precluded a definitive diagnosis. Because of the patient\u27s excessive transfusion requirements due to intra-tumoral hemorrhage, a palliative R2 resection was performed. Histopathological examination of the tumor revealed focal immunoreactivity for Melan-A, HMB-45, desmin, and CD117. Although a diagnosis of malignant PEComa was favored, other entities such as epithelioid gastrointestinal stromal tumor (GIST) or melanoma could not be definitively ruled out. Given the favored diagnosis, the patient was started on sirolimus, an mTOR inhibitor, rather than chemotherapy. Molecular analyses were performed and the tumor was found to harbor mutations in TP53 and TSC2, supporting a definitive diagnosis of malignant PEComa. The patient was then switched to nab-sirolimus, with initial stabilization of the disease. CONCLUSIONS: This report details a multidisciplinary approach for the diagnosis and management of a highly aggressive, metastatic malignant PEComa in a young male patient. The basis for the treatment of malignant PEComas with the recently FDA-approved mTOR inhibitor, nab-sirolimus, is also reviewed. In summary, this case highlights the importance of molecular analysis, particularly TSC1/2 alterations, for both the definitive diagnosis of malignant PEComas and predicting their response to nab-sirolimus

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Role of transcutaneous electric nerve stimulation in the management of trigeminal neuralgia

Background: Trigeminal neuralgia typically involves nerves supplying teeth, jaws and face of older females. Though the etiology is usually obscure, different treatment modalities have been tried for it viz. medicinal treatment, injection alcohol, peripheral neurectomy, rhizotomy, and microvascular decompression etc. Transcutaneous electric nerve stimulation (TENS) is an emerging and promising option for management of such patients. Aims and Design: The present study was designed with an aim to study the efficacy of TENS in management of trigeminal neuralgia. Materials and Methods: The study was conducted on 30 patients of trigeminal neuralgia confirmed by diagnostic nerve block. They were given bursts of TENS for 20-40 days over the path of the affected nerve and subsequently evaluated at 1 month and 3 month intervals by visual analogue scale (VAS), verbal pain scale (VPS), a functional outcome scales for main daily activities like sleep, chewing, talking, or washing face. Results: The results showed that, on VAS, the score decreased from 8.9 (Pre TENS) to 3.1 at 1 month and 1.3 at 3 months, and on VPS, the score decreased from 3.5 (Pre TENS) to 1.2 at 1 month and 0.3 at 3 months. Similarly, a considerable decrease in scores was seen on functional outcome scale for different activities. No side effects like irritation or redness of skin were seen in any of the patients. Conclusions: Thus, TENS was found to be a safe, easily acceptable, and non-invasive outdoor patient department procedure for management of trigeminal neuralgia

A Cadaveric Study of Different Angles of Scapula and Their Role in its Kinesiometrics and Muscle Morphology

Introduction: The bipedal gait and consequential freedom of the upper limb in human beings has made the movements of the shoulder joint a subject of extensive investigations. The scapular angles provide the base and leverage to various muscles and have been correlated with the different movements of the shoulder joint. Methods: In the present study, different angles of scapula namely superior, inferior, lateral, medial, acromial and coracoid angles were measured in the North Indian population. The study was conducted on 100 scapulas (R:L = 50:50) obtained from Department of Anatomy, Government Medical College, Amritsar. For measuring the angles, centimetre scales and protractor were used. Results: The mean value of superior angle was observed to be 100.830 (R=100.320 : L=101.340) ; inferior angle was 63.620 (R=68.10 : L=59.140) ; lateral angle was 61.720 (R=65.90 : L=57.540) ; medial angle was 147.640 (R=151.320 : L=143.960) ; acromial angle was 106.470 (R=107.680 : L=105.260) and coracoid angle was 83.30 (R=84.240 : L=82.020). Conclusions: It was observed that all angles were higher in the right sided bones except superior angle. Also a wide range was seen in all the angles. _______________________________________________________________________________________ Keywords: acromial; coracoid; inferior; medial; superior. ______________________________________________________________________________________

Symmetry and isometry of human adult hyoid bone: A cadaveric study in North Indian population

Introduction: Hyoid bone fracture is one of the most integral parts of internal examination during autopsy of hanging, ligature strangulation, or a throttling case. The reasons why some hyoids fracture and others do not may be related to the nature, magnitude, and position of the force applied to the neck, age of victim, nature of instrument (ligature or hand) used to strangle, and intrinsic anatomical features of the hyoid bone, such as rigidity and shape of the bone and symmetry of greater horns. Materials and Methods: The material for the present study comprised of 30 dried hyoid bones (M:F: 15:15). Their outline was drawn on the graph paper to study the symmetry and isometry of the bone. Results: Forty percent of the hyoids bones were symmetrical, while 60% were asymmetrical. Similarly, the number of anisometric bone is more (86.6%) as compared with isometric bone (13.3%) in both the sexes. Conclusion: Hyoid bone is not bilaterally symmetrical bone. The incidence of asymmetrical and anisometric bones is more as compared with symmetrical and isometric bones in both the sexes

Artificial intelligence-based approach to study the impact of climate change and human interventions on groundwater fluctuations

Water resource management is highly impacted by variations in rainfall, maximum and minimum temperature, and potential evapotranspiration. The rice area is also a key aspect for groundwater declination due to high-water consuming crop. Groundwater in Central Punjab has declined at an alarming rate over the last two decades. The decisions regarding water resource management need accurate information for the groundwater level. Therefore, to explore the main reason for the depletion of groundwater, it is essential that the most influential factors responsible for groundwater depletion should be addressed. A study was conducted in Central Punjab by using artificial neural network (ANN) and multiple linear regression (MLR) models during 1998–2018 to forecast the groundwater depth. ANN performed better than MLR. The sensitivity analysis showed that tubewell density, rice area, and rainfall are highly responsible for groundwater fluctuation. HIGHLIGHTS In the present study, both climatic and human-induced factors were taken for groundwater modeling.; Artificial neural network, a complex phenomenon was used to forecast groundwater depth.; Python was used for groundwater modeling.; ANN was found to be more accurate than MLR.

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Not AvailableThe rainfall data of Ludhiana for a period of 32 years of covering 1981 to 2012 have been collected from School of Climate Change and Agricultural Meteorology. the study was planned to find the rainfall variability and amount of rainfall at different probability levels for the year 1981-2012. The rainfall was analyzed on weekly basis to work out the initial and conditional probability for rainfall at different levels, i.e. >5 mm, > 10 mm, > 20 mm, > 30 mm, > 40mm and > 50mm using Markov chain model. In addition to this, incomplete gamma distribution was also used to find out the occurence of rainfall events at different probability levels, i.e. 20, 30, 40, 50, 65 and 75 percent. The study results in estimation of maximum and minimum initial probability and conditional probability wet and dry for standard meteorological week. The results will be useful for deciding the sowing time, irrigation / fertilizer scheduling and harvesting time for different crops. In addition to this study will be useful for determining the runoff volume, peak runoff rate and hence can be used for designing of rainwater harvesting structure.Not Availabl