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Some new di- and triphenyltin(IV) complexes of the general formulae Ph2SnL and Ph3SnL′, where H2L/HL′ = Schiff bases derived from the condensation of 2-hydroxy-1-naphthaldehyde (H2L) and benzaldehyde (HL′) with glycine (H2L-1/HL′-1), DL-α-alanine (H2L-2/HL′-2), L-methionine (H2L-3/HL′-3), DL-valine (H2L-4/HL′-4), D-phenylalanine (H2L-5/HL′-5), 2-aminobutyric acid (H2L-6/HL′-6), and L-leucine (H2L-7/HL′-7), have been synthesized and characterized by elemental analyses, molar conductance, electronic, infrared and far-infrared, multinuclear magnetic resonance (1H, 13C, and 117Sn), and 119Sn Mossbauer studies. Thermal decomposition of a few complexes using TG, DTG, and DTA techniques indicates the formation of SnO2 as a residue. The complexes have also been tested in vitro against bacteria [Streptococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus Penicillin resistance (2500 units)] and fungi [Candida albicans, Cryptococcus neoformans, Sporotrichum schencki...

Carotenoids are fat-soluble antioxidant vitamin compounds derived from the isoprenoid biosynthetic pathway. These natural pigments are secondary metabolites and can be divided into two classes—carotenes and xanthophylls—which play diverse biological roles in plants and animals. Carotenoids with unsubstituted β-ring end groups become more important because of their provitamin A activity. Maize is the third most staple food worldwide and also contains appreciable amount of provitamin A carotenoids with wide range of genetic variability. This makes it a good candidate crop for biofortification of provitamin A carotenoids. The quantity of provitamin A carotenoids needed to alleviate vitamin A deficiency (VAD) through biofortification depends upon its bioavailability, which is influenced by a number of factors in an individual. The bioavailability of biofortified maize can be known through determining vitamin A equivalence. Recent advances have shown that β-carotene in biofortified maize has good bioavailability as a plant source of vitamin A. So, a quantity of 15 μg provitamin A g−1 dry weight of kernel was targeted for biofortification. This chapter also includes the carotenoid biosynthetic pathway, biofortification strategies, recent advancements made toward biofortification of provitamin A, and future perspectives.

Limited data exist regarding the management of patients with acute coronary syndrome (ACS) in high-income countries compared with low/middle-income countries. We aimed to compare in-hospital trends of revascularization and prescription of medications at discharge in patients with ACS from high-income (Canada and United States) and low/middle-income (India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind, placebo-controlled, randomized trial investigating the effect of bupropion on smoking cessation in patients after an enzyme-positive ACS was used for our study. A total of 392 patients, 265 and 127 from high-income and from low/middle-income countries, respectively, were enrolled. Patients from high-income countries were older, and were more likely to have diagnosed hypertension and dyslipidemia. During the index hospitalization, patients from high-income countries were more likely to be treated by percutaneous coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI] 10.5 to 37.0). Patients with ST elevation myocardial infarction from high-income countries were more often treated by primary percutaneous coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from high-income countries were also more likely to receive evidence-based medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of aspirin, clopidogrel, and statin). In conclusion, patients with ACS in low/middle-income countries were less likely to be revascularized and to receive evidence-based medications at discharge. Further studies are needed to understand the underutilization of procedures and evidence-based medications in low/middle-income countries.

A 67-year-old diabetic and hypertensive man underwent permanent pacemaker implantation at right ventricular apical (RVA) site. After 11 years follow-up, the patient's New York Heart Association class changed from II to III. Coronary angiography revealed the presence of triple vessel disease [involving left anterior descending artery (LAD) (90%), OM1 …

In the present paper, the flames from DJHC burner, imitating MILD (Moderate and Intense Low Oxygen Dilution) combustion, are simulated using PDF transport modeling. Two different solution approaches have been used to resolve the joint composition PDF. First, a Lagrangian approach is used to solve the joint composition PDF, while in the second approach, the approximate solution is achieved by using presumed shape PDF and DQMOM-IEM modeling known as Multi-Environment Eulerian PDF (MEPDF). A quantitative comparison of the predictions from these two solution methods has been performed for two different jet Reynolds number, i.e. Re = 4100 & 8800. Moreover, the effect of molecular diffusion is also explored by comparing the predictions using different micro-mixing models such as Coalescence Dispersion (CD), Euclidean Minimum Spanning Tree (EMST), and Interaction-by-Exchange-with-Mean (IEM) model. The obtained numerical predictions from both approaches are compared with the experimental data to highlight the accuracy as well as the predictive capability of these models. In the case of low Reynolds number (Re = 4100), it is observed that the mean axial velocity and turbulent kinetic energy profiles are in good agreement with the measurements while the temperature profiles are slightly over-predicted in the downstream region. Although MEPDF results are in good agreement with the LPDF results, both the model predictions tend to exhibit discrepancies at higher Reynolds number.Copyright © 2013 by ASME

Introduction We aimed to assess the efficacy of fixed dose combination of atorvastatin plus ezetimibe in Indian patients with dyslipidaemia. Methods A double-blind study was conducted to assess the effect of fixed dose combination of ezetimibe 10 mg plus atorvastatin 10 mg on lipid profile, oxidised low-density lipoprotein (ox-LDL), high-sensitivity C-reactive protein (hsCRP) and soluble intercellular cell adhesion molecule (sICAM) in dyslipidaemic patients with or at high risk of coronary artery disease, and compare it with atorvastatin 10 mg monotherapy. 30 patients were randomised to receive ezetimibe plus atorvastatin or atorvastatin once daily for four weeks. Results Of the 30 patients, 10 men and 5 women (mean age 54.3 ± 1.6 years) received ezetimibe plus atorvastatin, while 13 men and 2 women (mean age 53.7 ± 2.8 years) received only atorvastatin. The combination treatment significantly reduced total cholesterol (percentage treatment difference -14.4 ± 6.5, 95% confidence interval [CI] -1.0 to -27.7; p = 0.041) and LDL cholesterol (LDL-C; percentage treatment difference -19.9 ± 6.1, 95% CI -7.4 to -32.4; p = 0.003) compared to atorvastatin monotherapy. 13 patients on combination treament achieved the National Cholesterol Education Program target for LDL-C as compared to 9 patients on atorvastatin monotherapy (p = 0.032). Significant reductions in very low-density lipoprotein cholesterol, triglyceride, ox-LDL and sICAM were observed with combination treatment compared to atorvastatin monotherapy. However, no significant change was seen in high-density lipoprotein cholesterol or hsCRP levels between the two groups. Conclusion Combination treatment with atorvastatin and ezetimibe had relatively better lipid-lowering and anti-inflammatory efficacy than atorvastatin monotherapy.

PDF transport modeling has been known to be the most accurate for modeling turbulence chemistry interactions with finite rate chemistry effects. But, this is computationally very expensive. The Direct quadrature method of moments with Interaction by exchange with mean closure (DQMOM-IEM) can be a potential alternative to solve the PDF transport equation in an efficient manner. The current work involves the validation of presumed shape multi-environment Eulerian PDF Transport method (MEPDF) using DQMOM-IEM approach for modeling turbulence chemistry interactions in non-premixed combustion problems. The joint composition PDF is represented as a collection of finite number of Delta functions. The PDF shape is resolved by solving the governing transport equations for probability of occurrence of each environment and probability weighted mass fraction of species and enthalpy in Eulerian frame for each environment. A generic implementation of the MEPDF approach is carried out for an arbitrary number of environments. In the current work, the MEPDF approach is used for a series of problems to validate each component of MEPDF approach in an isolated manner as well as their combined effect. First of all, a non reactive turbulent mixing problem with two different Reynolds number (Re = 7000, 11900) is used for validation of the mixing and correction terms appear in the MEPDF approach. The second problem studied is a diffusion flame with infinitely fast chemistry having an analytical solution. The reaction component is validated by considering a 1D premixed laminar flame. In order to validate the combined effect of mixing and turbulence chemistry interactions, two different turbulent non premixed problems using global one step chemistry are used. The first reactive problem used is H2 combustion (DLR Flame H3) while the second reactive validation case is a pilot stabilized CH4 flame. The current predictions for all validation problems are compared with experimental data or published results. The study is further extended by modeling a turbulent non premixed H2 combustion using finite rate chemistry effects and radiative heat transfer. The current model predictions for different flame lengths as well as minor species are compared with experimental data. The current model gave excellent predictions of minor species like OH. The differences in the current predictions with experimental data are discussed.

The paper presents numerical investigation using Multi environmental Eulerian PDF (MEPDF) transport model for turbulence-chemistry interaction. A turbulent flame (SM1) from Sydney swirling burner database is simulated along with two isothermal cases (N29S054, N16S159) of different swirl numbers. MEPDF methodology, a probability density function (PDF) transport modeling, exploits the advantages of the PDF transport equation and is also computationally less expensive compared to popularly used Lagrangian solution approach of PDF transport equation. In the MEPDF approach, the PDF transport equation is represented by direct quadrature method of moments with presumed shape PDF and the closure of micro-mixing is achieved by interaction by exchange with mean (IEM) model. In the current work, the reacting flow results using MEPDF are reported for SM1 flame, which is a part of the database of turbulent reacting flows and widely considered as benchmark test cases for validating turbulent-chemistry interaction models. Initially, the non-reacting flows are simulated to properly choose the boundary conditions, turbulence models as well as the grid; followed by reacting flow calculations. SKE and RKE predictions show good agreement with each other while the other turbulence model exhibit substantially different behavior, especially for non-reacting case. However, RKE model exhibits substantial improvement in the case of reacting flows.Copyright © 2012 by ASME

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 35-year-old woman with a pre-existing diagnosis of rheumatic heart disease and mitral stenosis presented this time to us with history of recent worsening of her dyspnea and new onset of fever for past 15 days. On examination

Aspirin and Clopidogrel are used in prophylaxis of patients undergoing percutaneous coronary intervention and long-term prevention of cardiovascular and cerebrovascular events. Clopidogrel resistance has been attributed to P2Y1 and P2Y12 adenosine diphosphate (ADP) receptor polymorphisms. This study enrolled 100 patients of coronary artery disease (CAD) who were on the maintenance dose of clopidogrel (75 mg OD) with or without aspirin. In addition, 10 received loading dose (300 mg) prior to percutaneous coronary intervention. Relevant clinical and drug history were elicited. ADP-induced platelet aggregation study and PCR-RFLP for P2Y1 (1622A G) and P2Y12 (i-T744C) polymorphisms were performed. Two groups of controls were used for defining cut-off for platelet aggregation response. Follow-up data, wherever available was recorded. The most common pattern of aggregation response was disaggregation, either complete (46.4%) or partial (53.6%). A frequency of 13% clopidogrel non-responders and 19% semi-responders was found. All the cases were H1/H1 haplotype for P2Y12 gene polymorphism and 28 (29.2%) patients carried P2Y1 1622A G (21(21.9%) AG and 7(7.3%) GG) gene polymorphism, the frequency being greater in clopidogrel responders compared to semi/non-responders but difference was not statistically significant. There was no statistically significant difference between responders and semi/non-responders in terms of the history of risk factor for CAD, concurrent atorvastatin use or past history of an acute vascular event. On follow up, the two patients who developed myocardial infarction/acute coronary syndromes (MI/ACS) were clopidogrel semi- and non-responder, respectively. Variability in clopidogrel response with 13% non-responders and 19% semi-responders was seen in this study with adverse outcome (MI/ACS) on follow up seen in two patients. Hence, poor response to clopidogrel may be related to increased likelihood of adverse long-term coronary event that may benefit from additional or alternative anti-platelet therapy. Clopidogrel resistance was not associated with ADP receptor P2Y1 and P2Y12 gene polymorphisms. Hence, it is postulated that clopidogrel resistance in CAD patients is multifactorial and not caused by single-gene polymorphisms.

Aims This study was carried out to evaluate high-resolution melting (HRM) curve analysis assay for detection of mutations in three drug resistance–associated genes of Mycobacterium tuberculosis. Methods and Results Clinical isolates of Myco. tuberculosis phenotypically resistant to rifampicin (n = 29), isoniazid (n = 35) and streptomycin (n = 34) were analysed for mutations in rpoB, katG and rpsL genes, respectively, by HRM curve analysis and DNA sequencing. HRM curve assay resulted in 11 clearly distinguishable melt curves denoting eight types of mutations responsible for drug resistance. For the three drugs, respectively, the sensitivity of HRM curve assay was found to be 93·1, 80 and 61·8% compared to the phenotypic resistance patterns, and 93·1, 93·3 and 100% in comparison with the DNA sequencing. Conclusions The sensitivity and specificity of HRM curve assay was found to be comparable to DNA sequencing. The assay offers the advantage of high throughput, single step, rapid work flow and cost effectiveness and can be utilized as a rapid screening method for detection of drug-resistant tuberculosis. Significance and Impact of the Study HRM curve assay may prove to be an important tool for the development of rapid molecular diagnostic assays for detection of mutation-based drug resistance.

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

BACKGROUND: Loop‐mediated isothermal amplification (LAMP) assay has come forward as a rapid, cost‐effective molecular technique for diagnosis of tuberculosis (TB) in developing countries. This study evaluated Mycobacterium tuberculosis–specific in‐house LAMP assay targeting 16s rRNA and compared it with other conventional tests and nucleic acid amplification assay (IS6110 PCR). METHODS: A total of 133 sputum specimens (103 from suspected pulmonary TB cases and 30 from non‐TB controls) were subjected to conventional tests, IS6110 PCR and 16s rRNA LAMP assay. RESULTS: Of the 103 patients, the maximum number of cases were found to be positive by LAMP assay, that is, in 87 (84.5%) patients, followed by culture positive in 78 (75.7%), IS6110 PCR in 74 (71.8%), and smear positive in 70 (67.9%) patients. Of the 83 smear positive and/or culture positive cases, LAMP detected 77 (92.77%) cases, and was found to be superior to IS6110 PCR, which could detect 69 (83.1%) cases; a concordance of 0.6 was obtained between the two tests using kappa statistics. CONCLUSION: Overall, LAMP was simple and efficacious for early diagnosis of smear positive, culture positive cases as well as for confirmation of smear negative, culture negative cases, and was found to be superior to IS6110 PCR.

Background The intrathoracic subclavian venous technique for pacemaker implantation may be associated with serious complications. We describe an alternative technique for obtaining venous access for pacemaker implantation through axillary vein under fluoroscopic guidance and compare it with the conventional, subclavian approach. Methods We conducted a single-centre, prospective, nonrandomized study. All adult patients with indication for permanent pacing who consented were recruited during a 3-year period. To access the axillary vein, we used the alternative technique with a new fluoroscopic landmark. The subclavian access was obtained as per the usual approach. Results We studied 478 lead placements during 3 years; 315 lead placements through axillary venous technique (group 1) were compared with 163 lead placements through subclavian venous technique (group 2). Both routes had a high and comparable success rate, 98.09% in group 1 and 96.93% in group 2. The axillary approach was successful at the first attempt in 194 punctures (61.6%), as vs 60 in group 2 (36.8%) P 0.0001. The average number of attempts in group 1 was 2.06 per patient and 2.56 in group 2 ( P 0.001). There were 3 (2.94%) pneumothoraxes in group 2 and none in group 1. During a mean follow-up period of 3.2 months in group1 and 3.7 months in group 2, 1 patient in group 2 had a lead fracture. Conclusions The fluoroscopically guided axillary venous approach for implanting permanent pacemakers is equivalent to the traditional anatomic landmark–guided intrathoracic subclavian approach and has fewer complications and shorter procedural time to access the vein.

QSAR analysis using multiple linear regression and partial least squares methods were conducted on a data set of 47 pyrrolidine analogs acting as DPP IV inhibitors. The QSAR models generated (both MLR and PLS) were robust with statistically significant s, F, r, r(2) and r(2) (CV) values. The analysis helped to ascertain the role of shape flexibility index, Ipso atom E-state index and electrostatic parameters like dipole moment, in determining the activity of DPP IV inhibitors. In addition to QSAR modeling, Lipinski's rule of five was also employed to check the pharmacokinetic profile of DPP IV inhibitors. Since none of the compounds violated the Lipinski's rule of five indicating that the DPP IV inhibitors reported herein have sound pharmacokinetic profile and can be considered as potential drug candidates for diabetes mellitus Type II.

T. foenum-graecum seed extract (100 mg/day/rat) was fed orally to male albino rats for 60 days. The sperm count and motility of cauda spermatozoa declined significantly leading to negative fertility tests. The organ weights as well as androgen dependent parameters (protein, sialic acid and fructose) were lower, revealing the reduction in circulating androgen. Cholesterol is a precursor of androgen. The increase in testicular and serum cholesterol may be co-related with its nonutilization by the system, leading to a fall in circulating androgen and hence the altered histoarchitecture observed. Therefore T. foenum-graecum extract exerts both antifertility and antiandrogenic activities.

Phytoremediation potential has been widely accepted as highly stable and dynamic approach for reducing eco-toxic pollutants. Earlier reports endorse remediation abilities both in herbaceous plants as well as woody trees. Poplars are dominant trees to the ecosystem structure and functioning in riparian forests of North America Rivers and also to other part of the world. Understanding of the fact that how genetic variation in primary producer structures communities, affects species distribution, and alters ecosystem-level processes, attention was paid to investigate the perspectives of genetic modification in poplar. The present review article furnishes documented evidences for genetic engineering of Populus tree for enhanced phytoremediation abilities. The versatility of poplar as a consequence of its distinct traits, rapid growth rates, extensive root system, high perennial biomass production, and immense industrial value, bring it in the forefront of phytoremediation. Furthermore, remediative capabilities of Populus can be significantly increased by introducing cross-kingdom, non-resident genes encoding desirable traits. Available genome sequence database of Populus contribute to the determination of gene functions together with elucidating phytoremediation linked metabolic pathways. Adequate understanding of functional genomics in merger with physiology and genetics of poplar offers distinct advantage in identifying and upgrading phytoremediation potential of this model forest tree species for human welfare.

Myrosinase, the only known S-glycosidase, occurs particularly in Cruciferae family. It is responsible for the hydrolysis of glucosinolates and serves as a vital element of plant defense system. The biological and chemical properties of myrosinase catalyzed products of glucosinolates are well characterized. The myrosinase-protein-sequence of Brassica juncea was retrieved from NCBI database and its 3-D model was generated on the basis of crystal structure of 1MYR-A, 1E4M-M and 1DWA-M chains of myrosinase from Sinapis alba by employing Modeller9v7 program. Homolog templates from S. alba exhibited 72% identity with target sequence. The model was optimized by using molecular dynamics (MD) approach together with simulated annealing (SA) methods in the same Modeller program, and eventually verified and validated on SAVES (Structure Analysis and Verification Server) and PROCHECK programs, respectively. Ramachandran plot obtained through PROCHECK program depicted that 99.8% of total residues were confined to the allowed region while only one residue (Thr92) was restrained to the disallowed region. Additionally, B. juncea myrosinase contains three disulphide bridges which were found to be conserved in S. alba homologs as well. Further, overlapping of B. juncea myrosinase with that of template protein 1MYR-A from S. alba stipulates the amino acid residues Arg115, Gln207, Thr210, Asn350, Tyr352 and Glu429 that constitute active site of the enzyme. Active site analysis also speculates the presence of a hydrophobic pocket in addition to seven N-glycosylation sites. Docking studies of enzyme and substrate illuminate the interactions of various active site residues with diverse groups of sinigrin. Therefore, the present study furnishes the first significant, in silico insight into the 3-D structure, active site machinery, and enzyme–substrate interactions of B. juncea myrosinase.

Aim The significance of passive stretching of the mitral valve as a contributor to valve opening, after percutaneous transvenous mitral commissurotomy (PTMC), is not known. Our objective was to determine whether any acute reduction in valve area occurs due to recoil of stretched valve structures. Methods and Results In a prospective observational study, we evaluated nine patients (age 30.1±8.0 years; median valve score 7) who underwent PTMC. We calculated mitral valve area (MVA) before, immediately after, and at 10 and 30 min after valvotomy. There was no acute reduction in MVA after successful PTMC. But there was a significant increase in MVA at 30 min, from that measured immediately after the procedure (1.8±0.4 to 2.0±0.4 cm 2 ; P =.048). This was attributable to the continuing fall in pulmonary artery wedge (PAW) pressures (17±3 to 15±3 mmHg; P =.003) and transmitral gradients (8±3 to 7±2 mmHg; P =.037). Conclusion Passive stretching of the valve apparatus does not play an important role in valve opening after PTMC in young patients with favorable valve morphology.

This is a collective review of 59 published cases of right pulmonary artery to left atrium communication in the English-language literature. In this article, we review the literature on the clinical presentation, anatomic variations, diagnostic features, and management considerations of previously reported cases. Two-dimensional echocardiography and cardiac catheterization including selective angiography provided the necessary diagnostic information and defined the anatomy before surgery in all patients. Various management options including medical, surgical, and transcatheter closure have been reported. The lesions have been classified into four types (I, II, III, and IV) that have a bearing on the appropriate surgical approach and techniques of repair that are discussed in the text. Use of extracorporeal circulation may be considered in selected instances. The operative mortality rate during the earlier era (1950 to 1979) was high, at 22%. More recently, the mortality rate has approached zero. An individualized surgical approach depending on the type of surgical connections is recommended.

Sildenafil, a phosphodiestrase-5 inhibitor, decreases pulmonary artery pressures (PAP) in patients with idiopathic pulmonary hypertension. There is little data pertaining to its use in unselected patients with idiopathic dilated cardiomyopathy (IDCM). A single oral dose of sildenafil (50 mg) was administered to 11 patients (mean age 44.9 +/- 7 years, 7 males) with IDCM with left ventricular ejection fractionor = 40% in New York Heart Association class II/III at the time of right heart catheterization. There was a significant decrease in pulmonary artery systolic pressure (from 31.5 +/- 9.7 to 19.0 +/- 5.2 mmHg, p0.001) and pulmonary vascular resistance (PVR) (from 3.0 +/- 2.1 to 1.6 +/- 0.8 dyne/s/m(2)/cm(5), p = 0.01) following sildenafil administration. The systemic vascular resistance (SVR) and pulmonary wedge capillary pressure also significantly decreased. No significant differences in heart rate, cardiac index and PVR/SVR ratio were observed. There were no side effects documented. Sildenafil produces favorable vasodilation in both pulmonary and systemic vascular beds with decrease in left ventricular filling pressures, in stable patients with IDCM.

The weighted sum of gray gases (WSGG) method has been used extensively for radiation modeling of non gray medium gases. The radiative transfer equation (RTE) for each gray gas can be solved using the Discrete Ordinate (DO) model, which is sufficiently accurate over wide range of optical thickness, but it is computationally expensive. The P1 approximation is an efficient alternative to solve the RTE, but applicable to optically thick medium only. In the present work, a hybrid solution methodology to solve RTE in a non gray medium using WSGG model is proposed. Results for the case of four gray gases are presented. The philosophy is to achieve the optimum performance using combination of the P1 and DO model with respect to the optical thickness of the gray gases being solved with minimal loss in accuracy. In this approach, the transparent and/or optically thin gases are solved using the DO model while the P1 approximation is used for the optically thick gases. This combination reduces the total number of radiation intensity equation to be solved very significantly. A study of accuracy and computational cost for the hybrid solution methodology has been done for a variety of test cases in order of increasing complexity. It has been found that the hybrid solution methodology, in which RTE for two gray gases are solved by DO model and the remaining two gray gases by P1 approximation, provided similar accuracy with significant speedup compared to the conventional approach in which RTE for all gray gases are solved with DO model. Another variant of the hybrid approach, in which DO model is used only for the transparent gas, is also considered and found to be sufficiently accurate for most of the cases.Copyright © 2009 by ASME

Idiopathic Ventricular Fibrillation is a rare cause of sudden cardiac death. It may be difficult to prospectively diagnose idiopathic ventricular fibrillation due to the episodic nature of the arrhythmias as well as the inability to induce the clinical tachycardia on electrophysiological studies. Although an implantable cardioverter defibrillator can terminate episodes of ventricular fibrillation, it cannot prevent recurrences. We describe a patient who underwent radiofrequency ablation of the culprit ectopics initiating ventricular fibrillation for frequent symptomatic episodes.

There is a concern that percutaneous transvenous mitral commissurotomy (PTMC) performed during acute rheumatic fever (ARF) may result in adverse outcomes. We performed a retrospective study at a tertiary care center. Ten patients (ages 8-12 years) with severe symptomatic mitral stenosis and ARF who underwent PTMC (ARF group) were compared with 10 controls with similar mitral valve area (MVA). The procedure was successful in all patients. The median MVA increased from 0.7 to 1.5 cm2 following PTMC in the ARF group and from 0.7 to 1.8 cm2 in the control group [p = not significant (NS)]. The median MVA was 1.2 cm2 in the study group compared to 1.6 cm2 in the control group (p = 0.02) over a mean follow-up of 17.5 +/- 11.7 months. Echocardiographic restenosis occurred in 4 patients (40%) in the ARF group compared to 1 patient (10%) in the control group (p = NS). The improvement in the New York Heart Association functional class was maintained in 8 patients of the ARF group and 9 patients of the control group. PTMC can be performed in children with ARF without an increase in procedural complications. However, the restenosis rates appear to be higher.

Transient abnormal Q waves during exercise ECG are rare and not well understood. Electrical axis alteration caused by hyperventilation, rate related fascicular block, or reversible ischaemia have been considered as possible causes for this abnormality. We report a relatively new cause of transient Q waves during exercise testing. A 45 year old asymptomatic man …

The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with severe rheumatic mitral stenosis and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation.We prospectively studied left atrial appendage function in 200 consecutive patients with severe mitral stenosis who underwent transesophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age was 30.2 +/- 9.4 years. Fifty-five (27.5%) patients were in atrial fibrillation. Left atrial appendage clot was present in 50 (25%) patients and 113 (56.5%) had spontaneous echo contrast. The older age, increased duration of symptoms, atrial fibrillation, spontaneous echo contrast, larger left atrium, depressed left atrial appendage function and type II and III left atrial appendage flow patterns correlated significantly (p0.05) with the left atrial appendage clot. Left atrial appendage ejection fraction was significantly less in patients with clot (21.8 +/- 12.8% v. 39.1 +/- 13.2%, p0.0001) and in those with spontaneous echo contrast (30.3 +/- 16.2 % v. 40.3 +/- 11.8%, p0.001). Left atrial appendage filling (18.0 +/- 11.7 v. 27.6 +/- 11.8 cm/s, p0.0001) and emptying velocities (15.4 +/- 7.0 v. 21.5 +/- 9.6 cm/s, p0.001) and filling (1.4 +/- 1.0 v. 2.5 +/- 1.4 cm, p0.0001) and emptying (1.5 +/- 1.2 v. 2.1 +/- 1.2 cm, p0.05) velocity time integrals were also significantly lower in patients with clot as compared to those without clot. On multivariate regression analysis, atrial fibrillation (odds ratio 6.68, 95% CI 1.85-24.19, p=0.003) and left atrial appendage ejection fraction (odds ratio 1.06, 95% CI 1.00 - 1.11, p=0.04) were the only two independent predictors of clot formation. Incidence of clot was 62.59% in patients with left atrial appendage ejection fractionor = 25% as compared to 10.4% in those having left atrial appendage ejection fraction25%. Similarly patients with spontaneous echo contrasthadlower filling (21.7 +/- 11.5 v. 29.4 +/- 12.7 cm/s, p0.0001) and emptying (17.0 +/- 8.1 v. 23.9 +/- 10.9 cm/s, p0.0001) velocities, as well as filling (1.9 +/- 1.3 v. 2.7 +/- 1.3 cm, p0.01) and emptying (1.7 +/- 1.0 v. 2.3 +/- 1.4 cm, p0.01) velocity time integrals as compared to patients without spontaneous echo contrast. In a subgroup of the patients with normal sinus rhythm, the left atrial appendage ejection fraction was significantly less in patients with clot compared to those without clot (31.2 +/- 13.2 v. 41.3 +/- 11.5 %, p0.01).In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function (left atrial appendage ejection fractionor = 25%) had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.

Background: Retinopathy of prematurity (ROP) is a disease related to low birth weight, prematurity, oxygen administration, and various other factors, which are yet to be identified. Aims: The aim was to find incidence of ROP and risk factors for causation in babies weighing Design: Prospective study. Materials and Methods: Neonates weighing ≤1800 g taking birth in our institution from January 2011 to January 2012 for a span of 1 year; were included in the study. The data were analyzed to determine risk factors for ROP causation. Information was collected using the standardized performa which included the maternal risk factors as well. Infants were classified by ophthalmologic examination findings using ICROP revisited. Statistics: Qualitative data were analyzed using Pearson's Chi-square test with Yates correction or Fisher's exact test and possible risk factors were analyzed by univariate analysis and multivariate analysis. Results: A total of 278 subjects was included in the study. Incidence of ROP in babies ≤1800 g was found to be 13.67% (38/278). Incidence of ROP in babies weighing between 1501 and 1800 g was 11.64% (17/146). Twenty-one risk factors were significant on univariate analysis in babies weighing ≤1800 g and 18 risk factors in the babies weighing between 1501 and 1800 g. Multiple gestations ( P P P P P P P P Conclusion: It should be considered to incorporate screening of babies ≤1800 g uniformly in developing nations. It is recommended that further studies be done taking representative population of babies in different sites with adequate follow-up.

VECC has undertaken the modernization of the K-130 Room Temperature Cyclotron (RTC) (operational since 1978) and commissioning of K-500 Superconducting Cyclotron (SCC) at present. The control system of RTC vacuum system has been upgraded to Programmable Logic Controller (PLC) based automated system from relay based manual system. A distributed PLC based system is under installation for SCC vacuum system. The requirement of high vacuum in both the cyclotrons (1×10−6 mbar for RTC and 5 × 10−8 mbar SCC) imposes the reliable local and remote operation of all vacuum components and instrumentation. The design and development of the vacuum control system of two cyclotrons using the Experimental Physics and Industrial Control System (EPICS) distributed real-time software tools are presented.

In 1975 the Government of India launched the Integrated Child Development Services (ICDS) scheme aiming to reduce the incidence of malnutrition and to reduce infant and child morbidity and mortality rates in the country. In this scheme a village-level center provides severely malnourished (SMN) children with therapeutic supplementary feed and advises mothers to continue breastfeeding and give adequate quantity of weaning foods. This prospective study assessed the impact of the ICDS package of services on the nutritional status of SMN children in India. A total of 926 children aged 6 months to

Objectives We sought to investigate the release pattern of different cardiac biomarkers (high-sensitivity C-reactive protein, cardiac troponin I, heart-type fatty acid–binding protein, creatine kinase-MB, and myoglobin) and to establish the diagnostic discrimination limits of each marker protein to evaluate perioperative myocardial injury in patients undergoing coronary artery bypass grafting with or without cardiopulmonary bypass. Methods Fifty patients were randomly assigned to on-pump or off-pump coronary artery bypass grafting. All cardiac biomarkers were measured in serial venous blood samples drawn before heparinization in both groups and after aortic unclamping at 1, 2, 4, 8, 24, 48, and 72 hours in the on-pump group. In the off-pump group samples were taken after the last distal anastomosis and at same time intervals as in the on-pump group. Results The total amount of heart-type fatty acid–binding protein, cardiac troponin I, and high-sensitivity C-reactive protein released was significantly higher in the on-pump group than in the off-pump group. Receiver operating characteristic curve analysis of cardiac biomarkers indicated cardiac troponin I and heart-type fatty acid–binding protein as the superior diagnostic discriminators of myocardial injury, with an optimal cutoff value of greater than 0.92 ng/mL (area under the curve, 0.95 [95% CI, 0.88–1.00]; sensitivity, 92%; specificity, 92%; likelihood ratio [+], 11.50) and greater than 6.8 ng/mL (area under the curve, 0.94 [95% CI, 0.88–1.00]; sensitivity, 88%; specificity, 88%; likelihood ratio [+], 7.33), respectively. Logistic regression analysis revealed that patients with increased cardiac troponin I levels of greater than 0.92 ng/mL and heart-type fatty acid–binding protein levels of greater than 6.8 ng/mL were at 132.25 (95% confidence interval, 17.14–1020.49) times and 53.77 (95% confidence interval, 9.76–296.12) times higher risk of myocardial injury after on-pump coronary artery bypass grafting. Conclusions Off-pump coronary artery bypass grafting provides better myocardial protection than on-pump coronary artery bypass grafting. Cardiac troponin I and heart-type fatty acid–binding protein, but not high-sensitivity C-reactive protein, served as superior diagnostic discriminators of perioperative myocardial damage after on-pump coronary artery bypass grafting.

Biventricular (BV) pacing is a promising option for patients with advanced heart failure and electromechanical conduction delay. We present our experience in 17 patients. 19 patients underwent the implant procedure at our institute: 3 others had their implant elsewhere and were on our follow-up. The mean age was 46.6+10.7 years and 14 were males. A conventional indication for pacing was present in 8; 4 of them had previously received a pacemaker. All had severe LV dysfunction. The implant procedure was successful in 12/14- in one the CS lead could not be anchored satisfactorily and a dual chamber device was inserted.

We present our initial experience with the use of CARTO system in mapping and ablation of complex arrhythmias. 33 patients (mean age 37±11.3 years, 23 males) were Studied. Clinical arrhythmias were atrial flutter (AF) in 5, intra-atrial reentrant tachycardia (IART) in 7, ectopic atrial tachycardia (EAT) in 3, inappropriate sinus tachycardia in I, Arrhythmogenic right ventricular cardiomyopathy (ARVC) in 5, fascicular VT in 1, left ventricular outflow (LVOT) VT in 3, ischemic VT in 2, right ventricular outflow (RVOT) VT, in 1 and left, ventricular (LV) VT in 5. There were 2 coronary artery disease, 5 ARVC, 1 each of dilated & restrictive cardiomyopathy, atrial septal defect and mitral stenosis. Nine patients had congenital heart disease, while 3 patients of left ventricular tachycardia had Left ventricular hypertrophy (LVH). Ablation was successful in 4 patients with AF, 5 with IART, 2 with EAT (1 non inducible), all LVOT VT, 2 with LVVT, 4 with ARVC and one each in the fascicular and RVOT VT. One patient with ischemic VT, 2 with ARVC and 1 with LVOT had recurrence, Two patients developed an allergic response to the reference patch.

Percutaneous Transseptal Mitral Commissurotomy (PTMC) has replaced surgical commissurotomy as a treatment of choice in selected patients of rheumatic mitral stenosis. Various randomized trials have shown PTMC to be equal or superior to surgical commissurotomy in terms of hemodynamic improvement as well as long term survival. Systemic embolism is one of the dreaded complications of PTMC, which is reported in 0.5–5% of cases and involves cerebral circulation in 1% of cases. Most of the time, periprocedural embolism during PTMC is caused by the mobilization of preexisting thrombus in the left atrial appendage. We report an unusual case of acute stroke due embolization of mitral valve tissue during PTMC.

Among the several diseases, asthma is categorized to be a chronic disorder or inflammatory ailment of the airways across the globe. Almost 18-20 million people in the United States and more than 250 million people worldwide are affected wit this syndrome. Numbers of patients are refractory to the available therapies. Newer agents are needed day by day to control symptoms and exacerbations in all patients. Over the years, there have been extensive advances in the understanding of asthma physiology at genetic level, airway biology, and immune cell signaling. Due to progression in the molecular level, diverse research groups have led to the development of number of molecules which may improve asthma care in the future. Several new classes of anti-asthma drugs—including ultra long acting β agonists, modulators of the interleukin pathways, adenosine receptor antagonist are named to be few. Some of the agents are in earlier phases of the development. Even though various groups have some preliminary efficacy data, there is insufficient confirmation to make strong recommendations about the use of these newer drugs. The mainstay of future research is on the clinical efficacy of newer agents, the effect of biological agents on severe asthma patients, and the understanding at cellular level of corticosteroid resistant asthma is needed to reduce the morbidity of asthma worldwide. The present review article is intended to give comprehensive information about the pathophysiology, pathogenesis and the medications for the management of asthma.