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SUMMARY Adipose-derived stem cell therapy offers plastic surgeons a novel treatment alternative for conditions with few therapeutic options. Adipose-derived stem cells are a promising treatment because of their broad differentiation potential, capacity for self-renewal, and ease of isolation. Over the past decade, plastic surgeons have attempted to harness adipose-derived stem cells' unique cellular characteristics to improve the survival of traditional fat grafting procedures, a process known as cell-assisted lipotransfer. However, the full implications of cell-assisted lipotransfer in clinical practice remain incompletely understood, stressing the urgent need to assess the scientific evidence supporting adipose-derived stem cell-based interventions. Furthermore, with the strict regulatory climate surrounding tissue explantation therapies, reviewing the safety and efficacy of these treatments will clarify their regulatory viability moving forward. In this report, the authors provide a comprehensive, up-to-date appraisal of best evidence-based practices supporting adipose-derived stem cell-derived therapies, highlighting the known mechanisms behind current clinical applications in tissue engineering and regenerative medicine specific to plastic and reconstructive surgery. The authors outline best practices for the harvest and isolation of adipose-derived stem cells and discuss why procedure standardization will elucidate the scientific bases for their broad use. Finally, the authors discuss challenges posed by U.S. Food and Drug Administration oversight of these cell-based therapies and examine the role of adipose-derived stem cell-based applications in the future of plastic surgery.

Travelling day to day became integrated part of everyone. To travel we use different types of vehicles. A machine is not for a life time and with day to day usage and time-tested in various conditions, it is meant to witness some kind of breakdowns. Many breakdowns can be resolved on the spot by self-repairing. A lot of people are facing difficulties getting help when their Vehicle breaks down on the road. These problems are the motivations for the development of this project to help those who are in need when their Vehicle breaks down along the roads. The objective is to develop an django application that will help the user to avail help by using the application and get access to the nearby mechanic and thereby contact them.

Vipādika is a common disorder of skin which affects the people irrespective of age and sex. Due to its severity and chronicity it hampers the daily activities of an individual. The main symptom for Vipādika is Daranam (crack) which presents along with Kandu (itching), Vedana (pain). Objective: A clinical study was conducted to evaluate the effect of Chitrakadi lepa with Punarnavadi kashaya in Vipadika. Materials and method: The study design is interventional study-pre and post-test with a sample size of 15 patients with signs and symptoms of Vipādika belonging to age group 20-60 years, attending the OPD of Agadatantra department, Govt. Ayurveda College, Thiruvananthapuram were selected. Patients on corticosteroids, pregnant and lactating woman are excluded. Before intervention, 25gm of Avipathy choornam was given for Anulomana. The study group was given Punaṙnavādi kaṣaya (48ml) internally twice daily half an hour before food and Chitṙakādi lepa mixed with Gritha and Tila taila was applied externally twice daily for 30 days. After completion of treatment, a follow up period of 15 days was advised. Symptomatic assessment was done before the treatment, 15th day, after the treatment (31st day) and after follow up period 45th day. The outcome variables like no. of crack, pain, itching, and nature of crack were assessed. Results and Discussion: Result was analysed statistically using non parametric statistical test - Freidmans test with Dunnets multiple comparison test (post-hoc). The result obtained was highly significant in relieving the cardinal symptoms of Vipādika especially pain.

Background Lipoplasty has undergone a series of refinements since its inception. It is now possible to apply superficial suction to enhance the outline of a muscle in order to improve the results of aesthetic lipoplasty. Objectives The aim of this study was to summarize the available evidence on the techniques and surgical outcomes of high-definition lipoplasty (HDL) in male patients. Methods A systematic search across PubMed MEDLINE, Web of Science, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and SCOPUS was performed in accordance with the PRISMA guidelines. Data regarding the surgical techniques, outcomes, and complications were extracted. Results Thirteen studies comprising 1280 patients fulfilled the inclusion criteria. The age of patients ranged from 18 to 71 years. The average BMI was 26.5 kg/m2. The follow-up ranged from 2 weeks to 10 years. The liposculpting concepts reported were abdominal etching, high-definition, muscular sculpture, and dynamic definition. Four studies used conventional liposuction, 3 used VASER-assisted HDL, and 6 studies used power-assisted liposculpting. Eight studies reported the use of fat grafting. All studies reported the use of postoperative garments and a well-established wound treatment protocol. Overall satisfaction ranged from 84% to 100%. The most common complications reported were fluid collection, hyperpigmentation, contour irregularities, anemia, and port dehiscence. Conclusions A wide variety of techniques are available to perform HDL with a variable degree of definition. Careful patient selection is critical for successful results because HDL is not suitable for every patient. Finally, proper training and adequate knowledge of abdominal anatomy is necessary to avoid complications. Level of Evidence: 4

Objective To estimate the burden of active infection and anti-SARS-CoV-2 IgG antibodies in Karnataka, India, and to assess variation across geographical regions and risk groups. Methods A cross-sectional survey of 16,416 people covering three risk groups was conducted between 3–16 September 2020 using the state of Karnataka’s infrastructure of 290 healthcare facilities across all 30 districts. Participants were further classified into risk subgroups and sampled using stratified sampling. All participants were subjected to simultaneous detection of SARS-CoV-2 IgG using a commercial ELISA kit, SARS-CoV-2 antigen using a rapid antigen detection test (RAT) and reverse transcription-polymerase chain reaction (RT-PCR) for RNA detection. Maximum-likelihood estimation was used for joint estimation of the adjusted IgG, active and total prevalence (either IgG or active or both), while multinomial regression identified predictors. Results The overall adjusted total prevalence of COVID-19 in Karnataka was 27.7% (95% CI 26.1–29.3), IgG 16.8% (15.5–18.1) and active infection fraction 12.6% (11.5–13.8). The case-to-infection ratio was 1:40 and the infection fatality rate was 0.05%. Influenza-like symptoms or contact with a COVID-19-positive patient were good predictors of active infection. RAT kits had higher sensitivity (68%) in symptomatic people compared with 47% in asymptomatic people. Conclusion This sentinel-based population survey was the first comprehensive survey in India to provide accurate estimates of the COVID-19 burden. The findings provide a reasonable approximation of the population immunity threshold levels. Using existing surveillance platforms coupled with a syndromic approach and sampling framework enabled this model to be replicable.

Hypercalcemia of malignancy (HCM) can present secondary to hypersecretion of parathyroid hormone (PTH)-related protein (PTHrP) from malignant tumors, but rare cases of HCM have also been documented due to inappropriate PTH secretion from ectopic neoplasms. Here, we report an unusual case of HCM due to hypersecretion of PTH suspected secondary to a disseminated mucinous ovarian adenocarcinoma. A 45-year-old female presented with severe hypercalcemia and significant elevations in both PTH and PTHrP two weeks after total abdominal hysterectomy with bilateral salpingo-oophorectomy and suboptimal debulking of a newly discovered left ovarian mucinous adenocarcinoma with numerous metastases. Ectopic PTH secretion was highly suspected after a negative parathyroid ultrasound. Pamidronate, calcitonin, and fluid resuscitation were unable to normalize her serum calcium, resulting in the need for dialysis and subsequent continuous renal replacement therapy. Further intervention with denosumab, etelcalcetide, and cinacalcet was attempted. Serum calcium began to decline, but repeat PTH resulted greater than 2,500 pg/mL. Unfortunately, the patient died just one week into her hospital course from septic shock and multi-organ system failure. While patients with localized PTH-secreting tumors carry a good prognosis, disseminated malignancies can result in significant morbidity and mortality due to severe treatment-resistant hypercalcemia.

Objective The aim of this study was to examine the relationship between changes in liver fat and changes in insulin sensitivity and β-cell function 2 years after gastric banding surgery. Methods Data included 23 adults with the surgery who had prediabetes or type 2 diabetes for less than 1 year and BMI 30 to 40 kg/m2 at baseline. Body adiposity measures including liver fat content (LFC), insulin sensitivity (M/I), and β-cell responses (acute, steady-state, and arginine-stimulated maximum C-peptide) were assessed at baseline and 2 years after surgery. Regression models were used to assess associations adjusted for age and sex. Results Two years after surgery, all measures of body adiposity, LFC, fasting and 2-hour glucose, and hemoglobin A1c significantly decreased; M/I significantly increased; and β-cell responses adjusted for M/I did not change significantly. Among adiposity measures, reduction in LFC had the strongest association with M/I increase (r = -0.61, P = 0.003). Among β-cell measures, change in LFC was associated with change in acute C-peptide response to arginine at maximal glycemic potentiation adjusted for M/I (r = 0.66, P = 0.007). Significant reductions in glycemic measures and increase in M/I were observed in individuals with LFC loss >2.5%. Conclusions Reduction in LFC after gastric banding surgery appears to be an important factor associated with long-term improvements in insulin sensitivity and glycemic profiles in adults with obesity and prediabetes or early type 2 diabetes.

PURPOSE To develop and evaluate an efficient precontrast T1 mapping technique suitable for quantitative high-resolution whole-brain dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI). METHODS Variable flip angle (VFA) T1 mapping was considered that provides 1 × 1 × 2 mm3 resolution to match a recent high-resolution whole-brain DCE-MRI protocol. Seven FAs were logarithmically spaced from 1.5° to 15°. T1 and M0 maps were estimated using model-based reconstruction. This approach was evaluated using an anatomically realistic brain tumor digital reference object (DRO) with noise-mimicking 3T neuroimaging and fully sampled data acquired from one healthy volunteer. Methods were also applied on fourfold prospectively undersampled VFA data from 13 patients with high-grade gliomas. RESULTS T1 -mapping precision decreased with undersampling factor R, althoughwhereas bias remained small before a critical R. In the noiseless DRO, T1 bias was

The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.

Purpose To mitigate a common artifact in spiral real-time MRI, caused by aliasing of signal outside the desired FOV. This artifact frequently occurs in midsagittal speech real-time MRI. Methods Simulations were performed to determine the likely origin of the artifact. Two methods to mitigate the artifact are proposed. The first approach, denoted as "large FOV" (LF), keeps an FOV that is large enough to include the artifact signal source during reconstruction. The second approach, denoted as "estimation-subtraction" (ES), estimates the artifact signal source before subtracting a synthetic signal representing that source in multicoil k-space raw data. Twenty-five midsagittal speech-production real-time MRI data sets were used to evaluate both of the proposed methods. Reconstructions without and with corrections were evaluated by two expert readers using a 5-level Likert scale assessing artifact severity. Reconstruction time was also compared. Results The origin of the artifact was found to be a combination of gradient nonlinearity and imperfect anti-aliasing in spiral sampling. The LF and ES methods were both able to substantially reduce the artifact, with an averaged qualitative score improvement of 1.25 and 1.35 Likert levels for LF correction and ES correction, respectively. Average reconstruction time without correction, with LF correction, and with ES correction were 160.69 ± 1.56, 526.43 ± 5.17, and 171.47 ± 1.71 ms/frame. Conclusion Both proposed methods were able to reduce the spiral aliasing artifacts, with the ES-reduction method being more effective and more time efficient.

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; PP=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

Purpose We propose and evaluate a new structured low-rank method for echo-planar imaging (EPI) ghost correction called Robust Autocalibrated LORAKS (RAC-LORAKS). The method can be used to suppress EPI ghosts arising from the differences between different readout gradient polarities and/or the differences between different shots. It does not require conventional EPI navigator signals, and is robust to imperfect autocalibration data. Methods Autocalibrated LORAKS is a previous structured low-rank method for EPI ghost correction that uses GRAPPA-type autocalibration data to enable high-quality ghost correction. This method works well when the autocalibration data are pristine, but performance degrades substantially when the autocalibration information is imperfect. RAC-LORAKS generalizes Autocalibrated LORAKS in two ways. First, it does not completely trust the information from autocalibration data, and instead considers the autocalibration and EPI data simultaneously when estimating low-rank matrix structure. Second, it uses complementary information from the autocalibration data to improve EPI reconstruction in a multi-contrast joint reconstruction framework. RAC-LORAKS is evaluated using simulations and in vivo data, including comparisons to state-of-the-art methods. Results RAC-LORAKS is demonstrated to have good ghost elimination performance compared to state-of-the-art methods in several complicated EPI acquisition scenarios (including gradient-echo brain imaging, diffusion-encoded brain imaging, and cardiac imaging). Conclusions RAC-LORAKS provides effective suppression of EPI ghosts and is robust to imperfect autocalibration data.

Introduction: Psoriasis is a chronic disorder with certain systemic compounds. It has been associated with increase in morbidity and mortality from cardiovascular events especially in chronic cases. Aims and Objectives: To compare the levels of CRP, S.ADA and S. Lipid profile among psoriatic patients and controls. Materials and Methods: This is a cross sectional case control study conducted in department of dermatology for a period of 6 months in a teaching institute of Gujarat. Cases included patients of psoriasis attending skin OPD. Controls were taken from health check-up scheme of our hospital with minimal confounding factor. CRP, S.ADA and S. Lipid profile were assessed in both groups. Statistical Analysis: We applied Unpaired T- test for statistical analysis and p value Results: Patient and control group consisted of 25 subjects each. Serum CRP, serum cholesterol and serum TG levels were found to be more significantly elevated in cases when compared to controls with p-value (by unpaired t test) of 0.001, 0.026 and 0.044 respectively. Serum ADA, LDL, VLDL was high among cases when compared to controls but were not statistically significant. (p>0.05). Conclusion: patients of psoriasis have to be evaluated for risk factors of atherosclerosis like Serum lipid profile, CRP. Keywords: Psoriasis, CRP, ADA, Lipid profile.

BACKGROUND AND PURPOSE: Accurate determination of glioma grade leads to improved treatment planning. The criterion standard for glioma grading is invasive tissue sampling. Recently, radiomic features have shown excellent potential in glioma-grade prediction. These features may not fully exploit the underlying information in MR images. The objective of this study was to investigate the performance of features learned by a convolutional neural network compared with standard radiomic features for grade prediction. MATERIALS AND METHODS: A total of 237 patients with gliomas were included in this study. All images were resampled, registered, skull-stripped, and segmented to extract the tumors. The learned features from the trained convolutional neural network were used for grade prediction. The performance of the proposed method was compared with standard machine learning approaches, support vector machine, random forests, and gradient boosting trained with radiomic features. RESULTS: The experimental results demonstrate that using learned features extracted from the convolutional neural network achieves an average accuracy of 87%, outperforming the methods considering radiomic features alone. The top-performing machine learning model is gradient boosting with an average accuracy of 64%. Thus, there is a 23% improvement in accuracy, and it is an efficient technique for grade prediction. CONCLUSIONS: Convolutional neural networks are able to learn discriminating features automatically, and these features provide added value for grading gliomas. The proposed framework may provide substantial improvement in glioma-grade prediction; however, further validation is needed.

Real-time magnetic resonance imaging (RT-MRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fast-switching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steady-state free precession, and single-shot rapid acquisition with relaxation enhancement. RT-MRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of soft-tissue contrast, as well as flow information. In this review, we discuss the history of RT-MRI, fundamental tradeoffs, enabling technology, established applications, and current trends. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 1.

Background Aesthetic augmentation phalloplasty is a set of procedures aimed at increasing penile length and/or girth; many of these procedures are investigational. This systematic review set out to summarize available literature on these procedures in patients with normal penile anatomy. Methods A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE/PubMed, Scopus, and Cochrane Databases were used to identify articles on aesthetic augmentation phalloplasty in cis-gender men without penile deformity from 1990 to 2018. Data on outcomes, complications, and patient-reported satisfaction were collected. Results Sixteen articles, involving 1192 patients, met our inclusion criteria. Mean age ranged from 23 to 44 years, and follow-up time ranged from 6 to 48 months. The quality of the studies was poor regarding methodology for patient selection and outcomes reporting. Surgical interventions included suspensory ligament incision, grafting, flaps, and penile disassembly. Augmentation was performed for length only in 16 percent of patients, girth only in 70.6 percent, and combined in 13.4 percent. Length gain ranged from 8 to 83 percent in the flaccid state and 12 to 53 percent in the erect state. Girth gain ranged from 16 to 56 percent in the flaccid state and 19 to 30 percent in the erect state. The pooled complication rate was 14.6 percent, with those undergoing combined augmentation having the highest complication rate. Patients were generally satisfied; reported satisfaction rates ranged from 50 to 100 percent. Conclusions Enhancement procedures are controversial and investigational. Data point to inconsistent methodology when reporting penile dimensions, outcomes, and patient satisfaction. Despite the reportedly high satisfaction rates, patients should be counseled regarding high complication rates. Best-practice guidelines will be critical to achieve safe and reliable outcomes.

We conducted a randomized phase III trial to evaluate whether adjuvant pembrolizumab for one year (647 patients) improved recurrence-free survival (RFS) or overall survival (OS) in comparison with high-dose IFNα-2b for one year or ipilimumab for up to three years (654 patients), the approved standard-of-care adjuvant immunotherapies at the time of enrollment for patients with high-risk resected melanoma. At a median follow-up of 47.5 months, pembrolizumab was associated with significantly longer RFS than prior standard-of-care adjuvant immunotherapies [HR, 0.77; 99.62% confidence interval (CI), 0.59–0.99; P = 0.002]. There was no statistically significant association with OS among all patients (HR, 0.82; 96.3% CI, 0.61–1.09; P = 0.15). Proportions of treatment-related adverse events of grades 3 to 5 were 19.5% with pembrolizumab, 71.2% with IFNα-2b, and 49.2% with ipilimumab. Therefore, adjuvant pembrolizumab significantly improved RFS but not OS compared with the prior standard-of-care immunotherapies for patients with high-risk resected melanoma. Significance: Adjuvant PD-1 blockade therapy decreases the rates of recurrence, but not survival, in patients with surgically resectable melanoma, substituting the prior standard-of-care immunotherapies for this cancer. See related commentary by Smithy and Shoushtari, p. 599. This article is highlighted in the In This Issue feature, p. 587

Introduction: Obstructive sleep apnea syndrome (OSAS), a common but under-recognized sleep-related breathing disorder (SRBD) which is associated with significant morbidity and increased mortality. The aim of this study done in South Kerala was to assess the clinical profile and comorbidities of patients with moderate to severe form of OSAS. Materials and Methods: Patients included in the study were from a speciality sleep clinic and had symptoms of OSAS or risk factors for significant sleep apnea. They underwent a supervised polysomnography (PSG) with a portable equipment at home after history taking, relevant clinical evaluation, and pre-requisite workup. Results: One hundred and forty patients were included in the study and 87.9% (123) of the patients were detected to have moderate or severe OSAS (Apnea Hypopnea Index AHI>15 episodes/hour), 81 % (100) of these patients with significant ( moderate or severe) sleep apnea were males having a mean age of 47.9 years, mean body mass index of 33.6 kg/m2and an average neck circumference of 41.2 cm. 80% of patients with moderate to severe OSAS were between the ages of 31-60 years.61.7% and 41% of patients with significant OSAS had hypertension and diabetes respectively. Body mass index and neck circumference had a direct correlation with the severity of OSAS. Statistical analysis: The data was analysed using SPSS 20.0. The factors and co-morbidities associated with OSAS were analysed using Chi-square tests and Independent Sample t-tests. Pearson’s correlation coefficient and a linear regression model was made to find out the possible predictors for AHI Scores and a p value of less than 0.05 was taken as significant. Conclusion: Our study on the clinical profile of patients with obstructive sleep apnea syndrome from a centre in South Kerala shows male predilection, frequent association with obesity and cardiovascular comorbidities such as hypertension and diabetes. Keywords: Obstructive sleep apnea syndr

Background Autologous breast reconstruction (ABR) has grown in popularity due to improved aesthetic and long-term patient reported outcomes, but data regarding sensory reinnervation of autologous flaps remain limited. Traditionally, the lateral cutaneous branch of the fourth intercostal nerve has been used for flap neurotization, but the use of the anterior cutaneous branch of the intercostal nerves (ACB) offer a more optimal location to the microsurgical field when using internal mammary vessels for the microanastomosis. This study aimed to evaluate the optimum ACB recipient site level for sensory nerve coaptation in ABR. Methods Twelve hemi-chests were dissected from six fresh cadaveric females. Costal cartilages were removed and the anterior cutaneous intercostal nerve (ACB) and the lateral (subcutaneous) division of the anterior cutaneous branch (LACB) of the intercostal nerve were exposed. Anatomical measurements were recorded, and nerve samples were evaluated histologically with carbonic anhydrase staining to differentiate sensory fascicles. Assessment of fascicular diameter, axonal counts, and fascicular area were compared. Results A total of 75 nerve specimens were assessed. The ACB was identified at all levels (100%) and the subcutaneous LACB was noted consistently in the second to fourth rib space (96% cadavers), with a median length of 43, 37.5, and 37 mm, respectively. Across all rib spaces, the fascicular and axonal counts were comparable between the LACB and ACB. Nerves in the second intercostal space had a significantly larger mean fascicular area mean (112,816 ± 157,120 µm2) compared with that in the fourth (mean 26,474 ± 38,626 µm2), p = 0.03. Axonal count of sensory fascicles was the highest in the second intercostal nerves (p Conclusion This study provides anatomical and histological basis to determine the optimum recipient site choice for sensory coaptation in microsurgical breast reconstruction. This would aid in operative decision-making regarding the ideal recipient anterior cutaneous intercostal nerve branches for recipient site coaptation in ABR.

The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.

Purpose Recent years have seen a technological change, Industry 4.0, in the manufacturing industry. Human–robot cooperation, a new application, is increasing and facilitating collaboration without fences, cages or any kind of separation. The purpose of the paper is to review mainstream academic publications to evaluate the current status of human–robot cooperation and identify potential areas of further research. Design/methodology/approach A systematic literature review is offered that searches, appraises, synthetizes and analyses relevant works. Findings The authors report the prevailing status of human–robot collaboration, human factors, complexity/ programming, safety, collision avoidance, instructing the robot system and other aspects of human–robot collaboration. Practical implications This paper identifies new directions and potential research in practice of human–robot collaboration, such as measuring the degree of collaboration, integrating human–robot cooperation into teamwork theories, effective functional relocation of the robot and product design for human robot collaboration. Originality/value This paper will be useful for three cohorts of readers, namely, the manufacturers who require a baseline for development and deployment of robots; users of robots-seeking manufacturing advantage and researchers looking for new directions for further exploration of human–machine collaboration.

Tumor lysis syndrome (TLS) is an oncological emergency characterized by a classic tetrad of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Risk assessment and prophylactic therapy is critical in preventing this oncological emergency. Treatment of established TLS involves aggressive hydration, electrolyte management, and the use of hypouricemic agents.

Production management teams often face unfamiliar situations where each team member must understand new phenomena individually before the team can make mutually understandable and acceptable decisi...

Objective To demonstrate that human visual illusion can contribute to sub-endocardial dark rim artifact in contrast-enhanced myocardial perfusion magnetic resonance images. Materials and methods Numerical phantoms were generated to simulate the first-passage of contrast agent in the heart, and rendered in conventional gray scale as well as in color scale with reduced luminance variation. Cardiac perfusion images were acquired from two healthy volunteers, and were displayed by the same gray and color scales used in the numerical study. Before and after k-space windowing, the left ventricle (LV)-myocardium boarders were analyzed visually and quantitatively through intensity profiles perpendicular the boarders. Results k-space windowing yielded monotonically decreasing signal intensity near the LV-myocardium boarder in the phantom images, as confirmed by negative finite difference values near the board ranging -1.07 to -0.14. However, the dark band still appears, which is perceived by visual illusion. Dark rim is perceived in the in-vivo images after k-space windowing that removed the quantitative signal dip, suggesting that the perceived dark rim is a visual illusion. The perceived dark rim is stronger at peak LV enhancement than the peak myocardial enhancement, due to the larger intensity difference between LV and myocardium. In both numerical phantom and in-vivo images, the illusory dark band is not visible in the color map due to reduced luminance variation. Conclusion Visual illusion is another potential cause of dark rim artifact in contrast-enhanced myocardial perfusion MRI as demonstrated by illusory rim perceived in the absence of quantitative intensity undershoot.

Autologous fat grafting is a dynamic modality used in plastic surgery as an adjunct to improve functional and aesthetic form. However, current practices in fat grafting for soft-tissue augmentation are plagued by tremendous variability in long-term graft retention, resulting in suboptimal outcomes and repetitive procedures. This systematic review identifies and critically appraises the evidence for various enrichment strategies that can be used to augment and improve the viability of fat grafts.A comprehensive literature search of the Medline and PubMed databases was conducted for animal and human studies published through October of 2017 with multiple search terms related to adipose graft enrichment agents encompassing growth factors, platelet-rich plasma, adipose-derived and bone marrow stem cells, gene therapy, tissue engineering, and other strategies. Data on level of evidence, techniques, complications, and outcomes were collected.A total of 1382 articles were identified, of which 147 met inclusion criteria. The majority of enrichment strategies demonstrated positive benefit for fat graft survival, particularly with growth factors and adipose-derived stem cell enrichment. Platelet-rich plasma and adipose-derived stem cells had the strongest evidence to support efficacy in human studies and may demonstrate a dose-dependent effect.Improved understanding of enrichment strategies contributing to fat graft survival can help to optimize safety and outcomes. Controlled clinical studies are lacking, and future studies should examine factors influencing graft survival through controlled clinical trials in order to establish safety and to obtain consistent outcomes.

INTRODUCTION Autologous fat grafting (AFG) is a popular and effective method of breast reconstruction after mastectomy; however, the oncological safety of AFG remains in question. The aim of this study was to determine whether AFG increases the risk of cancer recurrence in the reconstructed breast. METHODS A matched, case-control study was conducted from 2000 to 2017 at the senior author's institution. Inclusion was limited to female patients who underwent mastectomy and breast reconstruction with or without AFG. Data were further subdivided at the breast level. χ analyses were used to test the association between AFG status and oncologic recurrence. A Cox proportional-hazards model was constructed to assess for possible differences in time to oncologic recurrence. The probability of recurrence was determined by Kaplan-Meier analyses and confirmed with log-rank testing. RESULTS Overall, 428 breasts met study criteria. Of those, 116 breasts (27.1%) received AFG, whereas 312 (72.9%) did not. No differences in the rates of oncologic recurrence were found between the groups (8.2% vs 9.0%, P < 1.000). Unadjusted (hazard ratio = 1.03, confidence interval = 0.41-2.60, P < 0.957) and adjusted hazard models showed no statistically significant increase in time to oncologic recurrence when comparing AFG to non-AFG. In addition, no statistical differences in disease-free survival were found (P = 0.96 by log rank test). CONCLUSION Autologous fat grafting for breast reconstruction is oncologically safe and does not increase the likelihood of oncologic recurrence. Larger studies (eg, meta analyses) with longer follow-up are needed to further elucidate the long-term safety of AFG as a reconstructive adjunct.

A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA. To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.

Summary Background Publication of research in highly regarded journals is a laborious journey that requires a considerable amount of effort and time. The objective of this article is to obtain insight into the time required for articles to be accepted and published in the top six plastic surgery journals and to study the effects of article characteristics on their publication time. Methods A comprehensive review of all articles published by six scientific plastic surgery journals during a one-year period (2018) was performed. Time taken from submission to acceptance, online, and in-print publication was abstracted and analyzed. Results A total of 1141 articles were reviewed. The median total time (TT) from submission to in-print publication was 10.3 months (IQR 8–12.6), with a median time of 4.6 months (3–6.8) from submission to acceptance and 5.4 months (4.2–6.3) from acceptance to publication. TT varied among journals, ranging from 7.2 months for Aesthetic Plastic Surgery to 16.1 months for Microsurgery. The articles were available online after a median of 21 days from their acceptance date. When comparing our results to publication times in 2005, most journals showed a decrease in their total publication time. Conclusion Our study highlights the time taken for publication and the differences between plastic surgery journals and study characteristics. Most journals have demonstrated a quicker turnaround time during the last 13 years. Online publication has greatly decreased the time between acceptance and in-print publication. We advocate for improving certain areas of this timeline, but this improvement should not be at the expense of review quality.

Background: Abfraction is a loss of tooth structure along the gingival margin and manifests with different clinical appearances. It has multifactorial etiology and may occur due to normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The theory behind the abfraction is that the tooth flexure in the cervical area is caused due to occlusal compressive forces and tensile stresses. This results in the fractures in the hydroxyapatite (HA) crystals. It is also caused by the low packing density of the Hunter–Schreger band (HSB) at the cervical area. Unfortunately, there is a lack of evidence regarding the outcome of abfraction with or without intervention. The aim of this review is to collect clinical information from the literature and discuss the etiology, pathogenesis, clinical representation, and management. Also, search databases for clinical studies that describe the role of sclerotic dentine in non-carious cervical lesions (NCCLs) are becoming a clinical challenge. Methods: The literature was searched that described the etiology, pathogenesis, clinical representation, and management of the abfraction lesions. Also, a specific question regarding the formation of sclerotic dentin in the NCCL lesion was described and searched for evidence that challenges etching, bonding, and successfully restoring NCCLs. The databases PUBMED, SCOPUS, MEDLINE, WEB of SCIENCE, and EMBASE were searched using the key terms. The inclusion criteria were the randomized controlled clinical trial, cohort studies, and cross-sectional studies that aimed at determining the role of sclerotic dentine in NCCLs and its effect on etching, bonding. Results: One clinical study was retrieved according to the PRISMA flowchart and PICO format. The longer etching time, total-etch adhesive system, and EDTA pre-treatment of the sclerotic dentin of cervical wedge-shaped defects could improve the bonding strength in lesions like NCCL's. Conclusion: In conclusion, clinical challenges that occur due to NCCLs are better managed by a proper understanding of factors like etiopathogenesis, ultra-structure of enamel, and dentine and their effect on the bonding of restorations of the tooth.

Objectives To evaluate a novel method for real-time tagged MRI with increased tag persistence using phase sensitive tagging (REALTAG), demonstrated for speech imaging. Methods Tagging is applied as a brief interruption to a continuous real-time spiral acquisition. REALTAG is implemented using a total tagging flip angle of 180° and a novel frame-by-frame phase sensitive reconstruction to remove smooth background phase while preserving the sign of the tag lines. Tag contrast-to-noise ratio of REALTAG and conventional tagging (total flip angle of 90°) is simulated and evaluated in vivo. The ability to extend tag persistence is tested during the production of vowel-to-vowel transitions by American English speakers. Results REALTAG resulted in a doubling of contrast-to-noise ratio at each time point and increased tag persistence by more than 1.9-fold. The tag persistence was 1150 ms with contrast-to-noise ratio >6 at 1.5T, providing 2 mm in-plane resolution, 179 frames/s, with 72.6 ms temporal window width, and phase sensitive reconstruction. The new imaging window is able to capture internal tongue deformation over word-to-word transitions in natural speech production. Conclusion Tag persistence is substantially increased in intermittently tagged real-time MRI by using the improved REALTAG method. This makes it possible to capture longer motion patterns in the tongue, such as cross-word vowel-to-vowel transitions, and provides a powerful new window to study tongue biomechanics.

Introduction Although an infrequent cause of small penile size in adult men, acquired penile shortening represents a particular reconstructive challenge due to preexisting penile anatomic deformities. Aim With numerous techniques being performed, the purpose of our study is to assess available literature on length enhancement procedures used for acquired penile shortening deformities. Methods A systematic review was performed using the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-analyses. Medline/PubMed, Scopus, and Cochrane Databases were used to identify papers on augmentation Phalloplasty in non-transgender males with acquired penile shortening from 1990 to 2018. Main Outcome Measure Outcomes, complications, and patient-reported satisfaction were analyzed. Results 12 articles, involving 931 patients and 8 primary procedures, met our inclusion criteria. The majority of articles had level of evidence of 4 (83%) and Newcastle Ottawa Scale score of 6 (92%, moderate risk of bias). All studies reported mean penile length gain; however, inconsistent methodology was used when measuring penile dimensions. Mean length gain ranged from 0.6 to 6.4 cm. Overall, the mean complication rate for all techniques ranged from 0% to 50%. Post-operative satisfaction was reported in 10 (83%) studies, 7 of which used a validated scale. Patients were generally satisfied, with reported satisfaction rates ranging from 77% to 100%. Clinical Implications While numerous procedures have been described, the significant limitations in the available data preclude identifying a single superior procedure. Strengths & Limitations The significant heterogeneity in the reported literature is a limitation of this study and highlights the need for standardized reporting. However, this study is the first to analyze augmentation phalloplasty literature in the setting of acquired penile shortening. Conclusion Augmentation phalloplasty techniques for acquired penile shortening are evolving and are continuously being modified; best-practice guidelines are crucial to achieve safe and satisfactory outcomes in this population.

Stress imaging identifies ischemic myocardium by comparing hemodynamics during rest and hyperemic stress. Hyperemia affects multiple hemodynamic parameters in myocardium, including myocardial blood flow (MBF), myocardial blood volume (MBV), and venous blood oxygen levels (PvO2 ). Cardiac T2 is sensitive to these changes and therefore is a promising non-contrast option for stress imaging; however, the impact of individual hemodynamic factors on T2 is poorly understood, making the connection from altered T2 to changes within the tissue difficult. To better understand this interplay, we performed T2 mapping and measured various hemodynamic factors independently in healthy pigs at multiple levels of hyperemic stress, induced by different doses of adenosine (0.14-0.56 mg/kg/min). T1 mapping quantified changes in MBV. MBF was assessed with microspheres, and oxygen consumption was determined by the rate pressure product (RPP). Simulations were also run to better characterize individual contributions to T2. Myocardial T2, MBF, oxygen consumption, and MBV all changed to varying extents between each level of adenosine stress (T2 = 37.6-41.8 ms; MBF = 0.48-1.32 mL/min/g; RPP = 6507-4001 bmp*mmHg; maximum percent change in MBV = 1.31%). Multivariable analyses revealed MBF as the dominant influence on T2 during hyperemia (significant β-values >7). Myocardial oxygen consumption had almost no effect on T2 (β-values

Background The COVID-19 pandemic has brought about immense change in health care. Surgical specialties in particular have had to make major adjustments because of the cancellation of nonemergent surgeries. Aesthetic surgery fellowships are uniquely affected because of the high number of elective cases and the length of the fellowship. The impact of the COVID-19 pandemic on current and upcoming aesthetic surgery fellows has not been studied. Objective The aim of this article was to study the potential impact of the COVID-19 pandemic on both American Society for Aesthetic Plastic Surgeons-endorsed and nonendorsed aesthetic fellowship programs. Methods A 23-question anonymous web-based survey was sent to aesthetic surgery fellowship directors with an active program in the United States. Surveys were collected from April 18, 2020, through May 14, 2020, with Qualtrics and then analyzed with Microsoft Excel. A 7-question follow-up survey was sent to directors, and a 23-question survey was sent to aesthetic surgery fellows. Data for these surveys were collected from June 6, 2020, through August 18, 2020. The surveys asked questions pertaining to adjustments and impact on current fellow training, as well as possible impact on fellows starting in 2020 and 2021. Results There was a 65.5% (19 of 29) response rate for the initial director survey, a 31% (9 of 29) rate for the director follow up survey, and a 28% (9 of 32) rate for the fellow-specific survey. All directors and fellows reported that the pandemic had some impact on aesthetic fellow training. A total of 5.3% of directors reported that they believe COVID-19 would have a "significant impact" on their fellows becoming well-trained aesthetic surgeons, whereas 66.7% of fellows reported that it will have a "mild impact." Predicted impact on future fellows was not as significant. Conclusion Telemedicine, educational efforts, and standardization of guidelines can be increased to minimize loss of training due to COVID-19. Ongoing evaluation and shared experiences can assist fellowships in customizing programs to provide well-rounded education during the pandemic.

Objective Demonstrate the feasibility of using the existing sentinel surveillance infrastructure to conduct the second round of the serial cross-sectional sentinel-based population survey. Assess active infection, seroprevalence, and their evolution in the general population across Karnataka. Identify local variations for locally appropriate actions. Additionally, assess the clinical sensitivity of the testing kit used on account of variability of antibody levels in the population. Methods The cross-sectional study of 41,228 participants across 290 healthcare facilities in all 30 districts of Karnataka was done among three groups of participants (low, moderate, and high-risk). The geographical spread was sufficient to capture local variations. Consenting participants were subjected to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, and antibody (IgG) testing. Clinical sensitivity was assessed by conducting a longitudinal study among participants identified as COVID-19 positive in the first survey round. Results Overall weighted adjusted seroprevalence of IgG was 15.6% (95% CI: 14.9–16.3), crude IgG prevalence was 15.0% and crude active infection was 0.5%. Statewide infection fatality rate (IFR) was estimated as 0.11%, and COVID-19 burden estimated between 26.1 to 37.7% (at 90% confidence). Further, Cases-to-infections ratio (CIR) varied 3-35 across units and IFR varied 0.04–0.50% across units. Clinical sensitivity of the IgG ELISA test kit was estimated as ≥38.9%. Conclusion We demonstrated the feasibility and simplicity of sentinel-based population survey in measuring variations in subnational and local data, useful for locally appropriate actions in different locations. The sentinel-based population survey thus helped identify districts that needed better testing, reporting, and clinical management. The state was far from attaining natural immunity during the survey and hence must step up vaccination coverage and enforce public health measures to prevent the spread of COVD-19.

ObjectiveThe second round of the serial cross-sectional sentinel-based population survey to assess active infection, seroprevalence, and their evolution in the general population across Karnataka was conducted. Additionally, a longitudinal study among participants identified as COVID-19 positive in the first survey round was conducted to assess the clinical sensitivity of the testing kit used.MethodsThe cross-sectional study of 41,228 participants across 290 healthcare facilities in all 30 districts of Karnataka was done among three groups of participants (low, moderate, and high-risk). Consenting participants were subjected to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, and antibody (IgG) testing.ResultsOverall weighted adjusted seroprevalence of IgG was 15.6% (95% CI: 14.9–16.3), crude IgG prevalence was 15.0% and crude active prevalence was 0.5%. Statewide infection fatality rate (IFR) was estimated as 0.11%, and COVID-19 burden estimated between 26.1 to 37.7% (at 90% confidence). Clinical sensitivity of the IgG ELISA test kit was estimated as ≥38.9%.ConclusionThe sentinel-based population survey helped identify districts that needed better testing, reporting, and clinical management. The state was far from attaining natural immunity during the survey and hence must step up vaccination coverage and enforce public health measures to prevent the spread of COVD-19.

Background Advances in sub-Nyquist-sampled dynamic contrast-enhanced (DCE) MRI enable monitoring of brain tumors with millimeter resolution and whole-brain coverage. Such undersampled quantitative methods need careful characterization regarding achievable test-retest reproducibility. Purpose To demonstrate a fully automated high-resolution whole-brain DCE MRI pipeline with 30-fold sparse undersampling and estimate its reproducibility on the basis of reference regions of stable tissue types during multiple posttreatment time points by using longitudinal clinical images of high-grade glioma. Materials and Methods Two methods for sub-Nyquist-sampled DCE MRI were extended with automatic estimation of vascular input functions. Continuously acquired three-dimensional k-space data with ramped-up flip angles were partitioned to yield high-resolution, whole-brain tracer kinetic parameter maps with matched precontrast-agent T1 and M

OBJECTIVES: Pediatric Non-Alcoholic Fatty Liver Disease is prevalent among Hispanics, which may partially result from a higher frequency of the C > G polymorphism in the patatin-like phospholipase 3 (PNPLA3) gene. Our prior work showed an interaction between the GG genotype and high dietary sugar, resulting in higher liver fat. Additionally, studies show that extreme sugar depletion improves liver fat in children with obesity. This trial aimed to test whether a clinical intervention for sugar reduction versus standard diet advice in Hispanic youth differentially impacts liver fat, liver fibrosis, body weight and composition, and whether effects differed by PNPLA3 genotype. METHODS: Hispanic youth with obesity (n = 105; 72% GG) were randomized to a healthy eating control group or a sugar reduction group (goal, 0.05). No treatment by PNPLA3 genotype interaction was observed for any endpoint (P > 0.05). While there was no significant change in fat mass in either study arm, secondary analyses revealed that participants who reduced fat mass, significantly reduced liver fat compared to those without fat mass reduction [−1.8% (−6.2, −3.4) vs. 0.3% (−1.0, 1.1), P

Purpose of Review Immune checkpoint inhibitors (ICIs) have improved the survival of several cancers. However, they may cause a wide range of immune-related adverse events (irAEs). While most irAEs are manageable with temporary cessation of ICI and immunosuppression, cardiovascular toxicity can be associated with high rates of morbidity and mortality. As ICIs evolve to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of ICI-associated cardiotoxicity may be even higher. Recent Findings Several cardiovascular toxicities such as myocarditis, stress cardiomyopathy, and pericardial disease have been reported in association with ICIs. Recent findings also suggest an increased risk of atherosclerosis with ICI use. ICI-associated myocarditis usually occurs early after initiation and can be fulminant. A high index of suspicion is required for timely diagnosis. Prompt treatment with high-dose corticosteroids is shown to improve outcomes. Summary Although the overall incidence is rare, ICI cardiotoxicity, particularly myocarditis, is associated with significant morbidity and mortality, making it a major therapy-limiting adverse event. Early recognition and prompt treatment with the cessation of ICI therapy and initiation of high-dose corticosteroids are crucial to improve outcomes. Cardio-oncologists will need to play an important role not just in the management of acute cardiotoxicity but also to reduce the risk of long-term sequelae.

The digital financial transaction is on a continuous rise and going to be the order of the day. These transactions rely on the entry of the Personal Identification Number (PIN) by the user. The PIN is a common user authentication method for many applications such as ATM's, unlocking personal devices. Cyber-crimes are committed by shoulder surfing or thermal tracking. PIN entry is found vulnerable to password attacks such as shoulder surfing or thermal tracking. Intruders try to gain passwords or personal identification numbers (PIN) by glancing over the user's shoulder and observing the pattern of PIN entry (shoulder surfing). Thermal tracking is another method followed by cyber thieves, using the heat traces to decode the entered PIN by the user. This paper proposes a novel approach to authorization of PIN. To demonstrate the same, a web application is developed with trio-based authentications using machine learning techniques. Initially, the application detects and recognizes the user's face. A dynamic keypad is displayed which prompts the user to provide input PIN via eye blink. User's eye is detected and monitored by the application in order to capture the PIN and verifies the same with the existing PIN in the database. On a successful PIN verification process, the application allows the user to proceed with the transaction. The results show the proposed novel approach is better than existing approaches.

The explosion of social media data which holds important, massive, rapidly evolving unstructured information has provided an opportunity to research public opinion and know people's feelings. Capturing the views on social events, corporate strategies, political movements, marketing campaigns and product preferences et cetera brings growing interest from the scientific and business communities to improve their performances. This has resulted in an emerging field of social network mining or sentiment analysis. This paper describes a system that was built to analyze data from social media platforms such as Twitter, Instagram, Facebook and Reddit. The data is gathered from various services and programs which involves using the official API's and scraping tools. Machine Learning & Image Processing algorithms are applied on the gathered data to gain insights about the individual users' interests, usage patterns, media reachability, et cetera. These models are then relayed to a web application where various visualizations of the insights can be obtained.

Abdominal wall reconstruction is indicated when 1 or more of the abdominal wall components (skin, fascia, or muscle) are either injured or absent. When faced with defects requiring flap reconstruction, the decision regarding flap choice should take into consideration the volume of soft tissue required, the extent of the defect, donor site morbidity, and prior surgical scars that affect flap vascularity. We present a case of an abdominal wall defect with limited reconstructive options in which a spare ileal bowel segment was filleted to create a seromuscular flap for improving the abdominal wall blood supply. The postoperative course was complicated by abdominal fluid collection, which resolved following an ultrasound-guided drain. The patient had normal wound healing and recovery without further postoperative complications at the 7-month follow-up. Seromuscular flaps are a practical option in the armamentarium of plastic surgeons performing abdominal wall reconstruction, especially when other alternatives are limited.

INTRODUCTION: Appendix in a nger like projection situated just near the caecum. It is located in the right iliac fossa of the abdomen. The most common pathology which arises is appendicitis and is mostly treated surgically. Although appendix is considered to be a vestigial organ, it accounts for immune function upto some extent. OBJECTIVES: To study and analyse the various histopathological forms of appendicitis MATERIALS AND METHODOLOGY: A descriptive study was undertaken to analyse the different histopathological forms of appendicitis over a period of one year in the Department of Pathology, Government Medical College, Omandurar Government Estate. The acquired data was fed into Microsoft Excel and analysis was done. RESULT: A total of 100 specimens were analysed during the study period. Maximum number of cases (62% of cases) were reported amongst females. The most common age group which was affected was 9 years to 19 years. The most common histopathological form of appendicitis was analysed to be acute appendicitis (76% of cases) The statistical data for various histo pathological types of appendicitis are as follows Subacute appendicitis – 10 cases ; Acute appendicitis – 76 cases ; Chronic appendicitis – 13 cases ; Granulomatous appendicitis – 1 case. CONCLUSION: The incidence of appendicitis is higher in the second decade of life and is remarkably high amongst females. Among the pathological types, incidence of acute appendicitis is the highest and that is seen in the second decade of life

Platelets are small, anucleated effector cells that play an important role in linking the hemostatic and inflammatory processes in the body. Platelet function is known to be altered under various inflammatory conditions including aging. A gain in platelet function during aging can increase the risk of thrombotic events, such as stroke and acute myocardial infarction. Anti-platelet therapy is designed to reduce risk of serious cerebrovascular and cardiovascular events, but the adverse consequences of therapy, such as risk for bleeding increases with aging as well. Age-associated comorbidities such as obesity, diabetes, and hyperlipidemia also contribute to increased platelet activity and thus can enhance the risk of thrombosis. Therefore, identification of unique mechanisms of platelet dysfunction in aging and in age-associated comorbidities is warranted to design novel antiplatelet drugs. This review outlines some of the current areas of research on aging-related mechanisms of platelet hyperactivity and addresses the clinical urgency for designing anti-platelet therapies toward novel molecular targets in the aging population.