The sinking of the El Faro: predicting real world rogue waves during Hurricane Joaquin

We present a study on the prediction of rogue waves during the 1-hour sea state of Hurricane Joaquin when the Merchant Vessel El Faro sank east of the Bahamas on October 1, 2015. High-resolution hindcast of hurricane-generated sea states and wave simulations are combined with novel probabilistic models to quantify the likelihood of rogue wave conditions. The data suggests that the El Faro vessel was drifting at an average speed of approximately~$2.5$~m/s prior to its sinking. As a result, we estimated that the probability that El Faro encounters a rogue wave whose crest height exceeds 14 meters while drifting over a time interval of 10~(50) minutes is $\sim1/400$~$(1/130)$. The largest simulated rogue wave has similar generating mechanism and characteristics of the Andrea, Draupner and Killard rogue waves as the constructive interference of elementary waves enhanced by bound nonlinearities

Understanding King’s Health Questionnaire (KHQ) in assessment of female urinary incontinence

Urinary incontinence has emerged as one of the leading medical problems for the geriatric population worldwide. Women are affected physically, mentally and socially and face embarrassment, depression and isolation. Increased life expectancy further adds to the prevalence of the condition and social, economic and health care burden. Although not sinister by itself, urinary incontinence has a profound impact on a woman’s quality of life and warrants appropriate management. The efficacy of interventional procedures is measured by the caregiver mainly by improvement in urodynamic parameters. However, these gadgets do not assess the individual's satisfaction and feeling of wellbeing following the therapeutic intervention. Several generic QoL tools have been developed in an attempt to quantify these changes. But ironically, generic QoL questionnaires lack precision when applied to subjects with specific disease condition. In the context of female urinary problems, various QoL tools have been designed and investigated. King’s Health Questionnaire (KHQ), which was formulated as early as 1997 by the group of researchers from King’s College Hospital London still enjoys popularity till today, because of its strong psychometric properties, ease of administration and it adds objectivity to patient’s subjective symptoms. However, the available information about KHQ is somewhat inadequate for the novice research scholar. The following brief essay aims at easy understanding of implementation, documentation, analysis and interpretation of King’s Health Questionnaire in research settings.

Unusual sites of delayed metachronous metastases from renal cell carcinoma: a case series of five cases and review of literature

Renal cell carcinoma (RCC) is the most common malignant tumour of the kidney, representing 3% of all adult malignancies. Among men it is the sixth most common cancer while among women it is the ninth most common cancer. The mainstay of treatment for localized RCC is surgical resection with curative intent. The aggressive and often insidious nature of RCC is reflected by high recurrence rates of upto 20-40% after nephrectomy. Most commonly encountered sites of recurrent metastases include the lung, followed by bone, liver, brain, and local recurrence. Atypical sites of delayed metastases of RCC, although rare, have been reported in literature. We present our series of five cases where delayed metastasis has occurred at atypical sites including right sartorius muscle, right atrium and ventricle, urinary bladder, shaft of tibia and distal phalanx of hand upto six years later from the time of initial curative treatment of primary. The metastatic lesions in sartorius muscle, right atrium and ventricle, urinary bladder and distal phalanx were primarily managed by metastatectomy while that in the tibial shaft was managed by palliative targeted therapy with tyrosine kinase inhibitors. The key takeaway from this case series is that any primary neoplastic lesion in a patient with history of RCC should be evaluated with histopathology before definitive intervention is undertaken keeping in mind the notorious tendency of RCC to cause delayed metachronous metastases at unusual sites. In presence of solitary metastatic lesions at resectable locations, curative treatment can be offered by metastatectomy

Decreasing Mortality and Hospitalizations with Rising Costs Related to Gastric Cancer in the USA: An Epidemiological Perspective

BACKGROUND: There is no convincing data on the trends of hospitalizations, mortality, cost, and demographic variations associated with inpatient admissions for gastric cancer in the USA. The aim of this study was to use a national database of US hospitals to evaluate the trends associated with gastric cancer. METHODS: We analyzed the National Inpatient Sample (NIS) database for all patients in whom gastric cancer (ICD-9 code: 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9) was the principal discharge diagnosis during the period, 2003-2014. The NIS is the largest publicly available all-payer inpatient care database in the US. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by regression analysis. RESULTS: In 2003, there were 23,921 admissions with a principal discharge diagnosis of gastric cancer as compared to 21,540 in 2014 (P \u3c 0.01). The mean length of stay for gastric cancer decreased by 17% between 2003 and 2014 from 10.9 days to 8.95 days (P \u3c 0.01). However, during this period, the mean hospital charges increased significantly by 21% from $75,341 per patient in 2003 to$ 91,385 per patient in 2014 (P \u3c 0.001). There was a more significant reduction in mortality over a period of 11 years from 2428 (10.15%) in 2003 to 1345 (6.24%) in 2014 (P \u3c 0.01). The aggregate charges (i.e., national bill ) for gastric cancer increased significantly from 1.79 bn $to 1. 96 bn$ (P \u3c 0.001), despite decrease in hospitalization (inflation adjusted). CONCLUSION: Although the number of inpatient admissions for gastric cancer have decreased over the past decade, the healthcare burden and cost related to it has increased significantly. Inpatient mortality is decreasing which is consistent with overall decrease in gastric cancer-related deaths. Cost increase associated with gastric cancer contributed significantly to the national healthcare bill

Modeling wind waves from deep to shallow waters in Lake Michigan using unstructured SWAN

Accurate wind‐wave simulations are vital for evaluating the impact of waves on coastal dynamics, especially when wave observations are sparse. It has been demonstrated that structured‐grid models have the ability to capture the wave dynamics of large‐scale offshore domains, and the recent emergence of unstructured meshes provides an opportunity to better simulate shallow‐water waves by resolving the complex geometry along islands and coastlines. For this study, wind waves in Lake Michigan were simulated using the unstructured‐grid version of Simulating Waves Nearshore (un‐SWAN) model with various types of wind forcing, and the model was calibrated using in situ wave observations. Sensitivity experiments were conducted to investigate the key factors that impact wave growth and dissipation processes. In particular, we considered (1) three wind field sources, (2) three formulations for wind input and whitecapping, (3) alternative formulations and coefficients for depth‐induced breaking, and (4) various mesh types. We find that un‐SWAN driven by Global Environmental Multiscale (GEM) wind data reproduces significant wave heights reasonably well using previously proposed formulations for wind input, recalibrated whitecapping parameters, and alternative formulations for depth‐induced breaking. The results indicate that using GEM wind field data as input captures large waves in the midlake most accurately, while using the Natural Neighbor Method wind field reproduces shallow‐water waves more accurately. Wind input affects the simulated wave evolution across the whole lake, whereas whitecapping primarily affects wave dynamics in deep water. In shallow water, the process of depth‐induced breaking is dominant and highly dependent upon breaker indices and mesh types.Key PointsImpacts of three different wind field sources on lake wave dynamics are examinedModifications to wind input and whitecapping formulations are critical to deepwater wave dynamicsDepth‐induced wave breaking and the choice of mesh type dominate modeled shallow‐water wave dynamicsPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133611/1/jgrc21745.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133611/2/jgrc21745_am.pd

Crossed fused renal ectopia: a report of twelve cases at a tertiary health centre and literature review

Crossed fused renal ectopia (CFRE), second most common renal fusion anomaly of the kidney. These patients were mostly asymptomatic and present with complaints due to associated conditions. The management of these conditions was complicated not only by the approach to be picked, but also by the investigation to be performed. The following study was done at a tertiary care centre, with the duration of this study being from January 2019 to April 2021. A total of twelve patients with CFRE required surgical intervention for their symptoms during this period. As a routine history, routine investigations and ultrasound (US) of the abdomen and pelvis was followed for all the patients. Other imaging modalities were opted on case to case basis. Out of n=12 patients of CFRE with fusion who underwent surgical intervention, majority were male patients (n=10). The most common symptom was abdominal pain (n=9). The most common crossed renal ectopia was the left to right fusion (n=7), as compared to right to left CRE (n=5). The most common fusion anomaly was L-shaped (n=8). The endourological procedures (n=6), laparoscopic procedures (n=2) while open procedures (n=4). It is important for a urologist to bear in mind the various presentations of this less known anomaly with diverse presentations. We have highlighted the investigations used at our center which would help plan further treatment and surgical approach in such patient in view of complex renal as well as vascular anatomy.  

Atypical presentation of primary renal squamous cell cancer: a case report

Renal squamous cell cancer is one of the rare primary urothelial tumors with only a handful of cases reported in literature. Because of high grade, advanced and late presentation, they herald a grave prognosis. They are frequently associated with calculus disease, smoking, phenacetin consumption and foci of squamous metaplasia due to chronic irritation. Nephroureterectomy is the treatment of choice for such tumors. We hereby present a case of 59 year old female who presented with squamous cell cancer of renal pelvis. The case presented here is different from what has already been reported in literature, as the patient had no antecedent risk factors for renal squamous cell carcinoma.-------------------------------------------------Cite this article as: Pahwa M, Pahwa AR, Girotra M, Chawla A. Atypical presentation of primary renal squamous cell cancer: a case report. Int J Cancer Ther Oncol 2014; 2(1):02015.DOI: http://dx.doi.org/10.14319/ijcto.0201.

Tumor-targeting Salmonella typhimurium A1-R in combination with doxorubicin eradicate soft tissue sarcoma in a patient-derived orthotopic xenograft (PDOX) model.

A patient with high grade undifferentiated pleomorphic soft-tissue sarcoma from a striated muscle was grown orthotopically in the right biceps femoris muscle of mice to establish a patient-derived orthotopic xenograft (PDOX) model. Twenty PDOX mice were divided into 4 groups: G1, control without treatment; G2, Salmonella typhimurium (S. typhimurium)A1-R administered by intratumoral (i.t.) injection once a week for 4 weeks; G3, doxorubicin (DOX) administered by intraperitoneal (i.p.) injection once a week for 4 weeks; G4, S. typhimurium A1-R (i.t.) administered once a week for 2 weeks followed by i.p. doxorubicin once a week for 2 weeks. On day 25 from the initiation of treatment, tumor volume in G2, G3, and G4 was significantly lower than G1. Mice found without gross tumor included one mouse (20%) in G2; one mouse (20%) in G3; and 3 mice (60%) in G4. Body weight loss did not significantly differ between the 3 treated groups or from the untreated control. Histological examination revealed eradication of tumor only in G4 where mice were treated with S. typhimurium A1-R followed by DOX. Our present study indicates future clinical potential of combining S. typhimurium A1-R with chemotherapy such as DOX for soft tissue sarcoma patients

Urinary bladder paraganglioma: a clinical dilemma in diagnosis and management: our experience at a tertiary care center

Urinary bladder paraganglioma (UBP) are rare neuroendocrine tumors with variable biological behavior. High index of suspicion in the preoperative evaluation would enable the clinician to formulate appropriate management of the rare tumors. Clinical and pathological data of seven cases evaluated and treated as per a devised protocol for suspected bladder paraganglioma from 2008 to 2019 was retrospectively reviewed. Among the seven cases, UBP’s were predominantly seen in middle aged men. Most of these presented with storage symptoms (85.71%; n=7) and gross painless hematuria (42.85%; n=3). Three patients were hypertensives and post-micturition syncope was seen in two patients. Among the seven patients two patients had functionally active tumors confirmed by elevated urinary and serum markers for catecholamine excess. Functional tumors, nonfunctional tumors involving uretero-vesical junction or broad based polypoidal tumor were considered for partial cystectomy. Other small nonfunctional tumors underwent trans-urethral resection of bladder tumour (TURBT). Follow up protocol included repeat ultrasound, check cystoscopy and completion TURBT at one month and annually thereafter. Repeat urinary catecholamines at 1 month was done in functional UBP. Cystoscopic examination of a bladder lesion which are solid, sessile and predominantly intramural, a prior to a definitive planned surgery may differentiate UBP from urothelial cancer. Most of the non-functional UPB are diagnosed by histopathological examination.  In symptomatic cases, functional evaluation with biochemical estimation of catecholamine excess allow better treatment planning and avoiding intraoperative hemodynamic instability. Due to high recurrence rate life-long follow-up despite complete excision is strongly recommended

Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL)

The objective of this prospective observational study was to assess the clinical significance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) as potential biomarkers to identify post-PNL SIRS or sepsis. Demographic data and laboratory data including hemoglobin (Hb), total leucocyte count (TLC), serum creatinine, urine microscopy and culture were collected. The NLR, LMR and PLR were calculated by the mathematical division of their absolute values derived from routine complete blood counts from peripheral blood samples. Stone factors were assessed by non-contrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden (Volume = L x W x D x pi x 0.167), location and Hounsfield value and laterality. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Of 517 patients evaluated, 56 (10.8%) developed SIRS and 8 (1.5%) developed sepsis. Patients developing SIRS had significantly higher TLC (10.4 +/- 3.5 vs 8.6 +/- 2.6, OR 1.19, 95% CI 1.09-1.3, p = 0.000002), higher NLR (3.6 +/- 2.4 vs 2.5 +/- 1.04, OR 1.3, 95% CI = 1.09-1.5, p = 0.0000001), higher PLR (129.3 +/- 53.8 vs 115.4 +/- 68.9, OR 1.005, 95% CI 1.001-1.008, p = 0.005) and lower LMR (2.5 +/- 1.7 vs 3.2 +/- 1.8, OR 1.18, 95% CI 1.04-1.34, p = 0.006). Staghorn stones (12.8 vs 3.24%, OR 4.361, 95% CI 1.605-11.846, p = 0.008) and long operative times (59.6 +/- 14.01 vs 55.2 +/- 16.02, OR 1.01, 95% CI 1.00-1.03, p = 0.05) had significant association with postoperative SIRS. In conclusion, NLR, PLR and LMR can be useful independent, easily accessible and cost-effective predictors for early identification of post-PNL SIRS/sepsis.Manipal Academy of Higher Education, Manipa