Comparison of the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee

INTRODUCTION: Osteoarthritis (OA) of the knee is characterized by chronic pain, cartilage matrix degradation, deterioration of the mechanical properties of the synovial fluid, bony osteophyte formation, and episodic inflammation. Compared to healthy joints, the synovial fluid in joints affected by OA can be characterized by both diminished molecular weight and concentration of its primary functional constituent, hyaluronan. Hyaluronan is a polysaccharide consisting of repeating linear dimers of N-acetylglucosamine and glucuronic acid. It is physiologically ubiquitous in the animal kingdom, in particular existing as a large molecular weight substance in bony joints where small quantities serve as both a lubricant and a transport medium for nutrients, proteins, and degradation products related to joint tissue metabolism. Lower molecular weight hyaluronan found in osteoarthritic joints fails to retain its viscoelasticity and ability to withstand shear forces, both small (normal joint movement) and large (high impact forces). As a result, joint surfaces can become progressively damaged when endogenous hyaluronan production is reduced by disease. Corticosteroids may work through influencing levels of collagenase and aggrecan, as well as matrix metalloproteinases and proinflammatory cytokines. No single cause of OA found no far. Multiple factors that might cause OA includes, genetic predisposition, age, injury prior to adulthood, microtrauma, body weight, stress on the joint, occupational task i.e., repetitive knee bending, heavy lifting and previous surgery of joint. AIMS AND OBJECTIVES: To compare the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee. Study Centre: Government Institute of Rehabilitation Medicine, KK Nagar, Chennai-600 083. Duration of study: 18 months (March-2015 to August-2016). Study design: Prospective Single blinded Cohort study. - Subjects will be randomized by systematic random sampling, according to registration number of the study - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. METHODOLOGY: - Patients will be given test dose of 0.5ml of Lignocaine 2%. - They will be taken to Operation theatre and parts will be cleaned with Betadine and drapped with sterile towel. - Under aseptic precautions, Lignocaine 2% will be injected to anesthetise the injection site. - By following randomization procedure, either Hylan-GF20 (48mg)/methyl prednisolone acetate(40mg) will then be infiltrated into the knee joint space after confirmation by aspiration technique by infero lateral approach. - After infiltration the subjects will be observed for 15 minutes for adverse reactions. - Subjects will be asked to report immediately in case of adverse reactions like post injection flare (increased pain, swelling)/hypersensitivity reactions etc., - Also they will be given 3 days of analgesics and antibiotics. Inclusion criteria: 1. Age > 45 years, 2. Grade II osteoarthritis knee by Kellgren-Lawrence grading, 3. Knee pain with failed conservative treatment for 1 month, 4. Stiffness:< 30mts, 5. Crepitus, 6. Bony tenderness, 7. Bony enlargement, 8. No palpable warmth. Exclusion criteria: 1. Post Operative cases, 2. Cellulitis / Infections, 3. Any implants inside, 4. Associated with DVT calf muscles, 5. Non co-operative patient, 6. Low I.Q Patients /psychiatric patient, 7. Trauma, 8. Meniscal injury, 9. Anterior/Posterior cruciate ligament injury, 10. Medial/Lateral collateral ligament injury, 11. Bursitis, 12. Rheumatoid arthritis, 13. Pseudogout, 14. Other grades of osteo arthritis knee. Sample size: Approx 30+30. Product/Investigation details: Investigations: FBS, PPBS, X-ray knee-AP and Lateral. Product details: Methylprednisolone acetate – 80mg, Hylan-GF 20 – 48mg. Data collection and Methods: - Subjects will be randomized according to registration number of the study. - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. - Case History age, sex, duration of pain will be collected. Anthropometric measurements height and weight of the patient will be collected. - They will be assessed with pre procedural and post procedural. o pain score using Visual Analog Score (VAS). o WOMAC-C score. o Range of Movements of Knee. - The assessment will be analysed using SPSS software (version 21). RESULTS: There were 23 males and 37 females enrolled in the study, among which 14 males (60.9% of total males) and 16 females (43.2% of total females) were enrolled in Hylan group and 9 males (29.1% of total males) and 21 females (56.8% of total females) were enrolled in the steroid group. 49 patients had pain along anterior aspect of knee joint and 11 patients had pain along medial joint line. Among hylan group, 25 patients had pain along anterior aspect and 5 had pain along medial joint line. In steroid group, 24 had pain along anterior aspect and 6 had pain along medial joint line. Pain was assessed using Visual Analog Scoring (VAS) in this study. It showed significant pain relief with hylan group over due course of time. In steroid group, there was initial pain response till 8 weeks after the treatment, but later the pain score started to show upward trend in later weeks. In conclusion, pain relief was better in hylan group than steroid group with p value < 0.05 in all the follow up period except 8th week. Functional assessment after the treatment was done using WOMAC score (The Western Ontario and McMaster Universities Arthritis Index) and improvement in range of movements of the knee in this study. It showed significant functional improvement with hylan group over due course of time. In steroid group, there was initial better response till 8 weeks, but later the functional ability started to reduce in later weeks. In conclusion, functional improvement as per WOMAC score was better in hylan group than steroid group with p value <0.05. Functional assessment after the treatment was also done using range of movements (ROM). It showed significant improvement in ROM with hylan group over due course of time and remained stable in 12th and 26th weeks. In steroid group, there was initial better response around 4th and 8th weeks, but later ROM got reduced and did not show any further change in later weeks. In conclusion, functional improvement as per ROM was better in hylan group than steroid group with p value < 0.05. CONCLUSIONS: Intra articular Hylan GF-20 shows statistically significant improvement in Pain in analyzing the patients with Visual Analog Score (VAS). • Similarly, there is improvement in range of movements and WOMAC score (C domain) in hylan group. • For steroid group, there is initial statistical improvement upto 8 weeks in pain and other functional components, but after 8 weeks, there is no clinical improvement. • Hence Hylan GF-20 can be considered as an important therapeutic measure in the management of OA knee

Investigation of Interactions of the Rubella Virus P150 Replicase Protein with Host Cell Proteins in Infected Cells

Due to their simplicity, viruses require the assistance of host factors for various aspects of their replication cycle. This study investigated the interaction of one of the two non-structural replicase proteins of rubella virus (RUBV), P150, with cell proteins. RUBV forms replication complexes for replicating its RNA in association with membranes of endosomes and lysosomes; the thusly modified endosomes/lysosomes are termed cytopathic vacuoles or CPVs. In the first study, a RUBV expressing a FLAG epitope-tagged P150 was used to co-immunoprecipitate putative interacting cell proteins from an infected cell lysate fraction enriched for CPVs using differential centrifugation. However, the only interacting protein identified was the companion RUBV replicase protein P90. Thus, cell proteins do not bind with either sufficient affinity or in stoichiometric amounts to be detected by this method and may not be a component of the virus holoenzyme. In the second study, a proline-rich region within P150 with three PxxPxR consensus SH3 domain-binding motifs was investigated for its ability to bind cell proteins. Substitution mutations (to alanine) of the two prolines were made in each of these motifs with the finding that mutations in the first two motifs led to lower viral titers and a small plaque phenotype with reversion to the wt sequence within one passage. Mutations in the third motif had a wt phenotype and did not revert. However, these mutations did not affect viral RNA synthesis, suggesting that the importance of these motifs is in a later stage of viral life cycle, e.g. virion assembly and release. To extend these findings, the proline hinge region with either the wt or mutant sequence was expressed as a GST-fusion in human cells. Pulldown experiments revealed specific binding with human p32 protein (gC1qR), which was previously shown to interact with the RUBV capsid protein. Binding of p32 with P150 was confirmed. The function of p32 in the RUBV replication cycle is unclear, but could involve virion assembly and release or induction of apoptosis

A Study on Efficient Designs of Approximate Arithmetic Circuits

Approximate computing is a popular field where accuracy is traded with energy. It can benefit applications such as multimedia, mobile computing and machine learning which are inherently error resilient. Error introduced in these applications to a certain degree is beyond human perception. This flexibility can be exploited to design area, delay and power efficient architectures. However, care must be taken on how approximation compromises the correctness of results. This research work aims to provide approximate hardware architectures with error metrics and design metrics analyzed and their effects in image processing applications. Firstly, we study and propose unsigned array multipliers based on probability statistics and with approximate 4-2 compressors, full adders and half adders. This work deals with a new design approach for approximation of multipliers. The partial products of the multiplier are altered to introduce varying probability terms. Logic complexity of approximation is varied for the accumulation of altered partial products based on their probability. The proposed approximation is utilized in two variants of 16-bit multipliers. Synthesis results reveal that two proposed multipliers achieve power savings of 72% and 38% respectively compared to an exact multiplier. They have better precision when compared to existing approximate multipliers. Mean relative error distance (MRED) figures are as low as 7.6% and 0.02% for the proposed approximate multipliers, which are better than the previous state-of-the-art works. Performance of the proposed multipliers is evaluated with geometric mean filtering application, where one of the proposed models achieves the highest peak signal to noise ratio (PSNR). Second, approximation is proposed for signed Booth multiplication. Approximation is introduced in partial product generation and partial product accumulation circuits. In this work, three multipliers (ABM-M1, ABM-M2, and ABM-M3) are proposed in which the modified Booth algorithm is approximated. In all three designs, approximate Booth partial product generators are designed with different variations of approximation. The approximations are performed by reducing the logic complexity of the Booth partial product generator, and the accumulation of partial products is slightly modified to improve circuit performance. Compared to the exact Booth multiplier, ABM-M1 achieves up to 15% reduction in power consumption with an MRED value of 7.9 × 10-4. ABM-M2 has power savings of up to 60% with an MRED of 1.1 × 10-1. ABM-M3 has power savings of up to 50% with an MRED of 3.4 × 10-3. Compared to existing approximate Booth multipliers, the proposed multipliers ABM-M1 and ABM-M3 achieve up to a 41% reduction in power consumption while exhibiting very similar error metrics. Image multiplication and matrix multiplication are used as case studies to illustrate the high performance of the proposed approximate multipliers. Third, distributed arithmetic based sum of products units approximation is analyzed. Sum of products units are key elements in many digital signal processing applications. Three approximate sum of products models which are based on distributed arithmetic are proposed. They are designed for different levels of accuracy. First model of approximate sum of products achieves an improvement up to 64% on area and 70% on power, when compared to conventional unit. Other two models provide an improvement of 32% and 48% on area and 54% and 58% on power, respectively, with a reduced error rate compared to the first model. Third model achieves MRED and normalized mean error distance (NMED) as low as 0.05% and 0.009%. Performance of approximate units is evaluated with a noisy image smoothing application, where the proposed models are capable of achieving higher PSNR than existing state of the art techniques. Fourth, approximation is applied in division architecture. Two approximation models are proposed for restoring divider. In the first design, approximation is performed at circuit level, where approximate divider cells are utilized in place of exact ones by simplifying the logic equations. In the second model, restoring divider is analyzed strategically and number of restoring divider cells are reduced by finding the portions of divisor and dividend with significant information. An approximation factor $p$ is used in both designs. In model 1, the design with p=8 has a 58% reduction in both area and power consumption compared to exact design, with a Q-MRED of 1.909 × 10-2 and Q-NMED of 0.449 × 10-2. The second model with an approximation factor p=4 has 54% area savings and 62% power savings compared to exact design. The proposed models are found to have better error metrics compared to existing designs, with better performance at similar error values. A change detection image processing application is used for real time assessment of proposed and existing approximate dividers and one of the models achieves a PSNR of 54.27 dB

An Efficient Data Transmission in VANET using Clustering Method

A special type of Mobile Ad-hoc Networks (MANETs) which has frequent changes of topology and higher mobility is known as Vehicular Ad-hoc Networks (VANETs). In order to divide the network into groups of mobile vehicles and improve routing, data gathering, clustering is applied in VANETs. A stable clustering scheme based on adaptive multiple metric combining both the features of static and dynamic clustering methods is proposed in this work. Based on a new multiple metric method, a cluster head is selected among the cluster members which is taken from the mobility metrics such as position and time to leave the road segment, relative speed and Quality of Service metrics which includes neighborhood degree, link quality of the RSU and bandwidth. A higher QoS and cluster stability are achieved through the adaptive multiple metric. The results are simulated using NS2 and shows that this technique provides more stable cluster structured with the other method

Lack of Processing of the Expressed ORF1 Gene Product of Hepatitis E Virus

Background: Proteolytic processing is a common mechanism among plus strand RNA viruses and the replicases of all plus strand RNA viruses of animals thus far characterized undergo such processing. The replicase proteins of hepatitis E virus (HEV) are encoded by ORF1. A previous report published by our group [1] provided data that processing potentially occurred when ORF1 (Burma strain; genotype 1) was expressed using a vaccinia virus-based expression system. Findings: To further test for processing and to rule out artifacts associated with the expression system, ORF1 was re-expressed using a plasmid-based expression vector with the result that the previous processing profile could not be confirmed. When ORF1 from an HEV infectious cDNA clone (US swine strain; genotype 3) was expressed using the plasmid-based system, the only species detected was the 185 kDa precursor of ORF1. A putative papain-like cysteine protease [2] had been predicted within ORF1 using the original HEV genomic sequence. However, analysis of subsequent ORF1 sequences from a large number of HEV isolates reveals that this protease motif is not conserved. Conclusions: The expressed HEV ORF1 gene product does not undergo proteolytic processing, indicating that the replicase precursor of HEV is potentially unique in this regard

Maternal and Perinatal Outcome in Heart Disease Complicating Pregnancy One Year study in a Tertiary Care Centre

INTRODUCTION: Heart diseases complicating pregnancy constitute a major cause of non obstetric maternal deaths. This prospective study was conducted in a tertiary care centre over a period of one year. AIMS AND OBJECTIVES: To find the prevalence of heart diseases in women admitted for delivery or MTP in our institution and to know about the various heart diseases prevalent in them. MATERIALS AND METHODS: The study included 172 pregnant women with heart diseases of whom 15 underwent MTP. They were observed for maternal, cardiac and perinatal outcomes. RESULTS: The prevalence of heart disease was 1.08% in our study. RHD was the commonest type of heart disease. CONCLUSION: Heart disease constitute for a significant of number of maternal deaths. This can be prevented by a comprehensive multi disciplinary care

The influence of environmental attitude, environmental knowledge, social influence and self-image on green purchasing intention

This paper studies the factors that influence green purchasing intention among young consumer. Respondents in this study were 384 students who were chosen from four public universities in Selangor. The main purpose was to identify the relationships between environmental attitude, environmental knowledge, social influence and self-image on green purchasing intention. The result shows that self-image was the most important predictor followed by environmental attitude, while social influence and environmental knowledge variables did not influence the green purchasing intention. Reward and recognition activities and implementation of specific marketing efforts are recommended as the focus of marketers in influencing green purchasing intention among yout

Fetomaternal Outcome of Pregnancy beyond 40 weeks of Gestation

The definition of prolonged pregnancy according to international guidelines is 42 completed weeks or more than that from the first date of last menstrual period. Although 42 completed weeks is used as cut off it is not an absolute threshold. Accurate estimation of gestational age and expected date of delivery is important for successful outcome of pregnancy. Because both maternal and fetal morbidity increase once pregnancy goes beyond the dates. AIM OF THE STUDY: 1. To analyses the optimum period of intervention in pregnancy beyond the expected date of delivery. 2. To study the fetal and maternal outcome. 3. To study the mode of delivery in pregnancy beyond dates. MATERIALS AND METHODS: The study done in institute of obstetrics and gynecology in Egmore MMC in 2016. It is a prospective study. Pregnant women which includes pregnancy beyond 40 weeks. Patients were recruited based on inclusion criteria. From this analysis: More number induction is seen beyond 40weeks of gestation compared to term pregnancy. As with more induction more number Caesarian rate is seen in pregnancy beyond 40weks of gestation. In this study there is increased neonatal and perinatal morbidity beyond 40 weeks of gestation. CONCLUSION: Postdated pregnancies should be correctly diagnosed. Properly planned and effective management required. As the perinatal morbidity is more in postdated pregnancy careful intrapartum monitoring should be done. Proper monitoring will found that hypoxic fetus at an early time