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Background Although spinal canal narrowing is thought to be the defining feature for the clinical diagnosis of lumbar canal stenosis, the degree of spinal canal stenosis necessary to elicit neurologic symptoms is not clear. Several studies have been performed to detect an association between a narrow spinal canal and clinical symptoms. Through our prospective study, we compared the radiologic criteria with the clinical criteria using the Oswestry Disability Index (ODI) and assessed how they correlate.Materials and Methods We used the qualitative grading (morphological classification system on magnetic resonance imaging [MRI]) system, dural sac cross-sectional area (DSCA), and sedimentation sign on MRI images and compared them with the Self-Paced Walking Ability (Self-Paced Walking Test) and ODI of the patients in the study. The systems were applied to 85 patients divided into three groups: group A: 43 patients with neurogenic claudication and able to walk 30 minutes; and group C: 31 patients with simple back pain and no signs of neurologic claudication.Results The mean ODI was 21.19 in group C, 46.50 in group B, and 61.95 in group A. The difference was statistically significant. The mean DSCA was 164.42 mm2 in group C, 49.94 mm2 in group B, and 35.07 mm2 in group A. The difference was statistically significant. The sedimentation sign was negative in 96.8% patients in group C, 54.5% patients in group B, and 32.6% patients in group A. The difference was statistically significant. Group C had 9.3% patients in morphology grade A3, 51.6% in grade A2, and 38.7% patients in grade A1. Group B had 63.6% patients in grade C, 18.2% patients in grade B, 9.1% in grade A4, and 9.1% in grade A3. Group A had 18.6% patients in grade D, 39.5% in grade C, 27.9% in grade B, 11.6% in grade A4, and 2.3% in grade A3. The mean DSCA of group C was significantly different from group A and group B, but the difference of the mean DSCA between group A and group B was not statistically significant. The relationship of ODI to DSCA, ODI to sedimentation sign, and ODI to morphological grading for group C and group A was not statistically significant. The relationship of morphological grading to DSCA was statistically significant for all three groups.Conclusion DSCA, morphological grading, and sedimentation sign are good to excellent radiologic indicators differentiating patients with simple back pain from those with lumbar spinal stenosis. Clinically, ODI is an excellent indicator of the severity of stenosis. But ODI statistically has no significant correlation to any of these radiologic parameters.

Introduction:Acute painless bilateral foot drop without bowel/bladder involvement is a very rare presentation of lumbar degenerative disorders. Only a few cases have been published on it in the literature. An early intervention could prove to be very helpful for the neurological recovery. Case Report:We present three cases where patients developed acute onset bilateral foot drop without radiculopathy and without bowel/bladder involvement. The first case was due to acute lumbar disc herniation, the second was caused by acute disc prolapse in a pre-existing asymptomatic lumbar canal stenosis, and the third one precipitated in a progressive degenerative severe lumbar spinal stenosis. Two cases (case reports 1 and 3) underwent minimal invasive decompression while the other case (case report 2) underwent instrumentation+ decompression + fusion. Case 1 and 2 with a short duration of symptoms showed good neurological recovery, whileereas cCase 3 with longer duration of complaints did not improve. Conclusion:Patients presenting with painless bilateral foot drop without cauda equine syndrome should be evaluated for spinal causes besides central nervous systemCNS, peripheral nerve, metabolic and autoimmune causes. Any finding in support of lumbar degenerative disease as the cause after excluding other causes should prompt for surgical decompression of the spine as an early intervention might help patient recover back to a normal and active lifestyle. Keywords:Painless, bilateral, foot drop, acute.

Background: The common causes of vertebral body lesion are metastasis, infection, primary malignancies or osteoporotic fractures. Histopathological examination is necessary to confirm the diagnosis. There are different approaches to collect the biopsy samples and they have different adequacy and accuracy rates and also possible complications. This study aims to determine adequacy, accuracy and safety of the fluoroscopy guided percutaneous transpedicular biopsy of the vertebral body lesion.Methods: This is retrospective review of all the patients who underwent fluoroscopy guided percutaneous transpedicular biopsy from January 2013 to October 2016. We reviewed medical records and biopsy reports, plain radiographs, Computed Tomography Scan and Magnetic Resonance Imaging and additional necessary investigations required to confirm the diagnosis. Results: Fifty two patients underwent fluoroscopy guided percutaneous transpedicular biopsy of vertebral body lesion in 55 different levels. Thirty six patients were male and 16 were female with mean age of 54.17 years (range 2-87 years). This procedure was performed in 55 levels from D3 to S1. The adequate sample was retrieved from 50 samples in 47 cases (90.9%). The diagnosis was confirmed by histopathological examination from41 samples in 38 cases (82%). In three cases the histopathology was inconclusive but microbiological investigation of tissue sample confirmed the diagnosis. So in total 44 samples from 41 cases (80%), the diagnosis was confirmed by the procedure. We did not encounter any complications during the procedure.Conclusions: Fluoroscopy guided percutaneous transpedicular biopsy is a safe minimally invasive procedure with high adequacy and accuracy rate. Keywords: Accuracy, Adequacy, transpedicular biopsy, vertebral body lesion.

Stroke is a major clinical problem. The management of stroke patients involves frequent decisions which require careful ethical consideration. The diagnosis of stroke is favoured by the presence of risk factors. In order to make rational decisions about treatment options, one needs to have some information regarding the patient’s prognosis. A number of factors have been identified as conferring a poor prognosis. These include: unconscious on admission, multiple / severe comorbidity, advanced age, cognitive impairment, and pre existing dependence. The Oxfordshire Classification of stroke type gives a framework which the clinician can utilise in order to estimate a patient’s prospect of recovery more accurately in the early stages. The provision of nutrition and hydration has been regarded differently to provision of medical treatments in the past. The high incidence of dysphagia coupled with other factors such as reduced mobility, undernutrition and exposure to hospital pathogens means that chest infection is a common problem in acute stroke.

Background: Osteosynthesis of odontoid fractures, especially for type II odontoid fractures, is often achieved by the placement of screws. Here, utilizing CT, we evaluated the normal anatomy of the odontoid process in an Indian population to determine whether one or two screws could be anatomically accommodated to achieve fixation. Methods: CT-based morphometric parameters of the odontoid process were assessed in 200 normal Indian patients (2018–2020). Results: Of 200 patients, 127 were male, and 73 were female. The mean minimum external transverse diameter (METD) was 8.80 mm (range 6.1–11.9 mm). Six (3%) patients had a minimum internal transverse diameter (TD) of >8.0 mm that would allow for the insertion of two 3.5-mm cortical screws without tapping, while 10 (5%) patients had TDs of Conclusion: About two-thirds (59%) of the 200 subjects in our study had a METD of

Background: Among some of the known complications, breakage of epidural catheter, though is extremely rare, is a well-established entity. Visualization of retained catheter is difficult even with current radiological imaging techniques, and active surgical intervention might be necessary for removal of catheter fragment. We report such a case of breakage of an epidural catheter during its insertion which led to surgical intervention. Case Description: A 52-year-old, an 18G radiopaque epidural catheter was inserted through an 18G Tuohy needle into the epidural space at T8-T9 interspace in left lateral position. Resistance was encountered. While the catheter was being removed with gentle traction along with Tuohy needle, it sheared off at 12 cm mark. After informing the operating surgeon and the patient, immediately an magnetic resonance imaging and computed tomography (CT) scan were done. CT scan with sagittal and coronal reconstruction was done. Epidural catheter was visualized at D9 lamina-spinous process junction who was removed by surgical intervention. Conclusion: Leaving of epidural catheter puts the anesthetist in a dilemma. To evade such an event, it is important to stick to the traditional guiding principle for epidural insertion and removal. In spite of safety measures, if event occurs, the patient should be informed about it. Surgery is reserved for symptomatic patients or asymptomatic patients to avoid future complications.

Cuttlefish use image disparity between the two eyes to extract depth information when hunting., The camera-type eyes of vertebrates and cephalopods exhibit remarkable convergence, but it is currently unknown whether the mechanisms for visual information processing in these brains, which exhibit wildly disparate architecture, are also shared. To investigate stereopsis in a cephalopod species, we affixed “anaglyph” glasses to cuttlefish and used a three-dimensional perception paradigm. We show that (i) cuttlefish have also evolved stereopsis (i.e., the ability to extract depth information from the disparity between left and right visual fields); (ii) when stereopsis information is intact, the time and distance covered before striking at a target are shorter; (iii) stereopsis in cuttlefish works differently to vertebrates, as cuttlefish can extract stereopsis cues from anticorrelated stimuli. These findings demonstrate that although there is convergent evolution in depth computation, cuttlefish stereopsis is likely afforded by a different algorithm than in humans, and not just a different implementation.

Background: Congenital absence of the lumbosacral facet joint is extremely rare, with only 26 cases reported in the literature. Here, we present a patient with the unilateral absence of the left fifth lumbar inferior articular process and reviewed the relevant literature. Case Description: A 32-year-old gentleman, who had undergone right L4-5 lumbar microdiscectomy 3 months ago now presented with acute low back and left leg pain following a fall. He is now presented with acute low back and left leg pain following a fall. Plain radiographs of the L-S spine revealed an absent left L5–S1 zygapophyseal joint. The magnetic resonance imaging and computed tomography studies additionally confirmed an absent unilateral left L5 lumbar inferior articular process. Conclusion: Patients presenting for lumbar surgery may have unilaterally absent lumbosacral zygapophyseal joints, which may impact the outcome of surgical treatment.

Objectives:Underpowered trials risk inaccurate results. Recruitment to stroke rehabilitation randomised controlled trials (RCTs) is often a challenge. Statistical simulations offer an important opportunity to explore the adequacy of sample sizes in the context of specific outcome measures. We aimed to examine and compare the adequacy of stroke rehabilitation RCT sample sizes using the Barthel Index (BI) or modified Rankin Scale (mRS) as primary outcomes. Methods:We conducted computer simulations using typical experimental event rates (EER) and control event rates (CER) based on individual participant data (IPD) from stroke rehabilitation RCTs. Event rates are the proportion of participants who experienced clinically relevant improvements in the RCT experimental and control groups. We examined minimum sample size requirements and estimated the number of participants required to achieve a number needed to treat within clinically acceptable boundaries for the BI and mRS. Results:We secured 2350 IPD (18 RCTs). For a 90% chance of statistical accuracy on the BI a rehabilitation RCT would require 273 participants per randomised group. Accurate interpretation of effect sizes would require 1000s of participants per group. Simulations for the mRS were not possible as a clinically relevant improvement was not detected when using this outcome measure. Conclusions:Stroke rehabilitation RCTs with large sample sizes are required for accurate interpretation of effect sizes based on the BI. The mRS lacked sensitivity to detect change and thus may be unsuitable as a primary outcome in stroke rehabilitation trials.

Background: Following decompressive cervical surgery for significant spinal cord compression/myelopathy, patients may rarely develop the “White Cord Syndrome (WCS).” This acute postoperative reperfusion injury is characterized on T2W MRI images by an increased intramedullary cord signal. However, it is a diagnosis of exclusion, and WCS can only be invoked once all other etiologies for cord injury have been ruled out. Case Description: A 49-year-old male, 3 days following a C3-C7 cervical laminectomy and C2-T1 fusion for extensive cord compression due to ossification of the posterior longitudinal ligament (OPLL), developed acute quadriparesis. This new deficit should have been attributed to an intraoperative iatrogenic cord injury, not the WCS. Conclusion: Very rarely patients sustain postoperative significant/severe new neurological deficits attributable to the WCS. Notably, the WCS is a diagnosis of exclusion, and all other etiologies (i.e. intraoperative iatrogenic surgeon-based mechanical cord injury, graft/instrumentation extrusion, failure to adequately remove/resect OPLL thus stretching cord over residual disease, other reasons for continued cord compression, including the need for secondary surgery, etc.) of cord injury must first be ruled out.

Spinal melanocytomas are rare pigmented tumors of the central nervous system commonly affecting females in their fifth decades. It has been reported in various locations with intradural intramedullary being the rarest. Patients can present with varied symptomatology from mild backache to frank myelopathy. Here we report a case of 34-year-old man with no medical comorbidities with vague backache associated with numbness of anterior aspect of right thigh for 1 year aggravated by activities and relieved by rest. His neurologic examination revealed normal power and sensation in both lower limbs except for decreased temperature sensation in right L2 dermatome. MRI of dorsolumbar spine revealed a well-defined lesion that was hyperintense in T1- and hypointense in T2-weighted image at D11–12 region with uniform bright enhancement in gadolinium-enhanced T1 image. The patient underwent laminectomy of D11 and D12, and an en bloc excision was done. Diagnosis of primary intradural intramedullary melanocytoma was made from histopathologic examination. Spinal melanocytomas should be considered as a differential diagnosis for intradural space-occupying lesions. MRI remains the investigation of choice for diagnosis, but histopathologic examination is required to confirm and differentiate from other pigmented tumors and malignant melanomas. Total surgical excision of the tumor remains the standard treatment with radiotherapy reserved for cases of incomplete excision and recurrences.

Background: Sacrococcygeal joint dislocation is very rare. There are seven cases of sacrococcygeal joint dislocation found in the literature; most are anterior, and only one prior case of posterior dislocation was reported involving the mid-coccygeal joint. Here, we report another case of posterior dislocation of the sacrococcygeal joint. Case Description: A 19 year-old female developed acute low-back and groin pain following a fall from the first floor. She was diagnosed with an unstable pelvic fracture along with posterior dislocation of the sacrococcygeal joint. The next day, after being hemodynamically stabilized, she underwent percutaneous fixation of the sacral fracture, while the sacrococcygeal joint dislocation was managed conservatively. Her pain decreased, and she was discharged on the third postoperative day and followed up to 6 weeks. Conclusion: Most sacrococcygeal joint dislocations can be managed conservatively.

Background: The incidence of Mycobacterium abscessus (MA), a rapidly growing species of nontuberculous mycobacteria (NTM)-related infections, has been steadily rising over the past decade. Despite the increased prevalence of NTM-related infections, it is largely underreported from TB-endemic countries due to lack of awareness and limited laboratory facilities. Here, we report a rare case of L4–L5 spondylodiscitis caused by MA following ozone therapy (a noncondoned method of lumbar disc management). Case Description: A healthy, nonimmunocompromised 43-year-old female presented with bilateral lower extremity radiculopathy. She underwent a fluoroscopically guided percutaneous ozone treatment for degenerated disc disease at the L4–L5 level. She was symptom free for 3 months duration. She then presented with severe low back pain, bilateral lower extremity radiculopathy, and spondylodiscitis at the L4–L5 level. This was treated with a L4–L5 transforaminal lumbar interbody fusion. MA was cultured from the epidural purulent material collected during the surgery. The patient was discharged on oral clarithromycin 500 mg twice daily and intravenous amikacin 500 mg twice daily for 6 weeks. The plan was to then continue oral clarithromycin for another 6 weeks till resolution of primary infection. Conclusion: Early diagnosis and appropriate therapy is required to treat NTM which is more prevalent in epidemic/endemic regions.

Background: Vertebral osteomyelitis caused by Stenotrophomonas maltophilia is very rare. There are only two cases reported in literature. Here, we present a 48-year-old immunocompetent male who, following a lumbar microdiscectomy, developed postoperative spondylodiscitis due to S. maltophilia that mimicked a cotton granuloma. Case Report: Two months ago, a 48-year-old male underwent a lumbar L4-L5 microdiscectomy, he newly presented with the left thigh and leg pain of 4 weeks duration. Laboratory studies revealed a CRP of 26 mg/l, an ESR of 6 mm (1st h), and total leukocyte count of 7.85 thousand/ul. The MRI T2 images showed a focal hyperintense lesion in the left lateral recesses at the L4-L5 level; the accompanying hypointense-smooth margin resembled a cotton granuloma. At surgery, we found a localized epidural collection of pus; S. maltophilia was isolated from the culture. His symptoms gradually improved, and symptoms fully resolved with 3 months of subsequent antibiotic therapy. Conclusion: S. maltophilia causing vertebral osteomyelitis is extremely rare and can sometimes mimic a cotton granuloma. MR diagnosis, surgical decompression, and obtaining cultures are requisite to direct appropriate antibiotic therapy.

Introduction: Non-Hodgkin's lymphoma (NHL) is highly sensitive to chemotherapy and responds to adjuvant chemotherapy within days. Review of literature reveals very limited studies with low statistical significance that compare the surgical and nonsurgical outcomes of spinal NHL. This study aims to compare the surgical and nonsurgical outcomes of spinal extranodal lymphoma causing metastatic spinal cord compression (MSCC). Materials and Methods: We retrospectively analyzed the treatment records of 14 cases out of 32 cases with biopsy-proven diagnosis of NHL involving the spinal column from January 2014 to January 2020. Five (35%) cases were managed nonsurgically with chemotherapy and 9 (64%) patients were managed surgically with adjuvant chemotherapy. Variables taken for evaluation were Karnofsky Performance Status (KPS), Frankel Grade, Spinal Instability Neoplastic Score, Ann Arbor Staging System, and International Prognostic Index (IPI) score. Results: The mean age was 51.9 ± 9.6 years and the median follow-up was 32.5 months. The most study population belonged to Grade III and IV Ann Arbor classification. At final follow-up, 100% of patients in the nonsurgical group and 66% in the surgery group were able to carry out normal activities (KPS >70). All three reported deaths occurred in the intervention group (KPS ≤40) and all deaths occurred within the 6 months of surgery. Conclusion: Primary chemoradiotherapy is mainly indicated in patients of nonemergent mild-to-moderate (Frankel grade >C) neurological deficit patients. Combination therapy (chemotherapy + surgery) is indicated in patients with emergent severe neurological deficit (Frankel Grade A, B, and C), spinal instability, and patients not responding to systemic or adjuvant chemotherapy.

Background Concurrent injuries to both the odontoid and transverse atlantal ligament are rare and can be easily missed. Failure to diagnose both lesions potentially leads to the late onset of sagittal plane instability and acute myelopathy. Here, we present a patient with an odontoid fracture whose transverse atlantal ligament (TAL) injury was originally missed on magnetic resonance imaging (MRI) and computed tomography (CT) scans. He later developed atlantoaxial instability requiring surgery. Case description A 17-year-old male presented with neck pain, restricted cervical range of motion, but a normal neurological exam following a motor vehicle accident. The original X-rays showed a moderately displaced type-3 odontoid fracture. Additional MRI and CT scans excluded ligamentous injury, and he was initially treated with 13 weeks of halo vest immobilization. Radiographs 5 months later showed an enlarged atlanto-dens interval (e.g., >3 mm); the diagnosis of an odontoid fracture with an accompanying TAL injury was established, following which the patient successfully underwent a posterior C1-C2 fusion. Conclusion Odontoid fractures require strict clinical and radiographic (X-ray, MRI, CT) surveillance to help rule out accompanying TAL injuries that may warrant surgical intervention.

Background Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. Methods Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy. Results Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple–areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16–38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42–66) days. Conclusion Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.

Arteriovenous malformations of the spinal cord are a rare cause of neurological impairment and they represent 5% of all intraspinal pathology. They can occur anywhere in the spinal cord from occiput to coccyx and they can present in any way. Here we report a case of AV malformation of the spinal cord which was diagnosed as tuberculosis of the spine and presented as paraperesis. A 27 year old male presented to us with gradually progressive weakness of both lower limbs for 5 months and difficulty in micturition and defaecation for 5 days. He was investigated at his local place and was diagnosed as tuberculosis spine with myelitis and was on antitubercular therapy (ATT) for 5 months. However the symptoms worsened and at the time of presentation to us he had grade 1 power in bilateral lower limbs with decreased sensation below D12 and with bowel and bladder involvement. MRI showed signal intensity changes in multiple vertebrae which was hyperintense in both T1 and T2 weighted images and signal intensity changes in the spinal cord. An urgent digital subtraction angiogram was performed which revealed type I AV malformation at D11 level which was treated surgically by laminectomy and cauterization of the fistula. The power increased to grade 4 on the 5th postoperative day but however the bladder and bowel symptoms persisted. Spinal AV malformations should be entertained in the differential diagnosis of progressive myelopathy of uncertain etiology and when the clinical findings are not correlating with imaging findings. Advanced imaging studies like spinal MRA or CTA should be used to screen these lesions and spinal digital subtraction angiogram is the gold standard for diagnosing AV malformations. Early and prompt diagnosis and management in these cases in the form of complete occlusion of the fistula will prevent any further neurological deterioration.

Study Design Case report. Objective Cysticercosis (parasitic infection caused by Taenia solium) is the most common parasitic infection of the nervous system. However, spinal neurocysticercosis is rare. It can present as an extraspinal or intraspinal lesion, with intramedullary being the rarest location. The symptoms can vary from vague backache and radiculopathy to cauda equine syndrome. Methods We report a 32-year-old man who presented with neurocysticercosis in the lumbar spine and cauda equine syndrome. He had low backache for 1 month, hesitancy in micturition, and decreased perianal sensation for the previous 2 days. Magnetic resonance imaging revealed an intradural extramedullary lesion extending from L2–S1 that was hyperintense in T2- and hypointense in T1-weighted images. Results Because the patient presented with cauda equine syndrome, urgent decompressive laminectomy was done from L2–S1, and the thin-walled cysts with clear fluid were removed. Histopathologic examination confirmed neurocysticercosis. The perianal sensation and the bladder control recovered completely. Conclusion Neurocysticercosis should be considered in the differential diagnosis in patients presenting with a similar picture, and urgent surgical decompression should be attempted to prevent further worsening of the neurologic symptoms.

Background: Isolated cryptococcal osteomyelitis of the spine is extremely uncommon; there have been only seven cases identified in literature. The majority were originally misdiagnosed as tuberculosis. Here, we present a patient with cryptococcal osteomyelitis of the thoracic spine with associated fungal retinal deposits. Case Description: A 45-year-old, type II diabetic female presented with a 5-month history of severe back pain. Her magnetic resonance imaging (MRI) revealed osteomyelitis involving the T4 vertebral body with epidural and prevertebral extension; notably, the intervertebral disc spaces were not involved. Although the fine-needle aspiration cytologic examination was inconclusive, the patient was empirically placed on antitubercular drug therapy. One month later, she became fully paraplegic. The MRI now demonstrated osteolytic lesions involving the T4 vertebral body with cord compression. She underwent biopsy of the T4 vertebral body and a transfacet T4 decompression with T2-T6 pedicle screw fixation. Culture and histopathological examinations both documented a cryptococcal infection, and she was placed on appropriate antifungal therapy. Notably, 3 weeks after surgery, she developed a sudden loss of vision loss due to retinal fungal endophthalmitis. She recovered vision in one eye after the administration of intravitreal voriconazole but lost vision in the other eye despite a vitrectomy. Over the next 8 months, she gradually recovered with motor function of 4/5 in both lower extremities without evidence of recurrent disease. Conclusion: Cryptococcal infection should be among the differential diagnostic considerations for patients with vertebral osteomyelitis. Notably, diagnostic delay can lead to devastating neurological deficits and involvement of other organ systems.

There is no research investigating indoor tanning advertising on social media. We assessed the use of social media to promote indoor tanning. We subscribed to social media platforms in six US cities and content-analyzed promotional messages received. We captured 662 messages on Twitter and Facebook, through salon emails, and in daily deal coupons. Salon postings were most frequent on Twitter and Facebook, with an average of 2–3 postings per week. National chains posted more frequently than local businesses. Forty percent of messages were devoid of tanning content and included photos, jokes, or popular references. Thirty percent mentioned price reductions, and 28 % referenced an upcoming holiday. Sunless tanning (17 %) was promoted more often than ultraviolet tanning (9 %). Tanning salons actively use social media as a strategy for maintaining relationships with customers and offer pricing deals that promote loyalty and high-frequency tanning.

A study of photoinduced high- T c superconductivity is presented by canonical two-band BCS model containing Fermi surfaces of p and d holes. We have obtained two superconducting gaps from this model. Studies of chemical potential and hole concentration dependences on critical temperature ( T c ) are made. The enhancement of T c is found due to doping. The study of specific heat and density of states based on this model is also presented. The dependence T c ( n h ) for the system YBa 2 Cu 3 O 7− x (1 2 3) obtained theoretically agrees with the available experimental data.

This review discusses the prevalence of metabolic syndrome and cardiovascular disease in the South Asian population, evaluates conventional and emerging risk factors, and reinforces the need for ethnic-specific redefinition of guidelines used to diagnose metabolic syndrome. We reviewed recent and past literature using Ovid Medline and PubMed databases. South Asians represent one of the largest and fastest growing ethnic groups in the world. With this growth, a dramatic rise in the rates of acute myocardial infarction and diabetes is being seen in this population. Potential etiologies for this phenomenon include dietary westernization, poor lifestyle measures, adverse body fat patterning, and genetics. While traditional risk factors for diabetes and cardiovascular disease should not be overlooked, early metabolic syndrome has now been shown in the South Asian pediatric population, suggesting that “metabolic programming” and perinatal influences may likely play a substantial role. Health care practitioners must be aware that current guidelines used to identify individuals with metabolic syndrome are underestimating South Asian individuals at risk. New ethnic-specific guidelines and prevention strategies are discussed in this review and should be applied by clinicians to their South Asian patients.

The emergence of pressure induced superconductivity (SC) under the background of ferromagnetic state in 5f-electron based itinerant ferromagnetic superconductor UGe2 is studied in the single band model by using a mean-field approximation. The solutions to the coupled equations of superconducting gap (Δ) and magnetization (m) are obtained using Green’s function technique and equation of motion method. It is shown that there generally exists a coexistent (Δ≠0, m≠0) solution to the coupled equations of the order parameters in the temperature range 0

A microscopic coexistence of itinerant ferromagnetism and superconductivity is studied in a single- band homogeneous system, using an equation of motion method and Green’s function technique. Self-consistent equations for the superconducting order parameter Δ and magnetization m are derived. It is shown that there generally exists coexistent (Δ≠0 andm≠0) solutions to the coupled equations of the order parameters in the temperature range 0

Markku Kaste ja Filip Scheperjans työryhmän jäsenenä. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.

Aim Lipomodelling has been successfully used in reconstructive breast surgery but not yet in patients with permanent stomas. Method A feasibility study of six patients with permanent stomas was undertaken. Patients underwent lipomodelling of the peristomal area. The number of leakages and quality of life were measured before and for 6 months after the procedure. Results All patients reported an improvement in their stoma-related quality of life and a reduction in the number of leakages experienced (mean: 2.25 leakages/24 h before lipomodelling and 0.5 leakages/24 h after lipomodelling). Conclusion Lipomodelling appears to be an effective method to reduce stoma leakages caused by peristomal skin contour abnormalities.

Pesticidal Contamination of Foods in the Year 2000 A D

The Arrhenius parameters for the gas phase, unimolecular structural isomerizations of 1,1,2-trimethylcyclopropane to three isomeric methylpentenes and two dimethylbutenes have been determined over a wide range of temperatures, 688–1124 K, using both static and shock tube reactors. For the overall loss of reactant, Ea = 63.7 (± 0.5) kcal/mol and log10A = 15.28 (± 0.12). These values are higher by 2.6 kcal/mol and 0.7–0.8 than previously reported from experimental work or predicted from thermochemical calculations. Ea for the formation of trans-4-methyl-2-pentene is 1.5 kcal/mol higher than Ea for the formation of the cis isomer, which is identical to the Ea difference previously reported for the formation of trans- and cis-2-butene from methylcyclopropane. Substitution of methyl groups for hydrogen atoms on the cyclopropane ring is expected to weaken the CC ring bonds, and it has been reported previously that activation energies for structural isomerizations of methylcyclopropanes do decrease substantially over the series cyclopropane > methylcyclopropane > 1,1- or 1,2-dimethylcyclopropane. However, the present study shows that the trend does not continue beyond dimethylcyclopropane isomerization. Besides reductions in CC bond energy, steric interactions may be increasingly important in determining the energy surface and conformational restrictions near the transition state in isomerizations of the more highly substituted methylcyclopropanes. © 2006 Wiley Periodicals, Inc. Int J Chem Kinet 38: 475–482, 2006

Thermal decomposition of (CH 3 ) 2 C(OH)CD 3 in a static reactor and in a shock tube reactor led to intramolecular symmetry-corrected k H /k D kinetic isotope effects for eliminations of HOH and HOD of 1.80 ′ 0.08 at 436 to 481 °C and 1.54 ′ 0.12 at 813 to 883 °C. Calculations with B3LYP/6-31G* theory defined the transition structure for the 1,2-elimination reaction, the internal reaction coordinate path, and k H /k D predictions. The reaction takes place through a four-centered transition structure approached through very different progressions of bond length changes along the reaction coordinate.

A GIS based information management system has been developed to help Urban Malaria Control in India. The basic objective is to develop a model to assist planning and implementation of a suitable control measure. The system can help in: (i) identifying high receptive areas in time and space domain; (ii) identifying risk factors for high receptivity; (iii) monitoring and evaluating control measures. To demonstrate this system, information on 33 parameters and malaria cases has been attached to a digitised map of Dindigul, an urban town in Tamil Nadu. Functionalities of the system and its utility are described in this paper. A GIS based information management system ensures that if a localised spurt of the disease occurs, it can be associated rapidly with a likely cause, a specific vector, and a probable human source, so that appropriate preventive action can be taken to arrest any rising trend.

The plasma in several physical situations such as movement of electrons along the geomagnetic field lines in the magnetosphere, the movement of the ionosphere, propagation of cosmic rays, etc., can be appropriately simulated by a drifting relativistic model. Keeping this in view, a general dispersion relation for magnetohydrodynamic (MHD) waves has been derived in a laboratory stationary coordinate system with respect to which plasma is drifting with a velocity which need not be small compared with the speed of light. This dispersion relation gives several earlier well-known results for MHD waves supported by an ideal relativistic plasma. The characteristic equation for arbitrary direction of propagation with reference to the ambient magnetic field is quite unwieldy. So, the detailed discussion is confined to the special cases when the propagation vector is along or across the magnetic field. However, wherever feasible, approximate solutions for arbitrary direction of propagation have also been discussed.

A series of novel labeled phosphoramidites and CPG supports 1a-f with a new non-nucleosidic backbone based upon cyclohexyl-4-amino-1,1-dimethanol have been synthesized. These reagents have been used to label oligonucleotides with biotin and fluorescein at the 5′-, the 3′-, and internal positions.

The paper analyzes low-frequency waves in a plasma model that is made up of two thermally anisotropic magnetohydrodynamic components, by means of wave-front diagrams, a useful tool that has not attracted the desired attention. The wave-front diagrams of the fast propagating suprathermal mode, besides the usual fast, slow, and Alfven modes, have been plotted for a variety of situations. These diagrams are used to bring out the physical significance of the anisotropic model vis-a-vis the isotropic model. The question of stability that has been completely ignored so far in the plasma models based on two magnetohydrodynamic components has also been addressed. Analogues of the firehose and mirror instabilities, which are supported by this model, are examined. Their comparison with single-component anisotropic plasma results suggests the possibility of suppressing the mirror instability.

Rate constants for the thermal isomerizations of vinylcyclopropane to cyclopentene have been measured over a wide temperature range, 577−1054 K, in a static reactor and a single-pulse shock tube; they are well represented by log(A, s-1) = 14.3 and Ea = 51.7 kcal/mol. This activation energy is higher than two previously reported values by some 2 kcal/mol; rate constants at high temperatures are about a factor of 2 larger than calculated from the Arrhenius parameters derived from the earlier low-temperature data. The thermal decomposition and isomerization reactions of vinylcyclobutane to give ethene plus 1,3-butadiene and cyclohexene have also been followed in shock-tube kinetic studies at 839−965 K. Combining the new rate constants with those from two lower-temperature studies gives the following: for the total consumption of vinylcyclobutane, log(A, s-1) = 14.5 and Ea = 49.3 kcal/mol; for production of ethene and butadiene, log(A, s-1) = 14.5 and Ea = 49.8 kcal/mol; and for isomerization to cyclohexene,...

Low frequency plane waves supported by a medium containing a thermal plasma of isotropic pressure and a suprathermal collisionless plasma having anisotropic pressure are investigated. The usual Alfven, slow and fast modes of isotropic pressure magnetohydrodynamics persist. In addition, a suprathermal mode appears which displays a rich variety of behavior due to an additional degree of freedom compared to the analogous mode when both the plasma components are described by collision‐dominated magnetohydrodynamics. Since these modes are significant in a number of situations, they are extensively investigated by computing their phase speeds for wide‐ranging numerical parameters.

The paper models the suprathermal plasma as the concatenation of two different gravitating fluids each having its own separate density and pressure. One of the fluids has isotropic pressure while the other has an anisotropic pressure. The system is subjected to a uniform magnetic field which is frozen with the fluids. The gravitational instability of the model for low frequency plane waves has been investigated in a linear framework for plasma parameters relevant to the spiral arms of the galaxy and the cosmic gas clouds. The analysis shows that the wavelength of the instability is strongly dependent upon the anisotropy of the non-thermal plasma.

Background and Purpose Stroke unit rehabilitation tends to be directed toward stroke patients with moderately severe disabilities (“the middle group”). Data collected on a stroke rehabilitation unit, however, showed improving outcome over 3 years in patients with a poor prognosis (discharge home: 48% versus 16%, P P Methods A randomized controlled study was undertaken in 71 patients with a poor prognosis who were treated either on a stroke rehabilitation unit (n=34) or on general wards (n=37) to compare outcome between the two groups. Data collected were also compared with those from a methodologically similar study undertaken 3 years ago. Results Severe stroke patients treated on the stroke rehabilitation unit had a significantly better outcome compared with general wards (mortality: 21% versus 46%, P P P Conclusions Stroke rehabilitation units may improve outcome in severe stroke patients. This improvement appears to be due to the development of innovative management strategies that reduce mortality and institutionalization and enable caregivers to support more disabled stroke patients at home.