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Background and Objective: A delayed presentation of benign breast diseases may lead to a therapeutic challenge when they enlarge enormously or become multiple. Aim of this study was to evaluate the factors leading to delayed presentation of benign breast lumps. Methods: This cross-sectional study was conducted at Madinah Teaching Hospital and Allied Hospital, Faisalabad from January 2019 to October 2021. One hundred and forty five female patients were selected by non-probability purposive sampling. Patients with large size (>5cm) or multiple benign breast lumps were included. An interview was conducted using structured questionnaire translated in Urdu. Factors leading to delayed presentation and social impact scale for stigma were evaluated. Results: Patients had a mean age of 26.52 ± 6.90 years. The average delay of seeking medical care was 8.48 ± 8.41 months. Factors leading to delayed presentation were; lack of knowledge n=112 (77.2%) and parda (religious issues) n=112 (77.2%), followed by poverty n=109 (75.2%), and fear of cancer n=90 (62.1%). All the sub-scales of stigma, i.e., social rejection, financial insecurity, internalized shame and social isolation were high in late presenters, though, only financial insecurity was significantly high in late presenters (p=0.03). Conclusion: Lack of awareness, socioeconomic factors and disease related stigma were the main factors related to delayed presentation in young females with benign breast diseases. Addressing these factors may improve timely diagnosis and management of delayed and challenging cases. doi: https://doi.org/10.12669/pjms.39.1.6647 How to cite this: Saleem S, Tariq S, Tariq S, Irfan S, Javed F. Factors leading to delayed and challenging presentation of benign breast lumps in young females. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6647 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To compare the efficacy of paramedian and midline approach for spinal block in elderly, in terms of success rate and number of attempts required by either approach. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesia, Madina Teaching Hospital Faisalabad. Period: January 2018 to December 2019. Material & Method: 120 elderly ASA I-III patients scheduled to undergo lower abdominal or limbs; general or orthopaedic surgery were randomly divided into two equal groups A and B of sixty patients. Patients were assigned into groups by lottery method. Group A patients were supposed to receive spinal block by midline approach while group B patients were planned to receive spinal block by paramedian approach. Results: It was observed that success rate was significantly high in group B, 98.3% as compared to group A, 80%, (p value 0.001). The number of attempts were significantly less in group B in comparison to group A (p-value 0.0001). Conclusion: The paramedian approach for spinal block in elderly patient’s offers ease of administration and a higher success rate as compared to midline approach.

Objective: To compare the effects of intraincisional and intraperitoneal infiltration of local anaesthetic to relieve early postoperative pain in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Department of Anaesthesia and Surgery, Madinah Teaching Hospital Faisalabad. Period: July 2017 to March 2018. Material & Methods: A sample of 100 patients with American Society of Anaesthesiologists Physical status (ASA) I and II, undergoing laparoscopic cholecystectomy were selected using simple random sampling technique. Patients were randomly assigned into groups A and B. Group A patients received intraperitoneal infiltration of 20 ml solution of 0.25% bupivacaine and group B patients received intraincisional infiltration of 20 ml solution of 0.25% bupivacaine. Results: Demographic characteristics were not significantly different in both groups. Our study showed that Group A patients had better pain relief as compared to group B patients. Visual analogue score (VAS) for pain relief at 0, 3,6,12 and 24 hours was statistically different in both groups. The requirement of rescue analgesia between group A and B was found to be12% and 38% which is statically significant (p value 0.003). Conclusion: intraperitoneal infiltration of Bupivacaine offers better postoperative pain relief after laparoscopic cholecystectomy and is associated with less analgesic requirement in early postoperative period.

Introduction: Asian developing countries share the burden of colorectal cancer (CRC) with rising mortality rates. This prospective study aims to apprehend the clinical relevance of age, gender, lifestyle choices (dietary habits and addiction), and body mass index (BMI) to the occurrence and progression of colon cancer (CC). Methods: A cohort of non-cancer and CC patients of South-Central Asian origin registered for screening colonoscopy or surgery at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore, Pakistan, from 2015 - 2020 was identified. BMI (Kg/m2) was classified according to the World Health Organization (WHO) criteria as underweight (

Congenital cataract is causing one-third of blindness worldwide. Congenital cataract is heterogeneous in its inheritance patterns. The current study is aimed to explore the unknown genetic causes underlying congenital cataracts.Blood samples from affected and normal individuals of n = 25 Pakistani families identified with congenital cataracts were collected. Genomic DNA was extracted and Sanger sequencing was performed to identify novel pathogenic variants in the FYCO1 (MIM#607182) gene. Later structural bioinformatics tools and molecular dynamics simulations were performed to analyze the impact of these variants on protein structure and function.Sanger sequencing resulted in the identification of a novel splice site mutation (NM_024513.3: c.3151-29_3151-7del) segregating in an autosomal recessive manner. This novel variant was confirmed to be absent in the n = 300 population controls. Further, bioinformatics tools revealed the formation of a mutant protein with a loss of the Znf domain. In addition, we also found a previously known (c.4127 T C; p.Leu1376Pro) mutation in four families. We also report a novel heterozygous variant (c.3419G A; p.Arg1140Gln) in another family.In conclusion, we report a novel deletion (NM_024513.3: c.3151-29_3151-7del) in one family and a frequent homozygous missense mutation (c.4127 T C; p.Leu1376Pro) in four Pakistani families. The current research highlights the importance of autophagy in lens development and maintaining its transparency.

Objectives: To determine the oncological outcome of different types of phyllodes tumour (PT) and to analyze the impact of radiotherapy on outcome. Study Design: Experimental study. Setting: Madina Teaching Hospital, Faisalabad, Pakistan. Period: April 2015 to April 2020. Material & Methods: Female patients diagnosed as phyllodes tumour of breast were included and classified into benign, borderline and malignant PT according to WHO criteria. Borderline and malignant PT were further divided into 2 groups; Group A (Surgery alone) and Group B (Surgery + Radiotherapy). Oncological outcome based on local recurrence, distant metastasis and overall survival rate among different types of phyllodes tumour and those patients who received or not received radiotherapy was assessed. Results: In 5 years, 29 patients of phyllodes tumour were studied. 15 (51.7%) patients had benign, 8 (27.6%) malignant and 6 (20.7%) borderline tumour. Mean age of our patients was 39.5 years (range: 25-55 years).The disease free survival rate was 82.8% (100% for benign, 83.4% for borderline and 50% for malignant PT). Malignant histotype and tumour size >6cm were significantly associated with recurrence (p

Study Design: Sectional study. Setting: Madina Teaching Hospital Faisalabad. Period: July 2018 to June 2019. Material & Methods: A sample of 107 patients was selected using non-probability purposive sampling out of all the patients presenting with acute appendicitis. Study population was divided into Groups A and B, former undergoing appendectomy within 8 hours of admission and later undergoing surgery more than 8 hours after admission. Spinal and general anesthesia was used and both Laparoscopic and open surgical techniques were employed. Results: Out of total 107 patients, 62 (57.94%)were placed in group A and 45 (42.06%) in group B. Age and gender related distribution in both groups were similar. 5 patients in group A had perforated appendix and 3 patients in Group B were found to have perforated appendix. The difference between incidence of perforation between the two groups was not statistically significant. Conclusion: in-hospital delay before appendectomy does not significantly increase the risk of perforation in uncomplicated acute appendicitis.

Oral squamous cell carcinoma (OSCC) is the most prevalent subtype of head and neck cancers that has a disproportionately high incidence and mortality in developing countries in South-Central Asia, including Pakistan. The standard treatment for OSCC generally consists of surgery combined with radiotherapy or chemotherapy; however, the overall survival rates have not improved, and only ~50% of patients survive the disease. Therefore, identifying and validating new drug targets can provide new therapeutic options for improved treatment and better prognosis for OSCC patients. The present study aimed to develop an organoid model from patient-isolated primary tumour cells and determine their drug sensitivity profile coupled with mutational analysis. New combinations of targeted drugs with synergistic activity in oral cancer cells were identified through high-throughput screening followed by validation of their activity in oral cancer cells in 2D monolayer and 3D organoid cultures. Results indicate a synergistic activity of proteasome (PR-171) and survivin (YM155) inhibitors in all tested patient-derived tumour cells and four oral cancer cell lines. Moreover, chitosan-based nanocapsules harboring these drugs showed therapeutic efficacy comparable to free drug combinations, indicating a potential for efficient and targeted delivery. Next-generation sequencing data identified missense mutations in eleven cancer-related genes that encode BRAF, EGFR, KRAS, NRAS, HRAS, MEK1, PIK3CA, PTEN, NOTCH1, TP53 and TERT. The ongoing research aims to correlate the drug sensitivity data with the mutational profile of patient-derived tumour cells to find novel targets. In conclusion, we have developed 3D organoids from patient-derived primary tumours and utilized them to validate the synergistic combination between screen-identified proteasome and survivin inhibitors. Our preclinical study provides a rationale for further evaluation of the novel drug combination in vivo and in clinical settings. Citation Format: Muhammad Furqan, Iffat Aleem, Muhammad Tahseen, Raza Hussain, Asif Loya, Muhammad Tariq Mahmood, Philippe Gautier, Kevin Myant, Saira Saleem, Amir Faisal. Proteasome and survivin inhibitors synergize to inhibit the growth of oral cancer organoids. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4940.

One hundred and five (105) bread wheat (

Objectives: Oncoplastic breast surgery (OBS) is a revolutionary approach for managing breast cancer. This manuscript aimed to assess the oncological and cosmetic outcomes of OBS in breast cancer. Study Design: Descriptive, prospective study. Setting: Department of Surgery, Madina Teaching Hospital, Faisalabad. Period: January 2018 to June 2019. Material & Methods: Females with invasive breast cancer having 5-6 cm tumour size, Locally advanced tumour after chemotherapy, single tumour and patients < 70 years were included; while patients with fixed tumours, high tumour to breast size ratio, multiple axillary lymph nodes, metastatic cancer & patient’s choice for mastectomy were excluded. Oncological outcome was assessed by; Margin involvement, time lag for chemotherapy, local recurrence and distant metastasis. Cosmetic outcome was detected by score given by patient and an independent surgeon. Results: Thirty two female patients underwent OBS. Mean age of patients was 46.56 yr (SD =10.23). Six patients (18.8%) had central tumors. 3 patients were post neoadjuvant chemotherapy. In 28 patients volume displacement (VD) surgery; while in 4 patients volume replacement (VR) using different flaps like LICAP flap were done. Oncological outcome showed positive margin in one case only, in all other cases clear margins were found. Chemotherapy start time varied from 3 to 8 weeks after surgery (Mean=31.3 days). Delayed time was associated with high BMI and diabetes (P

The aim of the study is to identify cornulin (CRNN) protein expression associated with advancement of tongue squamous cell carcinoma (TSCC). A comparison of addictive (containing potential carcinogens) versus non-addiction causative agents was expected to allow detection of differences in CRNN expression associated with TSCC. Bespoke tissue microarrays (TMAs) were prepared and immunohistochemistry (IHC) performed to determine the changes in CRNN expression in epithelial cells of node-negative (pN-), node-positive (pN+) TSCC and non-cancer patients’ oral tissues. TMAs were validated by performing IHC on whole diagnostic tissues. Chi-square test or Fisher’s-exact tests were used to establish significant expression differences. Analogous analyses were performed for biomarkers previously associated with TSCC, namely collagen I alpha 2 (COL1A2) and decorin (DCN) to compare the significance of CRNN. Keratinisation and its level (low, extensive) were studied in relation to CRNN so that the extent of squamous differentiation could better be assessed. IHC immunoreactive score (IRS) clustered the patients based on weak/moderate (Low (IRS ≤ +3)) or strong (High (IRS ≥ +4)) expression groups. A low expression was observed in a larger number of patients in control proteins COL1A2 (77.3%), DCN (87.5%) and target protein CRNN (52.3%), respectively. Low CRNN expression was observed in TSCC where nodes were involved (pN+: mean 1.4 ± 2.1) (p = 0.248). Keratinisation (%) was low (0% ≤ 50%) in 42.2% and extensive (1% ≥ 50.0%) in 57.8% patients. In conclusion, our study suggested that Low CRNN expression was associated with grade and lymph node metastasis in TSCC. CRNN expression is independent of addiction, however potentially carcinogenic addictive substances might be aiding in the disease progression.

One hundred and five (105) bread wheat (Triticum aestivum L.) genotypes, including five commercial checks, were screened for stripe rust resistance at seedling and adult plant stages. Seedlings grown under controlled conditions were screened for disease resistance after 12 days concerning disease incidence percentage after inoculation. K-means cluster analysis divided the genotypes into five different classes according to the presence of virulence/avirulence profile, i.e., class 1, 2, 3, 4 and 5. The same set of genotypes was grown under field conditions for adult plant resistance. Data for disease scoring and different yield and yield-related parameters was recorded. A comparison of breeding lines indicated that all studied traits were negatively affected by disease incidence. Further cluster analysis ranked the genotypes into three distinct groups with Group I and III being the most diverse. Thirteen stripe rust resistance lines were identified using seedling and adult plant resistance strategies. Correlation analysis indicated a negative association between stripe rust incidence and yield and yield-related traits, particularly grains per spike, grain weight per spike, thousand-grain weight, and grain yield per plant. These findings suggested that stripe rust resistance negatively affects yield and yield related traits. The breeding programs aiming at the development of high yielding varieties must also focus on stripe rust resistance.

The key intention of this review is to summarize the different studies which relate the genome-diet interactions with future perspectives of exploring an insight into the well defined functions of diverse micronutrients and other dietary components that play a vital task in defining the early developmental patterns of an organism. Human fetus development is a complex process that is totally dependent on the dietary components which interact with the genes to regulate the different proliferation and differentiation stages. We want to explore those complex interactions that lay hidden between micro-nutrients and gene expressions but are means of the apparent changes of a phenotype of an individual. Along with this the review will also perceive some basics of development of certain diseases as well, due to these complex genome-diet interactions thus leading to refine the dietary outlines for maternal and prenatal develop- mental stages in future. Research has also shown that genome-diet interactions are very complex as without proper nutrients the end result is the genome instability which may lead to chronic diseases, developmental defects and certain types of cancer.

The demand for corn in the developing world will double by the end of 2050. The challenges due to the climate change are real. Where extreme weather events will become more frequent and climate change projections suggest that large yield losses occur in many regions of the world. Corn is cultivated throughout the world and is a strategic crop: can tolerate high radiation intensities and exhibits high efficiency in the use of water. A framework is needed to design maize ideotypes for site specific condition with the definitions of past, present and future environmental history, and the response of the local material using empirical or mechanistic modeling. The ideotype is a combination of different types of biological traits or the genetic basis that confer enhanced performance for a particular biophysical environment, specific cropping system and end use of the crop. Studies of genotype performance under climate variability always shows that a single trait will never improve plant performance in all climatic scenarios and similarly a single genotype will not cope with all the existing climatic variability. In the past, ideotyping was based on visual and growth phenotypes, but future ideotyping trend will focused more on the knowledge of the genotype. In the future, the strategies for ideotipificacion will be based on strong biotechnological techniques facilitated by the bioinformatics, filling gaps in the current knowledge and overcoming the climatic change challenges and increased the world population. Key words: Maize, ideotype, climate change.

Objectives: To analyze the complications following elective splenectomy. StudyDesign: Descriptive cross- sectional. Setting and Duration: This study was conducted in thedepartment of surgery, Madinah Teaching Hospital, Faisalabad from January 2011 to December2016. Method: After a good preoperative workup and preparation, 112 patients underwentelective open splenectomy from Jan 2011 to Dec 2016. Early postoperative complicationswere recorded. P value

Background The aim of this pilot study was to identify proteins associated with advancement of colon cancer (CC). Methods A quantitative proteomics approach was used to determine the global changes in the proteome of primary colon cancer from patients with non-cancer normal colon (NC), non-adenomatous colon polyp (NAP), non-metastatic tumor (CC NM) and metastatic tumor (CC M) tissues, to identify up- and down-regulated proteins. Total protein was extracted from each biopsy, trypsin-digested, iTRAQ-labeled and the resulting peptides separated using strong cation exchange (SCX) and reverse-phase (RP) chromatography on-line to electrospray ionization mass spectrometry (ESI-MS). Results Database searching of the MS/MS data resulted in the identification of 2777 proteins which were clustered into groups associated with disease progression. Proteins which were changed in all disease stages including benign, and hence indicative of the earliest molecular perturbations, were strongly associated with spliceosomal activity, cell cycle division, and stromal and cytoskeleton disruption reflecting increased proliferation and expansion into the surrounding healthy tissue. Those proteins changed in cancer stages but not in benign, were linked to inflammation/immune response, loss of cell adhesion, mitochondrial function and autophagy, demonstrating early evidence of cells within the nutrient-poor solid mass either undergoing cell death or adjusting for survival. Caveolin-1, which decreased and Matrix metalloproteinase-9, which increased through the three disease stages compared to normal tissue, was selected to validate the proteomics results, but significant patient-to-patient variation obfuscated interpretation so corroborated the contradictory observations made by others. Conclusion Nevertheless, the study has provided significant insights into CC stage progression for further investigation.

Objectives: Hypotensive anesthesia remains essential throughout endoscopic sinus operation to attain the peaceful medical ground. The purpose of our current research remained to associate excellence of clinical arena experiencing propofol or else desflurane anesthesia. Methodology: By and large 50 respondents of both sexes, becoming to ASA massive function 1 and 2, in like manner age set of 19 – 61 years remained randomized into 2 sets to get whichever propofol moreover morphine or else desflurane furthermore morphine anesthesia. This examination was once led from March 2015 to May 2016 at Mayo Hospital, Lahore Pakistan. The goal MAP remained held in the preference of 66-76 mmHg. The flawlessness of therapeutic discipline stayed evaluated through experiencing the proven checking diagram at each 20 mins via vague specialist in all matters regarded patients to ward off pro's partiality. Results: The average group gauge worth remained 4.668 ± 1.245 in propofol collection also 3.201 ± 0.411 in desflurane set (p=0.001). The period to appearance remained meaningfully fewer in desflurane set (10.36 ± 2.28) as associated to propofol set (15.61 ± 3.07 minutes). Conclusion: Researchers accomplish that together propofol also desflurane might remain experienced to accomplish the acceptable medical ground excellence nonetheless desflurane delivers the fast appearance as associated to propofol. Key words: Measured hypotension, Endoscopic sinus operations, Desflurane; Propofol.

Background/aim: Diabetic foot ulcers and related complications are a major cause of morbidity and hospital admissions. Our aim was to evaluate the risk factors associated with poor outcome in diabetic foot ulcers. Materials and methods: A prospective study was conducted on patients with diabetic foot ulceration attending the Madinah Teaching Hospital from June 2014 to December 2015. Potential risk factors and laboratory test results at presentation were recorded and their association with outcome (healing vs. amputation) was analyzed using IBM SPSS Statistics for Windows, Version 22.0. Results: In total, 112 patients were studied during our study period. The majority of the patients were male (60.7%) and aged 50 years and older (62.5%). Regarding the outcome, 68% healed completely, 27.7% underwent amputation, and 4.5% died during this period. Patient age of 50 and older, long duration of diabetes (>10 years), rural origin, and heel ulcers were significantly associated with poor outcome (P < 0.05). Conclusion: Patients with diabetes should have a detailed annual foot examination; those having risk factors for poor outcome require more frequent foot care, patient education, and early referral to tertiary care centers.

Aims: A sub-population of cells named cancer stem cells (CSCs) that initiate and promote tumour growth have been demonstrated to exist in several malignancies including colon carcinoma. The objective of our pilot study was to isolate CD133+CD26+CD44+ CSCs from patient colon tumours, culture spheres or organoids and observe their proliferation in primary cultures. Parallel cultures of non-cancer controls from colon normal lining and nonadenomatous polyps were set up. Methods: Magnetic activated cell sorting was used to isolate CD133+CD26+CD44+ cell populations followed by primary cell culturing under stem cell culture conditions. Number, cells/organoid and daughter generations of organoids were calculated using phase contrast microscope. Trypan blue exclusion method was used to test the viability of the cells. Results: Both colon tumour and colon non-adenomatous polyp formed floating organoids in suspension; however non-adenomatous polyp cultures did not show self-renewal properties for more than 1 passage. Normal colon singlecell suspension did not create organoids. Metastatic colon tumours rapidly produce cancer cell organoids in less than 24 hours in larger numbers compared to non-metastatic colon tumours (1-3 weeks). Metastatic colon tumour organoids have the ability for proliferation for upto five daughter generations in primary culture compared to three generations for those grown from non-metastatic tumours. Conclusions: This in vitro CSC organoid model will help study colon cancer biology, in particular providing a valuable source of primary cell-derived tissue for studying personalized molecular profiling using ‘omics strategies to direct therapeutic intervention.

Cancer significantly affects millions of people worldwide. It is possible to use proteomic techniques to aid in detection, monitoring of treatment and progression, as well as gaining an increased understanding of cancer. Matrix-assisted laser desorption/ionisation (MALDI) mass spectrometry can be utilised to detect the presence of proteins and peptides within various samples from the body, including blood, biological fluids and tumour tissue. This review aims to introduce MALDI mass spectrometry and discuss a range of applications in the field of cancer research, from quantitative to qualitative methods. Also described is MALDI imaging mass spectrometry which differs from typical sample preparation methods, as analytes are ionised directly from the tissue. Finally, presented is a brief summary of the status of biomarker discovery using blood/serum and biological fluids samples, and the implications in the clinic.

Recent evidence has shown that stem cell factor (SCF) and its receptor, c-Kit, have an important role in pancreatic islet development by promoting islet cell differentiation and proliferation. In this study, we examined the role of c-Kit and SCF in the differentiation and proliferation of insulin- and glucagon-producing cells using a human pancreatic duct cell line (PANC-1). Our study showed that increased expression of endocrine cell markers (such as insulin and glucagon) and transcription factors (such as PDX-1 and PAX-6) coincided with a decrease in CK19 and c-Kit cells (P0.001) during PANC-1 cell differentiation, determined by immunofluorescence and qRT-PCR. Cells cultured with exogenous SCF showed an increase in insulin (26%) and glucagon (35%) cell differentiation (P0.01), an increase in cell proliferation (P0.05) and a decrease in cell apoptosis (P0.01). siRNA knockdown of c-Kit resulted in a decrease in endocrine cell differentiation with a reduction in PDX-1 and insulin mRNA, as well as the number of cells immunostaining for PDX-1 and insulin. Taken together, these results show that c-Kit/SCF interactions are involved in mediating islet-like cluster formation and islet-like cell differentiation in a human pancreatic duct cell line. © 2010 USCAP, Inc All rights reserved.

beta1 integrin and collagen matrix interactions regulate the survival of cells by associating with focal adhesion kinase (FAK) and initiating MAPK/ERK signalling, but little is known about these signalling pathways during human fetal islet ontogeny. The purpose of this study was to investigate whether beta1 integrin/FAK activation of the MAPK/ERK pathway regulates human fetal islet cell expression of endocrine cell markers and survival. Isolated human (18-21 weeks fetal age) islet-epithelial cell clusters, cultured on collagen I, were examined using beta1 integrin blocking antibody, beta1 integrin siRNA and FAK expression vector. Perturbing beta1 integrin function in the human fetal islet-epithelial cell clusters resulted in a marked decrease in cell adhesion, in parallel with a reduction in the number of cells expressing PDX-1, insulin and glucagon (p < 0.05). beta1 integrin blockade disorganized focal adhesion contacts in the PDX-1(+) cells and decreased activation of FAK and ERK1/2 signalling in parallel with an increase in expression of cleaved caspases 9 and 3 (p < 0.01). Similar results were obtained following an siRNA knock-down of beta1 integrin expression. In contrast, over-expression of FAK not only increased phospho-ERK and the expression of PDX-1, insulin and glucagon (p < 0.05) but also abrogated the decreases in phospho-ERK and PDX-1 by beta1 integrin blockade. This study demonstrates that activation of the FAK/ERK signalling cascade by beta1 integrin is involved in the differentiation and survival of human fetal pancreatic islet cells.

Objectives: The aim of this study was to compare the management of puerperal breast abscess by ultrasound guidedpercutaneous drainage v/s incision and drainage with special attention to resolution time and complications. Setting: Allied Hospital Faisalabad.Period: Jan 2005- June 2007. Patients and Methods: 60 patients with puerperal breast abscess were studied. Patients were divided into twogroups randomly after informed consent. In Group A; patients were treated with percutaneous drainage under local anesthesia while GroupB patients were treated by conventional incision and drainage, and results were compared with reference to resolution time and complicationsrate using student’s t-test. Results: By percutaneous method abscess healed in 5-8 days time. Recurrent abscess was found in one case (3%),milk fistula formation in one case (3%) and no residual abscess was found. There was no scar formation, induration or distortion of the breastparenchyma. Breast-feeding was interrupted in four patients (13%) only due to milk fistula (one case), recurrent abscess (one case) andpatient’s own preference (two cases). On the other hand by conventional method healing took 15-25 days with pain and discomfort of dailydressings, scarring and cessation of breast feeding in most of the cases. Conclusion: Percutaneous ultrasound guided placement of suctiondrainage catheter in puerperal breast abscess for 5-8 days is less invasive, high resolution rate, scarless, low complication rate and preservesthe function of breast-feeding as compared to conventional incision and drainage.

In this paper we present a system that monitors cargo compartments in transport vehicles in near real-time using RGB-D sensors (Asus Xtion Pro Live, Microsoft Kinect). The main component of this sensor system is a 3D analysis module that determines relevant logistical parameters of cargo compartment conditions such as free load meters, free cargo space and volume of cargo. Wireless GPRS technology transmits the results data to a central server along with GPS positioning. The latest information on a vehicle’s location and its cargo compartment parameters are always available to dispatchers, thus enabling them to route vehicles flexibly based on incoming transportation orders. The mobile sensor system’s easy and fast integration in the process make it extremely practicable. We also developed a calibration method based on simple planar markers.

Recently a sub-population of cells with stem cell characteristics, reported to be associated with initiation, growth, spread and recurrence, has been identified in several solid tumors including oral tongue squamous cell carcinoma (OTSCC). The aim of our pilot study was to isolate CD44+ cancer stem cells from primary cultures of OTSCC and neck node Level I (node-I) biopsies, grow cell spheres and observe their characteristics in primary cultures. Parallel cultures of hyperplastic lesions of tongue (non-cancer) were set up as a control. Immunohistochemistry was used to detect CD44/CD24 expression and magnetic activated cell sorting to isolate CD44+ cell populations followed by primary cell culturing. Both OTSCC and node-I biopsies produced floating spheres in suspension, however those grown in hyperplastic and node-I primary cultures did not exhibit self-renewal properties. Lymph node metastatic OTSCC, express higher CD44/CD24 levels, produce cancer cell spheres in larger number and rapidly (24 hours) compared to node negative OTSCC (1 week) and non-cancer specimens (3 weeks). In addition, metastatic OTSCC have the capacity for proliferation for up to three generations in primary culture. This in vitro system will be used to study cancer stem cell behavior, therapeutic drug screening and optimization of radiation dose for elimination of resistant cancer cells. Electronic supplementary material The online version of this article (doi:10.1186/s12935-014-0143-3) contains supplementary material, which is available to authorized users.

In this paper, we aim to investigate the image-based approaches and propose a framework to examine the pedestrian flow in crowds on various real situations. This research is inclined on two main aspects: first, an in-depth analysis of image-based approaches is given particularly for the situation containing large number of pedestrians (i.e., crowds) and second, our proposed approach which mainly focuses on computing the flow data, modeling, and classifying the corresponding behaviors of pedestrians in a crowd. The dynamic data of underlying crowd scenes establish a large cloud of information (i.e., correlated or un-correlated data). Therefore, it is essential to extract the meaningful information from the data cloud however the selection of criteria is a crucial task which is answered in the first part of the paper. Moreover, in crowded scenes, it is challenging to extract individual characteristics (e.g., head, torso, or leg count) of every pedestrian forming the crowd. Because, the pedestrians do not own these characteristics while moving in the form of groups. Therefore, we can not rely on such individual information of every pedestrian for longer time instances. Based on this fact, in this research, we measure the dynamic contents over consecutive frames. After this, we model this information by computing the Histogram of Flow (HOF) for each time instance. Later, we classify these HOF features according to our behavior-specific classes. We have tested the proposed approach on the dataset recorded with the help of approximately 30 volunteers. In the context of pedestrian behaviors characterization, we have employed Support Vector Machines on our recorded dataset and achieved 91 % classification rate.

Inthis paperwe presentan approach foroptical vehicle positioning (e.g. fork lifters). Our approach is motivated by planar marker detection systems like ARTag or ARToolkit, in which poses of planarmarkers relative to the camera can be determined. In contrast toexisting optical positioning systems(e.g. SkyTrax), we mount cameras on the ceiling and passive (non-electronic) planar markers on the top of the vehicles. The absenceof complexelectronic components on the high stressed vehicles enablesrapid process integration, which is particularly important forrental vehicles. We have evaluated our method keeping the most important user requirementscoverage, costsand accuracyunder consideration for three intra-logistic scenarios a) zone monitoring with zone precise positioning, b) storage aisle monitoring with storage place precise positioning and, c) complete driving rangemonitoringwith maximumprecision.

Currently, large areas are continuously monitored by camera networks, whereas an overall situation assessment within a reasonable time is a crucial requirement. In this paper, we propose our Virtual Top View (VTV) approach that provides a clear, concise and direct interpretation of on-field activities in real-time preserving the spatial relationship and, technically, employs planar homography to aggregate the Virtual Top View out of multiple, individual video streams. With an increasing number of cameras or size of the monitored area, the aggregation process slows down. Therefore, we develop acceleration methods (autogenerated warp maps) to achieve a real-time aggregation within large camera networks. Finally, we evaluate the performance and demonstrate our approach in an intra-logistics environment.

The governing behaviors of individuals in crowded places offer unique and difficult challenges. In this paper, a novel framework is proposed to investigate the crowd behaviors and to localize the anomalous behaviors. Novelty of the proposed approach can be revealed in three aspects. First, we introduce block-clips by sectioning video segments into non-overlapping patches to marginalize the arbitrarily complicated dense flow field. Second, flow field is treated as a 2d distribution of samples in block-clips, which is parameterized by using mixtures of Gaussian keeping the generality intact. The parameters of each Gaussian model, particularly mean values are transformed into a sequence of Gaussian mean densities for each block-clip namely a sequence of latent-words. A bank of Conditional Random Field model is employed, one for each block-clip, which is learned from the sequence of latent-words and classifies each block-clip as normal and abnormal. Experiments are conducted on two challenging benchmark datasets PETS 2009 and University of Minnesota and results show that our method achieves higher accuracy in behavior detection and can effectively localize specific and overall anomalies. Besides, a comparative analysis is presented with similar approaches which demonstrates the dominating performance of our approach.

The governing behaviors of individuals in crowded places offer unique and difficult challenges, and limit the scope of conventional surveillance systems. In this paper, we investigate the crowd behaviors and localize the anomalies due to individual's abrupt dissipation. The novelty of the proposed approach can be described in three aspects. First, we introduce block-clips by sectioning the video segments into non-overlapping spatio-temporal patches to marginalize the arbitrarily complicated and dense flow field. Second, we treat the flow field in each block-clip as 2d distribution of samples and mixtures of Gaussian is used to parameterize it keeping generality of flow field intact. K-means algorithm is employed to initialize the mixture model and is followed by Expectation Maximization for optimization. These mixtures of Gaussian result in the distinct flow patterns precisely a sequence of dynamic patterns for each block-clip. Third, a bank of Conditional Random Field model is employed one for each block clip and is learned from the sequence of dynamic patterns and classifies each block-clip as normal and abnormal. We conduct experiment on two challenging benchmark crowd datasets PETS 2009 and University of Minnesota and results show that our method achieves higher recognition rates in detecting specific and overall crowd behaviors. In addition, the proposed approach shows dominating performance during the comparative analysis with similar approaches in crowd behavior detection.

Crowd behavior analysis is a challenging task for computer vision. In this paper, we present a novel approach for crowd behavior analysis and anomaly detection in coherent and incoherent crowded scenes. Two main aspects describe the novelty of the proposed approach: first, modeling the observed flow field in each non-overlapping block through social entropy to measure the concerning uncertainty of underlying field. Each block serves as an independent social system and social entropy determine the optimality criteria. The resulted in distributions of the flow field in respective blocks are accumulated statistically and the flow feature vectors are computed. Second, Support Vector Machines are used to train and classify the flow feature vectors as normal and abnormal. Experiments are conducted on two benchmark datasets PETS 2009 and University of Minnesota to characterize the specific and overall behaviors of crowded scenes. Our experiments show promising results with 95.6% recognition rate for both the normal and abnormal behavior in coherent and incoherent crowded scenes. Additionally, the similar method is tested using flow feature vectors without incorporating social entropy for comparative analysis and the detection results indicate the dominating performance of the proposed approach.

A generic approach for tracking humans and objects under occlusion using semantic analysis is presented. The aim is to exploit knowledge representation schemes, precisely semantic logic where each detected object is represented by a node and the association among the nodes is interpretated as flow paths. Besides, maximum likelihood is computed using our CWHI technique and Bhattacharyya coefficient. These likelihood weights are mapped onto the semantic network to efficiently infer the multiple possibilities of tracking by the manipulation of “propositional logic” at a time window. The logical propositions are built by formularizing facts, semantic rules and constraints associated with tracking. Currently, we are able to handle tracking under normal, occlusion, and split conditions. The experimental results show that the proposed approach enables accurate and reliable tracking by resolving the ambiguities of online data association under occlusions.

This paper proposes a system to recognize isolated American Sign Language and Arabic numbers in real-time from stereo color image sequences using Hidden Markov Models (HMMs). Our system is based on three main stages; preprocessing, feature extraction and classification. In preprocessing stage, color and 3D depth map are used to detect and track the hand. The second stage, 3D combined features of location, orientation and velocity with respected to Cartesian and Polar systems are used. Additionally, k-means clustering is employed for HMMs code-word. In the final stage, the hand gesture path is recognized using Left-Right Banded topology (LRB) in conjunction Viterbi path. Experimental results demonstrate that, our system can successfully recognize isolated hand gestures with 98.33% recognition rate.

beta1 integrin and collagen matrix interactions regulate the survival of cells by associating with focal adhesion kinase (FAK) and initiating MAPK/ERK signalling, but little is known about these signalling pathways during human fetal islet ontogeny. The purpose of this study was to investigate whether beta1 integrin/FAK activation of the MAPK/ERK pathway regulates human fetal islet cell expression of endocrine cell markers and survival. Isolated human (18-21 weeks fetal age) islet-epithelial cell clusters, cultured on collagen I, were examined using beta1 integrin blocking antibody, beta1 integrin siRNA and FAK expression vector. Perturbing beta1 integrin function in the human fetal islet-epithelial cell clusters resulted in a marked decrease in cell adhesion, in parallel with a reduction in the number of cells expressing PDX-1, insulin and glucagon (p0.05). beta1 integrin blockade disorganized focal adhesion contacts in the PDX-1(+) cells and decreased activation of FAK and ERK1/2 signalling in parallel with an increase in expression of cleaved caspases 9 and 3 (p0.01). Similar results were obtained following an siRNA knock-down of beta1 integrin expression. In contrast, over-expression of FAK not only increased phospho-ERK and the expression of PDX-1, insulin and glucagon (p0.05) but also abrogated the decreases in phospho-ERK and PDX-1 by beta1 integrin blockade. This study demonstrates that activation of the FAK/ERK signalling cascade by beta1 integrin is involved in the differentiation and survival of human fetal pancreatic islet cells.

Kalman filtering, a recursive state estimation filter is a robust method for tracking objects. It has been proven that Kalman filter gives a good estimation when tested on various tracking systems. However, unsatisfying tracking results may be produced due to different real-time conditions. These conditions include: inter-object occulusion and separation which are observed when objects are being tracked in real-time. Thus, it is challenging to handle for the classical Kalman filter. In this paper, we proposed an idea of intelligent feature-guided tracking using Kalman filtering. A new method is developed named Correlation-Weighted Histogram Intersection (CWHI), in which correlation weights are applied to Histogram Intersection (HI) method. We focus on multi-object tracking in traffic sequences and our aim is to achieve efficient tracking of multiple moving objects under the confusing situations. The proposed algorithm achieves robust tracking with 97.3% accuracy and 0.07% covariance error in different real-time scenarios.

Robust tracking of multi-objects is still challenging in real scenarios such as crowed scenes. In this paper a novel method in color image sequences is proposed for tracking multiple objects in non-cooperative situations. A system of independent particle filters with an adaptive motion model is used which tracks the moving objects under complex situations. Besides, in order to handle the conflicted situations, an integrated data association technique is exploited which adjusts the particle filters accordingly. Results have shown the good performance of the proposed method on various complex-situation image sequences.

We propose an Online Inferential Framework (OIF) for tracking humans and objects under occlusions with Kalman tracker. The OIF is constructed on knowledge representation schemes, precisely semantic logic where each node represents the detected moving object and flow paths represent the association among the moving objects. A maximum likelihood is computed using our CWHI-based technique and Bhattacharyya coefficient. The proposed framework efficiently interprets multiple possibilities of tracking by manipulating the "propositional logic" on the basis of maximum likelihood at a time window. The logical propositions are built by formularizing facts, semantic rules and integrity constraints associated with tracking. The experimental results show that our novel OIF is able to track objects along with the interpretation of their physical states accurately and reliably under complete occlusion, illustrating its contribution and advantages over various other approaches.

This work proposes new static and dynamic based methods for facial expression recognition in stereo image sequences. Computer vision 3-d techniques are applied to determine real world geometric measures and to build a static geometric feature vector. Optical flow based motion detection is also carried out which delivers the dynamic flow feature vector. Support vector machine classification is used to recognize the expression using geometric feature vector while k-nearest neighbor classification is used for flow feature vector. The proposed method achieves robust feature detection and expression classification besides covering the in/out of plane head rotations and back and forth movements. Further, a wide range of human skin color is exploited in the training and the test samples.

Compound palmer ganglion is an uncommon condition characterized by a swelling in the distal part of volar aspect of wrist and communicating with another swelling over palm across the flexor retinaculum. It commonly results from tuberculous tenosynovitis. It may lead to carpal tunnel syndrome and need surgical excision with division of flexor retinaculum.

In this paper, we investigate the crowd behaviours and localise the anomalies due to individual’s abrupt dissipation. The novelty of proposed approach is described in three aspects. First, we create the spatio-temporal flow-blocks of the video sequence allowing the marginalisation of arbitrarily flow field. Second, the observed flow field in each flow-block is treated as 2D distribution of samples and mixtures of Gaussian is used to parameterise the flow field. These mixtures of Gaussian result in the distinct representation of flow field named as flow patterns for each flow-block. Third, conditional random field is employed to classify the flow patterns as normal and abnormal for each flow-block. Experiments are conducted on two challenging benchmark datasets PETS 2009 and UMN, and results show that our method achieves higher recognition rates in detecting specific and overall crowd behaviours. In addition, proposed approach shows dominating performance during the comparative analysis with similar approaches.

A Kalman filter is a recursive estimator and has widely been used for tracking objects. However, unsatisfying tracking of moving objects is observed under complex situations (i.e. inter-object merge and split) which are challenging for classical Kalman filter. This paper describes a multi-hypothesis framework based on multiple features for tracking the moving objects under complex situations using Kalman Tracker. In this framework, a hypothesis (i.e. merge, split, new) is generated on the basis of contextual association probability which identifies the status of the moving objects in the respective occurrences. The association among the moving objects is computed by multi-featured similarity criteria which include spatial size, color and trajectory. Color similarity probability is computed by the correlation-weighted histogram intersection (CWHI). The similarity probabilities of the size and the trajectory are computed and combined with the fused color correlation. The accumulated association probability results in online hypothesis generation. This hypothesis assists Kalman tracker when complex situations appear in real-time tracking (i.e. traffic surveillance, pedestrian tracking). Our algorithm achieves robust tracking with 97.3% accuracy, and 0.07% covariance error in different real-time scenarios.