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Progression of Alzheimer’s disease (AD) bears close proximity with the tissue loss in the medial temporal lobe (MTL) and enlargement of lateral ventricle (LV). The early stage of AD, mild cognitive impairment (MCI), can be traced by diagnosing brain MRI scans with advanced fuzzy c-means clustering algorithm that helps to take an appropriate intervention. In this paper, firstly the sparsity is initiated in clustering method that too rician noise is also incorporated for brain MR scans of AD subject. Secondly, a novel neighbor pixel constrained fuzzy c-means clustering algorithm is designed where topoloty-based selection of parsimonious neighbor pixels is automated. The adaptability in choice of neighbor pixel class outliers more justified object edge boundary which outperforms a dynamic cluster output. The proposed adaptive neighbor constrained deviation sparse variant fuzzy c-means clustering (AN_DsFCM) can withhold imposed sparsity and withstands rician noise at imposed sparse environment. This novel algorithm is applied for MRI of AD subjects and normative data is acquired to analyse clustering accuracy. The data processing pipeline of theoretically plausible proposition is elaborated in detail. The experimental results are compared with state-of-the-art fuzzy clustering methods for test MRI scans. Visual evaluation and statistical measures are studied to meet both image processing and clinical neurophysiology standards. Overall the performance of proposed AN_DsFCM is significantly better than other methods.

Introduction: Carcinoma of gallbladder is an aggressive disease with poor outcome. The Epidermal Growth Factor Receptor (EGFR) is a transmembrane receptor that regulate growth, proliferation and differentiation in cells. Increased EGFR receptor expression has been studied in various cancers like lung, colorectal, breast and pancreatic tumours and anti-EGFR antibody has been used successfully for therapeutic and diagnostic purposes. Aim: To evaluate EGFR expression in gallbladder carcinoma and its association with clinicopathological factors to reveal its relation to prognosis. Materials and Methods: This cross-sectional retrospective observational study in which 64 samples were collected of resected specimen of Gallbladder Carcinoma (GBC), from the Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India, between March 2017 to September 2018. Haematoxylin and Eosin (H&E) stained sections were evaluated for tumour type and histopathological grading and TNM staging was done. Immunohistochemistry (IHC) was performed and analysed prospectively using ready to use anti-EGFR as per manufacturer’s protocols. Association between EGFR expression and clinicopathological factors were statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The EGFR expression was positive in 52 (81.25%) cases of GBC which showed a highly significant association between tumour grade and stage. About 60% of poorly differentiated GBC displayed strong (3+) staining intensity as compared to 30% of moderately differentiated (3+) and 10% of well differentiated tumours (3+). It suggests that with decreasing differentiation of tumour EGFR staining intensity increases (p

Despite significant advancements in the field of medicine, management of complex obstetric perineal injuries remains a challenge. Although several surgical techniques have been described, no techniques have provided satisfactory long-term results. Recently, a perineal transposed antropyloric valve has been used for anorectal reconstruction in patients with damaged or excised anal sphincters. We describe this technique in the case of complex obstetric perineal trauma with extensive tissue loss, presenting with end stage fecal incontinence. The functional outcome after this procedure was evaluated. The patient tolerated the surgery well, and there were no procedure-related upper gastrointestinal disturbances. Short-term functional outcomes were encouraging. At the 36-month follow-up, the patient’s neoanal resting and squeeze pressures were 50 and 70 mmHg, respectively. The postoperative St. Mark’s incontinence score was 7. Perineal antropyloric valve transposition is feasible and can be successfully applied in the management of end-stage fecal incontinence associated with complex obstetric perineal injury.

Introduction: Laparoscopic ventral mesh rectopexy (LVMR) has gained widespread acceptance for the management of complete rectal prolapse (CRP). However, there have been concerns considering its use in patients with a redundant sigmoid colon. This study was conducted to evaluate the anatomical and functional results following LVMR, particularly in cases of CRP with a redundant sigmoid colon. Materials and Methods: Retrospective analysis of 25 patients who underwent LVMR from January 2011 to September 2016 was performed. Patients were divided into two groups according to the duration of follow-up. Group A (long-term) with follow-up >3 years and Group B (mid-term) 3 years). Conclusions: LVMR seems to be a feasible surgical procedure with minimum morbidity and good long-term functional outcomes. It provides satisfactory results in patients with redundant sigmoid colon and improves pre-existing constipation and FI.

Introduction: Most centres offer laparoscopic treatment for liver hydatid cyst (LHC). There have been concerns about the management of intra-peritoneal spillage, bleeding, and cystobiliary communication (CBC) during laparoscopic surgery for LHC. CBC can exist in 13%–37% of cases of LHC. No randomised studies have compared open versus laparoscopic approach for the treatment of LHC. We specifically analysed the outcomes of laparoscopic treatment of LHC with special reference to associated biliary complications. Patients and Methods: We analysed our prospectively collected data of patients undergoing laparoscopic treatment of LHC from 2009 to 2016. Patients undergoing open surgery or interventional radiology procedures were not included. Data analysed included demographic profile, investigational parameters, intra-operative findings and postoperative results with special reference to biliary complications and presence/management of CBC. Results: A total of 41 patients underwent laparoscopic treatment of LHC. History of jaundice was present in 5 (12.2%) patients. CBC was documented in 16 (39.02%) patients. In 11 patients, CBC was detected intra-operatively as visible communication, which was suture ligated or clipped. Five patients had occult CBC, detected as bile leak in the post-operative period. The leak resolved spontaneously in 7 patients and with biliary stenting in 2 patients. Only one patient had a persistent biliary leak. Postoperative bile leak was more common in patients with raised alkaline phosphatase. No statistically significant association was seen with size or location of the cyst, number of cysts and World Health Organisation classification. Conclusion: Laparoscopic treatment of LHC with associated CBC provides acceptable results.

Digital signal processing (DSP) is one of the most powerful technologies which will shape the science, engineering and technology of the twenty-first century. Since 1970, revolutionary changes took place in the broad area of DSP which has made it an essential tool in many engineering applications. Digital filter is considered to be one of the most important components of almost every DSP sub-systems and therefore a number of extensive works had been carried out by researchers on the design of such filter. In order to meet the stringent requirements of filter specification, order of the designed filter is generally assumed to be very large and this leads to high power and area consumption during their implementation. As a matter of fact, design of hardware efficient digital filter has drawn enormous attention which needs to be addressed by various useful means. One popular approach has been to encode the tap coefficients of such filter in the form of sum of signed powers-of-two and thus the operation of multiplication is substituted by simple addition and shifting. This paper presents a detailed review of the basic design approaches applicable for the synthesis of hardware efficient finite duration impulse response (FIR) filter. Both the traditional and heuristic search algorithms have been incorporated and properly arranged in this review.

Background: Clinical significance of survivin (antiapoptosis protein) in gallbladder cancer is not yet established. Aims: This study was performed to assess the expression pattern of survivin in benign and malignant gallbladder lesions using immunohistochemistry (IHC), and to assess its clinicopathological significance. Settings and Design: Prospective study from July 2012 to July 2014 was performed as a part of intramural research project. Materials and Methods: Tissue samples from resected gallbladder for cholelithiasis (n = 27) and carcinoma gallbladder (n= 24) were evaluated for survivin expression by IHC using a scoring system. Their expression was correlated with different clinicopathological parameters. Statistical Analysis: Fisher's exact test, Student's t-test, and Chi-square test were used as appropriate for data analysis. Kaplan–Meier methods were used to calculate overall and disease-free survival rates among different groups. Two-sided P< 0.05 was considered as significant. Results: Benign group (19 females, age [mean ± standard deviation [SD] 45 ± 14 years) and malignant group (20 females, age [mean ± SD] 48.9 ± 13.4 years) were comparable with respect to menopausal status, presence, size and types of stones. However, survivin expression was significantly higher (66.7%, 95% confidence interval [CI] 24–75) in gallbladder cancer than in cholelithiasis group (33%, CI 46–83), P= 0.025). Its expression did not correlate with gender, age, menopausal status, presence of gallstones or their size, number and type, tumor differentiation, and tumor stage. Conclusions: Significantly higher expression of survivin protein in gallbladder cancer as compared to cholelithiasis group suggests its role in gallbladder carcinogenesis though it may not have prognostic value.

Trichloroethylene (TCE) is widely used as a metal degreaser in industrial processes. The present study reports on the effects of TCE exposure on workers employed in the lock industries. To ensure exposure of the workers to TCE, its toxic metabolites, trichloroacetic acid (TCA), dichloroacetic acid (DCA) and trichloroethanol (TCEOH) were detected in the plasma of the subjects through solid phase microextraction-gas chromatography-electron capture detection. TCA, DCA and TCEOH were detected in the range of 0.004–2.494 μg/mL, 0.01–3.612 μg/mL and 0.002–0.617 μg/mL, respectively. Quantitative reverse transcription polymerase chain reaction analysis revealed up-regulated expression of p53 (2.4-fold; p

Sepsis-a state of systemic bacterial infection-often leads to multiorgan failure and is associated with high mortality despite the recent advances achieved in intensive care treatment. Many of the ill effects of sepsis are attributed to an abnormally enhanced host inflammatory response that leads to neutrophil recruitment and activation involving selectins, a class of adhesion molecules, in the initial stages. Nitric oxide and its various isoforms have also been implicated in various vascular alterations and directly participate in the cellular toxicity in sepsis. This review briefly describes the role of selectins and nitric oxide in experimental and clinical sepsis as well as the therapeutic outcomes of blocking therapies.

The Circle of Willis is the junction of two carotid arteries and two vertebral arteries that supply the brain with nutrition. Junctions where these arteries come together may develop weak spots that can balloon out and fill with blood, creating aneurysms. These sac-like areas may leak or rupture, spilling blood into surrounding tissues which may cause artery spasm leading to potential stroke or even death. Clipping and coiling are two treatment options preferred by neurosurgeon which require proper detection of aneurysm. Medical practitioners are therefore emphasizing on the prior detection of cerebral aneurysm (CA) before rupture occurs leading to subarachnoid haemorrhage (SAH). This paper presents an efficient detection technique rooted in Modified Hough Circle Transform (MHCT) on the image extracted from Digital Subtraction Angiogram (DSA). Experimental results have firmly substantiated that the proposed method is highly efficient in properly detecting the location, size and type of aneurysm.

BACKGROUND: The wound healing properties of the human omentum are well known and have extensively been exploited clinically. However, the underlying mechanisms of these effects are not well understood. We hypothesize that the omentum tissue promotes wound healing via modulation of anti-inflammatory pathways, and because the omentum is rich in adipocytes, the adipocytes may modulate the anti-inflammatory response. Factors released by human omentum may affect healing, inflammation and immune defense. METHODOLOGY: Six human omentum tissues (non obese, free from malignancy, and any other systemic disorder) were obtained during diagnostic laparoscopies having a negative outcome. Healthy oral mucosa (obtained from routine oral biopsies) was used as control. Cultured adipocytes derived from human omentum were exposed to lipopolysaccharide (LPS) (1-50 ng/mL) for 12-72 hours to identify the non-cytotoxic doses. Levels of expression (mRNA and protein) were carried out for genes associated with pro- and anti-inflammatory cytokine responses and antibacterial/antimicrobial activity using qRT-PCR, western blotting, and cell-based ELISA assays. RESULTS: The study shows significant higher levels of expression (mRNA and protein) of several specific cytokines, and antibacterial peptides in the omentum tissues when compared to oral sub-mucosal tissues. In the validation studies, primary cultures of adipocytes, derived from human omentum were exposed to LPS (5 and 10 ng/mL) for 24 and 48 h. The altered expressions were more pronounced in cultured adipocytes cells when exposed to LPS as compared to the omentum tissue. CONCLUSIONS/SIGNIFICANCE: Perhaps, this is the first report that provides evidence of expressional changes in pro- and anti-inflammatory cytokines and antibacterial peptides in the normal human omentum tissue as well as adipocytes cultured from this tissue. The study provides new insights on the molecular and cellular mechanisms of healing and defense by the omentum, and suggests the potential applicability of cultured adipocytes derived from the omentum for future therapeutic applications.

Introduction: Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods: The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results: 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion: Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications. 中 文 摘 要: 引言：脛骨骨折是骨科醫生遇到的最常見的長骨骨折；脛骨骨折中，遠端骨折比較中段三分之一骨折的發生率少，居第二位。由於其接近踝關節及其表面位置，脛骨遠端骨折是獨特的，被認為是治療難度最大的骨折。 本研究的目的是比較兩種脛骨遠端骨折內固定手術治療：髓內釘和微創鋼板內固定(MIPP) 技術。方法：回顧性分析2011年1月至2012年12月間的63例脛骨遠端骨折髓內釘和MIPPO技術治療。根據美國骨科足踝評分標準，對患者的臨床資料評價。結果：31例患者採用髓內釘治療，32例採用MIPPO技術。當腓骨骨折處於或低於脛骨骨折水平的情況下，進行腓骨固定。 我們發現骨折癒合時間、畸形癒合、不癒合率、手術時間和失血量沒有差異。 但感染率和住院時間差異有統計學意義。 與MIPPO組相比，髓內組可以更早負重。結論：因此，我們認為髓內釘是關節外脛骨遠端骨折患者更好的選擇，有助於患者早期負重和移動和較少並發症。 Keywords: distal tibia metaphyseal fracture, interlocking nail, minimally invasive plate osteosynthesis

Introduction: The calcaneus is the most frequently injured tarsal bone. Many calcaneal fractures are work-related as they result from a fall from height, especially in males' age 35–45 years. These fractures frequently result in long-term disability with potentially severe economic impact on the patient. Operative treatment of displaced calcaneal fractures has been a controversial due to tissue condition and wound infection. In this study, our objective is to investigate the outcome of percutaneous fixation of displaced calcaneal fractures with cannulated cancellous screws. Materials and Methods: A retrospective review of 14 patients with 16 calcaneal fractures who had percutaneous reduction and screw fixation for displaced fracture of calcaneus was done. The patients were assessed with plain radiography. In developing countries like India, cost of medical treatment is often a concern, so computed tomography scan was not done as most of the patients were poor and did not afford the treatment. The fractures were classified according to Essex-Lopresti classification system. Functional assessment involved the use of calcaneal fracture scoring system of Kerr et al. and the Maryland foot scoring. Results: The age of the patients ranged from 23 to 62 years (mean: 34 years). Time to union averaged 13 weeks (range 11–16). The treatment outcome as measured by calcaneal fracture scoring system ranged from 63 to 94 (mean 79). The mean calcaneal fracture score was 87 (72–91/100) for the tongue-shaped group and 73 (52–83/100) for the joint depression group (P = 0.0034). The mean Maryland foot score was 73/100, with 86% of patients achieving fair to excellent results. The mean functional score was 83 (42–91/100) for the tongue-shaped group and 61 (52–73/100) for the joint depression group (P = 0.002). Conclusion: Percutaneous fixation of fracture calcaneum, offers the prospect of fewer complications and better outcome, especially in Essex-Lopresti tongue-type fracture.