Search

Biofloc technology is much highlighted these days because of its tremendous effects on aquaculture. Microbes were enriched on cheapest organic carbon source i. e., powdered banana peels and were incorporated in different aquaria rearing grass carp fingerlings under different C/N treatments (10:1, 15:1 and 20:1) and 10% water daily water exchange. The initial growth of fingerlings was recorded. The experiment was settled in triplicates for 60 days and run parallel to control group provided with commercial feed and daily water exchange. Its effect was evaluated by measuring the growth of fingerlings and water parameters of each aquarium. The average % gain in weight and length of fingerlings was obtained significantly highest (28.12 ± 0.30g and 17.29 ± 0.46cm respectively) in aquaria containing pure powdered banana peels with 10% water exchange and C/N ratio was adjusted at 20: 1 (T3) than other treatments and control. Ammonia and other water parameters were also under control in T3 than other experimental and control groups. By all counts, it was concluded that the highest C/N ratio in biofloc system had the potential to increment C. idella growth rate by reducing toxicity and could be used as fish meal substitute. Resumo A tecnologia Biofloc é muito destacada hoje em dia por causa de seus tremendos efeitos na aquicultura. Os micróbios foram enriquecidos com a fonte de carbono orgânico mais barata, i. e., cascas de banana em pó, e foram incorporadas em diferentes aquários de criação de alevinos de carpa-capim sob diferentes tratamentos C/N (10: 1, 15: 1 e 20: 1) e 10% de troca diária de água. O crescimento inicial dos alevinos foi registrado. O experimento foi resolvido em triplicatas por 60 dias e executado paralelamente ao grupo controle fornecido com ração comercial e troca diária de água. Seu efeito foi avaliado medindo o crescimento dos alevinos e os parâmetros da água de cada aquário. O% de ganho médio em peso e comprimento dos alevinos foi obtido significativamente mais alto (28,12 ± 0,30g e 17,29 ± 0,46 cm respectivamente) em aquários contendo cascas de banana em pó puro com 10% de troca de água e a relação C/N foi ajustada em 20: 1 (T3) do que outros tratamentos e controle. A amônia e outros parâmetros da água também estavam sob controle no T3 mais do que nos outros grupos experimentais e de controle. Por todas as contagens, concluiu-se que a maior razão C/N no sistema de bioflocos tem o potencial de incrementar a taxa de crescimento de C. idella reduzindo a toxicidade e pode ser usada como substituto da farinha de peixe.

Purpose The aim of the present study is to investigate the prognostic significance of nutritional risk factors and sarcopenia on the outcome of patients with recurrent gynaecological malignancies treated by pelvic exenteration. Methods We retrospectively evaluated muscle body composite measurements based on pre-operative CT scans, nutritional risk factors as assessed by a validated pre-operative questionnaire, and clinical–pathological parameters in 65 consecutive patients with recurrent gynaecological malignancies, excluding ovarian cancer, treated by pelvic exenteration at the Royal Marsden Hospital London. Predictive value for postoperative morbidity was investigated by logistic regression analyses. Relevant parameters were included in uni- and multivariate survival analyses. Results We found only (1) low muscle attenuation (MA)—an established factor for muscle depletion—and (2) moderate risk for malnutrition to be independently associated with shorter overall survival (p = 0.006 and p = 0.008, respectively). MA was significantly lower in overweight and obese patients (p = 0.04). Muscle body composite measurements were not predictive for post-operative morbidity. Conclusion The study suggests that pre-operative low MA and moderate risk for malnutrition are associated with shorter survival in patients with recurrent gynaecological malignancies treated with pelvic exenteration. Further studies are needed to validate these findings in larger cohorts.

We present the design, fabrication, and radiation testing of a custom 20-channel application-specific integrated circuit (ASIC) for amplification and digitization of microvolt signal levels from space instrumentation (e.g., thermopile sensors) operating in harsh space radiation environments. The ASIC is fabricated in a commercial 180-nm complementary metal oxide silicon (CMOS) process node using a combination of radiation hard by design and discrete-time analog signal processing to mitigate leakage, offset, 1/ $f$ , and thermal noise. The chip has an input-referred integrated noise voltage of 190 nV in a 240-Hz bandwidth. Irradiation with very high total ionizing dose (TID) and high-energy heavy ions was carried out to evaluate the chip’s radiation hardness. The chip’s postradiation performance evidenced parametric immunity to greater than 50 Mrad (Si) TID and no single-event latch-up up to at least 123.6 MeV-cm2/mg linear energy transfer.

Background: The whole world is facing one of the biggest health related disasters of the century. As a novel disease, Covid-19 has so many parameters yet to explore. Aim: To explore varied pattern of clinical presentation of COVID-19 in obstetric population in tertiary care hospital. Study design: Cross-sectional study. Methodology: This study with enrolled pregnant females (n=36) was carried out after ethical review committee’s (ERC) approval at Department of Gynecology & Obstetrics, Sir Ganga Ram Hospital, Lahore-Pakistan over a period of 3 months in 2020. Data was analyzed by SPSS software, version-20. Presenting symptoms of subjects were presented as frequency and percentage. Results: Total 36 patients were selected. Twenty four (66.66%) patients were symptomatic while the rest 12 (33.33%) patients were asymptomatic. Conclusion: We concluded that clinical presentation of COVID-19 pregnant patients is similar as in rest of the world and it is also same as in general population. Keywords: Covid-19, Pregnant Patients and Clinical Presentation.

Background An integrated structured approach to atrial fibrillation (AF) management is recommended by ESC.1 However, limited data is available on its “real-world” impact on anticoagulation uptake and subsequent AF-related hospitalisation and stroke rates. Purpose To evaluate the long-term impact of the introduction of a community-wide integrated AF service based in a secondary care hospital. Methods In September 2017 we implemented a new integrated pathway for patients with newly diagnosed “symptomatic” atrial arrhythmias across two regions (population 450,000) in England in collaboration with primary care. All patients were seen in a one-stop multi-professional clinic (Arrhythmia nurse and Electrophysiologist with ECG and echocardiogram) within 2 weeks. They underwent standardised screening for modifiable risk factors, counselling regarding diagnosis/ anticoagulation and received an individualised AF management plan as well as access to a nurse-led telephone helpline. We followed up the first 126 consecutive patients for a period of 12 months. Results Baseline characteristics are shown in Table 1, showing a high incidence of modifiable risk factors (previously un-identified in the majority). After review in clinic, 30-day AF-related readmission rates to hospital were low (1.6%, n=2) as compared to historical local data (5.8%). This was sustained at 3 months (4.7%, n=6) and at 12 months (7.9%, n=10). 99% of 83 of eligible patients (CHA2DS2-VASc score of >2 with no major contra-indications) received oral anticoagulation. Over 12 months follow-up, rates of TIA/stroke was low (n=3, 2.4%). All-cause mortality was also low (n=1, 0.8%). NHS England region-wide data showed a marked reduction in percentage of total stroke admissions with history of AF not taking anticoagulation at stroke presentation in 2018/19 as compared to 2017/18 across our two regions; this was lower than the national average and the lowest within West Yorkshire (Figure 1). Conclusions An integrated service for AF management implemented community-wide was associated with high uptake of oral anticoagulation among eligible patients and low rates of AF-related hospitalisations and all-cause mortality. Across the community, among stroke admissions with AF at presentation, a lower percentage of patients without anticoagulation was observed in comparison with previous years and neighbouring regions. Funding Acknowledgement Type of funding sources: None.

Aim Free clinical teaching online delivered by NHS junior doctors to address a drop in face-to-face teaching. Method We created a block-based syllabus of topics that are commonly examined and created an SBA format series of online lectures. The lectures were delivered online and the lectures were carried out by NHS doctors. We delivered 30 continuous lectures in a 30-day period that covered a variety of topics. Each lecture lasted between 45 to 60 minutes and featured real time interactive mcqs which the students had a limited time to answer to simulate exam conditions. We also maintained a unique conference like format where the lecture provider would also be assisted by a ‘host' who would provide an environment that simulated a real-life lecture with a back-and-forth conversation. Lastly each session was reinforced with a feedback survey at the end which helped us improve our service but also provided key indicators on the needs of the audience. Results We were able to provide a series of lectures that on average had a viewership of 120-150 attendees per lecture and grew a social media following of 3500 people. Although the following on social media is not a full reflection of our reach. A good indication is our prescribing safety assessment series which attracted over 2000 people interested and 260 confirmed for one event. Conclusions We feel that the format we followed in delivering medical teaching provided a very effective format and we hope to continue this into the future.

Immune system hypersensitivity is believed to contribute to mental frailty in the elderly. Solid evidence indicates NOD-like receptor pyrin domain containing-3 (NLRP3)-inflammasome activation intimately connects aging-associated chronic inflammation (inflammaging) to senile cognitive decline. Thioredoxin interacting protein (TXNIP), an inducible protein involved in oxidative stress, is essential for NLRP3 inflammasome activity. This study aims to find whether TXNIP/NLRP3 inflammasome pathway is involved in senile dementia. According to our studies on sex-matched mice, TXNIP was significantly upregulated in aged animals, paralleled by the NLRP3-inflammasome over-activity leading to enhanced caspase-1 cleavage and IL-1β maturation, in both sexes. This was closely associated with depletion of the anti-aging and cognition enhancing protein klotho, in aged males. Txnip knockout reversed age-related NLRP3-hyperactivity and enhanced thioredoxin (TRX) levels. Further, TXNIP inhibition along with verapamil replicated TXNIP/NLRP3-inflammasome downregulation in aged animals, with FOXO-1 and mTOR upregulation. These alterations concurred with substantial improvements in both cognitive and sensorimotor abilities. Together, these findings substantiate the pivotal role of TXNIP to drive inflammaging in parallel with klotho depletion and functional decline, and delineate thioredoxin system as a potential target to decelerate senile dementia.

The authors have requested that this preprint be removed from Research Square.

BackgroundGermline TP53 gene pathogenic variants (pv) cause a very high lifetime risk of developing cancer, almost 100% for women and 75% for men. In the UK, annual MRI breast screening is recommended for female TP53 pv carriers. The SIGNIFY study (Magnetic Resonance Imaging screening in Li Fraumeni syndrome: An exploratory whole body MRI) study reported outcomes of whole-body MRI (WB-MRI) in a cohort of 44 TP53 pv carriers and 44 matched population controls. The results supported the use of a baseline WB-MRI screen in all adult TP53 pv carriers. Here we report the acceptability of WB-MRI screening and effects on psychosocial functioning and health-related quality of life in the short and medium terms.MethodsPsychosocial and other assessments were carried out at study enrolment, immediately before MRI, before and after MRI results, and at 12, 26 and 52 weeks’ follow-up.ResultsWB-MRI was found to be acceptable with high levels of satisfaction and low levels of psychological morbidity throughout. Although their mean levels of cancer worry were not high, carriers had significantly more cancer worry at most time-points than controls. They also reported significantly more clinically significant intrusive and avoidant thoughts about cancer than controls at all time-points. There were no clinically significant adverse psychosocial outcomes in either carriers with a history of cancer or in those requiring further investigations.ConclusionWB-MRI screening can be implemented in TP53 pv carriers without adverse psychosocial outcomes in the short and medium terms. A previous cancer diagnosis may predict a better psychosocial outcome. Some carriers seriously underestimate their risk of cancer. Carriers of pv should have access to a clinician to help them develop adaptive strategies to cope with cancer-related concerns and respond to clinically significant depression and/or anxiety.

Objective: We determined the sensitivity and specificity of multiparametric magnetic resonance imaging (MP-MRI) in detection of locally recurrent prostate cancer and extra prostatic extension in the post-radical radiotherapy setting. Histopathological reference standard was whole-mount prostatectomy specimens. We also assessed for any added value of the dynamic contrast enhancement (DCE) sequence in detection and staging of local recurrence. Methods: This was a single centre retrospective study. Participants were selected from a database of males treated with salvage prostatectomy for locally recurrent prostate cancer following radiotherapy. All underwent pre-operative prostate-specific antigen assay, positron emission tomography CT, MP-MRI and transperineal template prostate mapping biopsy prior to salvage prostatectomy. MP-MRI performance was assessed using both Prostate Imaging-Reporting and Data System v. 2 and a modified scoring system for the post-treatment setting. Results: 24 patients were enrolled. Using Prostate Imaging-Reporting and Data System v. 2, sensitivity, specificity, positive predictive value and negative predictive value was 64%, 94%, 98% and 36%. MP-MRI under staged recurrent cancer in 63%. A modified scoring system in which DCE was used as a co-dominant sequence resulted in improved diagnostic sensitivity (61%–76%) following subgroup analysis. Conclusion: Our results show MP-MRI has moderate sensitivity (64%) and high specificity (94%) in detecting radio-recurrent intraprostatic disease, though disease tends to be under quantified and under staged. Greater emphasis on dynamic contrast images in overall scoring can improve diagnostic sensitivity. Advances in knowledge: MP-MRI tends to under quantify and under stage radio-recurrent prostate cancer. DCE has a potentially augmented role in detecting recurrent tumour compared with the de novo setting. This has relevance in the event of any future modified MP-MRI scoring system for the irradiated gland.

The poultry sector is an important and vibrant segment of agriculture in Pakistan with a significant contribution to the national GDP (1.3%). Commercial poultry production in Pakistan started in the 1960's and has been providing a significant portion of daily proteins to the Pakistani population ever since. During its evolution the industry enjoyed promotional policies of the Government, but has faced several challenges such as disease outbreaks and retail price fluctuations. Despite its important role in the country's economy, not a single scientific study is available on its evolutionary history. The data available in this regard are scattered and lack reliability. This review is an effort to encompass the history of the overall growth of the poultry industry in Pakistan, its present status (2012 statistics) and future directions and challenges. This article may serve as the basic source of information on Pakistan's poultry industry achievements. It will also guide poultry experts and policy makers for developing strategic planning for further growth of the industry.

Summary Aims To synthesise the evidence relating influenza and influenza‐like symptoms to the risks of myocardial infarction (MI), heart failure (HF) and stroke. Methods We conducted a systematic review and meta‐analysis of the evidence relating influenza and influenza‐like symptoms to the risks of MI, HF and stroke. We systematically searched all MEDLINE and EMBASE entries up to August 2014 for studies of influenza vs. the cardiovascular outcomes above. We conducted random effects meta‐analysis using inverse variance method for pooled odds ratios (OR) and evaluated statistical heterogeneity using the I 2 statistic. Results We identified 12 studies with a total of 84,003 participants. The pooled OR for risk of MI vs. influenza (serologically confirmed) was 1.27 (95% CI, confidence interval 0.54–2.95), I 2 = 47%, which was significant for the only study that adjusted for confounders (OR 5.50, 95% CI 1.31–23.13). The pooled OR for risk of MI vs. influenza‐like symptoms was 2.17 (95% CI 1.68–2.80), I 2 = 0%, which was significant for both unadjusted (OR 2.23, 95% CI 1.65–3.01, five studies) and adjusted studies (OR 2.01, 95% CI 1.24–3.27, two studies). We found one study that evaluated stroke risk, one study in patients with HF, and one that evaluated mortality from MI – all of these studies suggested increased risks of events with influenza‐like symptoms. Conclusions There is an association between influenza‐like illness and cardiovascular events, but the relationship is less clear with serologically diagnosed influenza. We recommend renewed efforts to apply current clinical guidelines and maximise the uptake of annual influenza immunisation among patients with cardiovascular diseases, to decrease their risks of MI and stroke.

The article of record as published may be found at http://dx.doi.org/10.1785/0220170222 We describe a set of benchmark exercises that are designed to test if computer codes that simulate dynamic earthquake rupture are working as intended. These types of computer codes are often used to understand how earthquakes operate, and they produce simulation results that include earthquake size, amounts of fault slip, and the patterns of ground shaking and crustal deformation. The benchmark exercises examine a range of features that scientists incorporate in their dynamic earthquake rupture simulations. These include implementations of simple or complex fault geometry, off-fault rock response to an earthquake, stress conditions, and a variety of formulations for fault friction. Many of the benchmarks were designed to investigate scientific problems at the forefronts of earthquake physics and strong ground motions research. The exercises are freely available on our website for use by the scientific community. Southern California Earthquake Center (SCEC)

Highlights • Endorectal T2W + DW-MRI is potentially useful for prostate cancer screening. • MRI is specific for detecting prostate cancer in men with increased genetic risk. • Detection of prostate cancer in men at genetically low risk with MRI is limited., Background Diffusion-weighted (DW)-MRI is invaluable in detecting prostate cancer. We determined its sensitivity and specificity and established interobserver agreement for detecting tumour in men with a family history of prostate cancer stratified by genetic risk. Methods 51 men with a family history of prostate cancer underwent T2-W + DW-endorectal MRI at 3.0 T. Presence of tumour was noted at right and left apex, mid and basal prostate sextants by 2 independent observers, 1 experienced and the other inexperienced in endorectal MRI. Sensitivity and specificity against a 10-core sampling technique (lateral and medial cores at each level considered together) in men with >2× population risk based on 71 SNP analysis versus those with lower genetic risk scores was established. Interobserver agreement was determined at a subject level. Results Biopsies indicated cancer in 28 sextants in 13/51 men; 32 of 51 men had twice the population risk (>0.25) based on 71 SNP profiling. Sensitivity/specificity per-subject for patients was 90.0%/86.4% (high-risk) vs. 66.7%/100% (low-risk, observer 1) and 60.0%/86.3% (high-risk) vs. 33.3%/93.8% (low-risk, observer 2) with moderate overall inter-observer agreement (kappa = 0.42). Regional sensitivities/specificities for high-risk vs. low-risk for observer 1 apex 72.2%/100% [33.3%/100%], mid 100%/93.1% [100%/97.3%], base 16.7%/98.3% [0%/100%] and for observer 2 apex 36.4%/98.1% [0%/100%], mid 28.6%/96.5% [100%/100%], base 20%/100% [0%/97.3%] were poorer as they failed to detect multiple lesions. Conclusion Endorectal T2W + DW-MRI at 3.0 T yields high sensitivity and specificity for tumour detection by an experienced observer in screening men with a family history of prostate cancer and increased genetic risk.

Molasses is a significant by-product of sugar industry and can be used as substrate in anaerobic digestion process for biogas production. Molasses was diluted ten time; inoculated by methane producing bacteria, mixed thoroughly in 2 liter batch bioreactor, kept at 370C for 15 days under anaerobic conditions for biogas yield. pH in the process was monitored three times a day. Total solids, volatile solids and COD were measured at alternate days. The gas production was measured by water displacement method. Ten times diluted molasses under anaerobic conditions, in the presence of methane producing bacteria was converted to 6.55 dm3/kg of biogas or 3.93 dm3/kg CH4 and 0.144 kWh electricity. Keywords: Agro industrial waste; Molasses; Methanogen; Anaerobic digestion; Biogas production. © 2014 JSR Publications. ISSN: 2070-0237 (Print); 2070-0245 (Online). All rights reserved. doi: http://dx.doi.org/10.3329/jsr.v6i2.17320 J. Sci. Res. 6 (2), 347-357 (2014)

Aims This report reviews current radiotherapy practice across the UK in the management of lung cancer, and the way new treatments and technologies are being introduced, where improvements have occurred, and where work is still required. We wanted to determine adherence to both National Radiotherapy Advisory Group and National Institute for Health and Clinical Excellence (NICE) guidance. This survey was conducted on behalf of the Department of Health Lung Cancer & Mesothelioma Advisory Group. Materials and methods We sent a questionnaire to all UK radiotherapy departments. It covered radical radiotherapy dose fractionation, the use of concurrent or sequential chemotherapy for both non-small cell and small cell lung cancers, the use of continuous hyperfractionated accelerated radiotherapy, new radiotherapy techniques, the use of positron emission tomography/computed tomography for planning purposes and patient accrual into current National Cancer Research Network UK trials. Results This UK-wide survey of radiotherapy practice for lung cancer showed broad compliance with NICE clinical guidance, but highlighted significant variation in fractionation schedules and the use of concomitant chemoradiotherapy. Clinical trial entry into lung cancer radiotherapy trials was variable and many centres are not fully participating in recruitment into these trials. Conclusions This report has shown the variability of radiotherapy provision nationally. Current practice is largely consistent with current and updated NICE recommendations and best practice and should be recognised as such. It has also highlighted areas where improvements are still needed, particularly fractionation and new technologies. One particular aspect of concern is the poor recruitment to current UK-based clinical trials in lung cancer.

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? This article reviews what is currently known about diffusion weighted MRI (DW-MRI) in prostate cancer. This mini-review concisely summarises, for clinical managing patients with prostate cancer, the clinical utility of diffusion weighted MRI. OBJECTIVE • To review the clinical utility of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with prostate cancer. MATERIAL AND METHODS • The current literature on prostate cancer and DW-MRI was reviewed. RESULTS • DW-MRI can be readily acquired on a modern scanner with a short image acquisition time and no need for i.v. contrast medium. • The image contrast is based on the diffusion of water molecules and thus reflects tissue cellularity. • There is increasing evidence that DW- MRI improves the sensitivity and specificity of prostate cancer detection as well as the identification of tumour aggressiveness. • DW-MRI is also showing substantial promise as a response biomarker for both local and metastatic disease CONCLUSIONS • DW-MRI is proving to be a useful adjunct to conventional T2-weighted MRI sequences. • The eventual role of DW-MRI in combination with other MRI techniques for multiparametric assessment of prostate cancer needs to be defined further.

Resume Objectif Evaluer l’apport d’un logiciel original de reconstruction 3D base sur le principe de la « croissance de region » a partir d’images tomodensitometriques, au diagnostic des malformations des osselets de l’oreille moyenne. Methode Etude prospective sur une population de dix patients presentant une surdite de transmission uni- ou bilaterale. Vingt oreilles ont ete etudiees par scanner multicoupes. Toutes les donnees ont ete traitees par un logiciel original de segmentation d’images basee sur le principe de la « croissance de region ». Les images 3D ont ete comparees avec les coupes originales de scanner afin d’en juger l’apport potentiel a la prise en charge de ces patients. Resultats Toutes les images obtenues ont ete jugees de qualite diagnostique suffisante. Les deux oreilles normales sur les coupes scanner l’etaient egalement sur les vues 3D. Des images scanner typiques d’otospongiose retrouvees chez deux patients n’avaient aucune traduction sur les images 3D. Les 18 malformations ossiculaires ont beneficie d’une bonne analyse sur les images obtenues ; ces dernieres permettant en outre une meilleure visualisation des anomalies et des lesions associees (en particulier les anomalies de position du nerf facial) permettant ainsi un planning operatoire juge de bonne qualite par le chirurgien. Conclusion La methode de reconstruction d’images etudiee, par « croissance de region », nous semble, sur cet echantillon limite, etre un complement utile aux images tomodensitometriques classiques, dans l’etude des anomalies constitutionnelles de l’oreille moyenne.

OBJECTIVE. The objective of this article is to describe recent developments in imaging patients with testicular germ cell tumors (GCTs). CONCLUSION. Most patients with testicular GCTs can now be expected to be cured, so the focus on management moves toward identifying patients who need more aggressive treatment and avoiding long-term complications. CT remains central in the selection of a management strategy, although the roles of MRI and PET continue to evolve.

The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease.

Retrospective analysis in 150 patients with metastatic prostate cancer was conducted to determine whether early detection with MRI spine and treatment of clinically occult spinal cord compromise (SCC) facilitate preservation of neurologic function. Our results suggest that prophylactic radiotherapy for patients with back pain or radiological SCC without neurologic deficit may facilitate preservation of neurologic function. Thus MRI surveillance for SCC may be important for prostate cancer patients with bone metastases.

OBJECTIVE. Metastatic disease occurs in a significant percentage of patients with renal cell carcinoma. Recent advances in systemic therapies for metastatic renal cell carcinoma are likely to have a significant effect on the way patients with advanced disease are imaged. These new therapies have shown a significant increase in progression-free survival. CONCLUSION. Imaging is likely to play an increasing role in the management, diagnosis, and monitoring of response to treatment of metastatic renal cell carcinoma.

Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment have a markedly shortened life expectancy in large part owing to cardiovascular disease (CVD), not explained by established risk factors. We tested the hypothesis that therapy with valsartan, an angiotensin receptor blocker and amlodipine, an antioxidant calcium channel blocker will reduce oxidative stress and the plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. We confirmed that compared with age- and gender-matched healthy controls, ESRD patients have excessive oxidative stress and arginine methylation as indexed by elevated plasma levels of oxidation products of lipids (13-hydroxyoctadecadienoic acid (13-HODE)), thiols (oxidized:reduced glutathione, oxidized glutathione (GSSG):GSH), proteins, and nucleic acids, and the methylation products ADMA and symmetric dimethylarginine (SDMA). We undertook a double blind, crossover study of equi-antihypertensive treatment with amlodipine and valsartan for 6 weeks each to test our hypothesis. Both treatments significantly reduced GSSG:GSH, 8-hydroxy 2-deoxyguanosine, ADMA, and SDMA levels and amlodipine reduced 13-HODE. We conclude that hypertensive patients with ESRD receiving HD have evidence of extensive oxidation of lipids, thiols, proteins, and nucleic acids and methylation of arginine that could contribute to CVD. Many of these changes can be reduced by short-term treatment with amlodipine and valsartan.

Purpose: This study assesses the accuracy of NOMOS B-mode acquisition and targeting system (BAT) compared with computed tomography (CT) in localizing the prostate. Methods and Materials: Twenty-six patients were CT scanned, and the prostate was localized by 3 observers using the BAT system. The BAT couch shift measurements were compared with the CT localization. Six of the patients had gold markers present in the prostate, and the prostate movement determined by BAT was compared with the movement determined by the gold markers. Results: Using the BAT system, the 3 observers determined the prostate position to be a mean of 1-5 mm over all directions with respect to the CT. The proportion of readings with a difference >3 mm between the observers was in the range of 25% to 44%. The prostate movement based on gold markers was an average of 3-5 mm different from that measured by BAT. The literature assessing the accuracy and reproducibility on BAT is summarized and compared with our findings. Conclusions: We have found that there are systematic differences between the BAT-defined prostate position compared with that estimated on CT using gold grain marker seeds.

Background and Aims: Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap. Methodology: In a multicentre prospective study, children aged 1–59 months with auscultatory/audible wheeze and fast breathing and/or lower chest indrawing were screened. Response to up to three cycles of inhaled salbutamol was recorded. The responders were enrolled and sent home on inhaled bronchodilators, and followed up on days 3 and 5. Results: A total of 1622 children with wheeze were screened from May 2001 to April 2002, of which 1004 (61.8%) had WHO defined non-severe and 618 (38.2%) severe pneumonia. Wheeze was audible in only 595 (36.7%) of children. Of 1004 non-severe pneumonia children, 621 (61.8%) responded to up to three cycles of bronchodilator. Of 618 severe pneumonia children, only 166 (26.8%) responded. Among responders, 93 (14.9%) in the non-severe and 63 (37.9%) children in the severe pneumonia group showed subsequent deterioration on follow ups. No family history of wheeze, temperature >100°F, and lower chest indrawing were identified as predictors of subsequent deterioration. Conclusions: Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.

The consumption of vitamins, minerals, herbs and other supplements (VMHS) has grown in popularity over the past several years due to an increase in health and physical appearance awareness within the young population. However, there is very little information about the consumption of VMHS and the possible outcomes on learning performance. A validated questionnaire assessing the frequency and type of supplement use was developed and distributed, after obtaining ethical approval, to 18-22 years old students at De Montfort University (DMU, UK). Students reported the consumption of VMHS and the grades obtained during their last academic year. A total of 110 students (78 female and 32 male) participated in this study. No statistical significant difference was found due to sex and supplement consumption. 46.4% of the participants stated they took supplements sometimes or rarely with students from the Faculty of Business and Law reporting the lowest intake. The most commonly used were: multivitamins/minerals, vitamin C, vitamin D, iron, fish oil and Aloe Vera (Aloe barbadensis). Although most of the students reported some benefits from the consumption of VMHS, no significant relationship between their intake and examination results was seen. However, 50% of students who obtained first class marks (A or 1st) reported that they never used any VMHS. 25% of students, who reported frequent use of any of these substances, obtained very low marks (D or 3rd). Further research to assess the possible impact of supplements on learning should be performed due to the increase rates of consumption and acceptance of use of VMHS.

This paper investigates the leverage effect and switching of market efficiency after the GST imposition on fee-based financial services in Bursa Malaysia and Australian Securities Exchange (ASX). The sample in this paper comprises of public listed companies for the period of one year before and after the GST imposition. GJR-GARCH is employed to evaluate the asymmetry response that is associated with the negative news shocks. To assess the effect of transactional efficiency on the informational efficiency and the structural change of time-varying volatility, SGARCH is adopted. This research reveals the presence of leverage effect in developing and developed market. The GST imposition on fee-based financial services significantly reduces the informational efficiency in Bursa Malaysia, but not in ASX. To boost the tax revenues generated from the financial sector, the policymakers in the developed markets (similar to ASX) should contemplate imposing GST on the fee-based financial services without affecting the stability of the stock market. The investors in thin markets (such as Bursa Malaysia) could forecast the stock returns of the thin market upon GST imposition on fee-based financial services.

Introduction: Assessing the impact of a training programme is important for quality assurance and further development. It also can helps with accountability and marketing purposes. This study evaluated the impact of King's College London (KCL) Master of Science programme in Dental Public Health in terms of graduates' perceived learned skills and professional development. Methods: An online questionnaire was sent to individuals who completed successfully the KCL Master of Science programme in Dental Public Health and had a valid email address. Participants provided information on demographic characteristics, perceived learned skills (intellectual, practical and generic) and professional development (type of organisation, position in the organisation and functions performed at work before and after the programme). Learned skills' scores were compared by demographic factors in multiple linear regression models, and the distribution of responses on career development was compared using nonparametric tests for paired groups. Results: Although all scores on learned skills were on the favourable side of the Likert scale, graduates reported higher scores for practical skills, followed by intellectual and generic skills. No differences in scores were found by sex, age, nationality or time since graduation. In terms of career development, there were significantly higher proportions of graduates working in higher education institutions and taking leadership/managerial roles in organisations as well as greater number and variety of functions at work after than before the programme. Conclusion: This online survey shows that the programme has had a positive impact on graduates in terms of perceived learned skills and professional development.

Background: Blindness and eye disorders represented a problem of major public health concern in Pakistan. Bacterial keratitis (Corneal ulcer) is an inflammatory disease of the cornea caused by bacterial infections. Bacterial keratitis is a significant cause of ocular morbidity that can result in severe visual loss and should be considered a medical emergency. Endophthalmitis is a severe inflammation of the anterior and posterior segments of the eye caused by the introduction of contaminating microorganisms following trauma, surgery, or hematogenous spread from a distant infection site. Methods & Materials: A prospective study was performed to analyze trends in resistance of Keratitis and endophthalmitis causativebacteria to commonlyusedantibiotics and toevaluate the final visual outcomes after therapeutic management. The 397 clinical specimens collected from the infected patients were processed forbacteriological analysis and theantibiogramof the isolates.After specific therapeuticmanagement of these patients, final visual outcomes were evaluated. Results: The isolation of various types of organisms from Bacterial keratitis and Endophthalmitis samples included species of Staphylococci, Streptococci, Diptheroids, Bacillus, Enterococci, Clostridia, Diplococcoids, Pseudomonas, Proteus, Serratia, Haemophilus, Enterobacter, Klebsiella, and yeast and fungi.All isolates were resistant to Cephalosporins, Tobramycin, Gentamycin, andAmikacin. These isolates showed resistance to other drugs such as 80.0% to Chloramphenicol, 73.3%were resistant to Ciprofloxacin, 66.7% to Augmentin, 53.3% to Meropenem, 46.7% to Moxifloxacin, 40% to Sparfloxacin, 40% to Fucidin, and 13.3% to Vancocin. However, all the isolates were found sensitive to Linezolid.During the study, the most commonly used empirical combinations for intravitreal administration were vancomycin and ceftazidime or vancomycin and amikacin. The present study also reported vancomycin, amikacinandceftazidimeas the least resistant antibiotics. Conclusion: The emergence of various bacterial strains resistant to commonly used antibiotics indicates the irrational use of antibiotics in medical practice and the community. The poor visual outcomes of Bacterial keratitis and Endophthalmitis were ascribed to several other factors besides antibiotic resistance.

Bipedicle flaps have been used to provide good quality soft tissue cover for defects in many anatomical sites. The indications for the use of this flap have not been well defined and with the advent of more complex modes of tissue transfer this simple technique is often overlooked. We have found it to be a safe and expedient method of providing cover for difficult defects on the extremities. We present a series of 9 flaps raised on 7 patients over a 12-month period and discuss the indications and refinements in flap design.

Temperature and resuscitation profiles of 15 non-survivors were compared with matched survivors of major burns. All patients were intubated and ventilated for smoke inhalation injury, survived more than 3 days postburn and had a cutaneous burn greater than 15 per cent of the body surface area (mean 32.3 +/- 11.0 per cent SD). Cases were matched for similar ages (within 10 years) and total body surface area burn (within 10 per cent). The rate of core temperature rise following admission to the burn unit was significantly greater in survivors (mean 0.46 +/0 0.18 degree C/h) compared with matched non-survivors (mean 0.30 +/- 0.15 degrees C/h; p0.01). Core temperature increased at a rate of 0.27 degrees C/h or greater in all survivors, whereas 7 non-survivors raised their core temperature at a rate less than this. The rate of skin temperature rise was also significantly greater in the survivors (mean 1.35 +/- 0.91 degrees C/h) compared with matched non-survivors (mean 0.63 +/- 0.43 degrees C/h, p0.01). In 13/15 survivors, the skin temperature increased at a rate of 0.6 degree C/h or greater, whereas in 8/15 non-survivors skin temperature increased at a rate less than this. There was a negative relationship between initial core temperature and delay from time of burn to admission to the burns unit in non-survivors (correlation coefficient = -0.92; p0.01), whereas there was no effect of delay in the survivors. These findings suggest that patients with a high mortality probability can be detected early in their clinical course by means of temperature profiles.