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To evaluate whether Kawasaki disease predisposes to premature atherosclerosis and to assess status of coronary artery abnormalities at least 10 years after diagnosis.
Material and methods:
A prospective study was carried out on 21 patients who were diagnosed with Kawasaki disease at least 10 years back and are on regular follow-up. The study was conducted on 128 Slice Dual Source computed tomography scanner with electrocardiography-triggered radiation optimised protocols for assessment of coronary artery abnormalities and calcifications.
Study cohort had 21 subjects – 15 males and 6 females (age range: 11–23 years; mean: 15.76 + 3.72 years). Mean age at time of diagnosis was 3.21 + 2.48 years. Mean time interval from diagnosis of Kawasaki disease to computed tomography coronary angiography was 12.59 + 2.89 years. Four children had evidence of coronary artery abnormalities on transthoracic echocardiography at time of diagnosis. Of these, two had persistent abnormalities on computed tomography coronary angiography. One subject (4.76%) had coronary calcification that was localised to abnormal coronary artery segment. Four coronary artery abnormalities (one saccular; three fusiform aneurysms) were noted in two subjects.
Prevalence of coronary artery calcification is low and, if present, is localised to abnormal segments. This calcification is likely dystrophic rather than atherosclerotic. It appears that coronary artery abnormalities can persist for several years after acute episode of Kawasaki disease. Periodic follow-up by computed tomography coronary angiography is now a feasible non-invasive imaging modality for long term surveillance of patients with Kawasaki disease who had coronary artery abnormalities at time of diagnosis.
Graphene oxide (GO)/MnO2 nanocomposites were synthesized by adding KMnO4 in a solution of water and ethanol (3:1), containing 10 mg of GO. Brown precipitates were obtained after a continuous stirring for 1 hr. The precipitates were then washed with deionized water (DI) water and dried to obtain the MnO2-GO nanocomposites. Pure MnO2 was also synthesized using the same method without GO for the comparison. X-ray diffraction pattern confirm δ-MnO2 type of MnO2 with birnessite type MnO2 structure. The TEM images show the average diameter of MnO2 nanorods as 15 nm. Electrochemical characterizations were carried out in an aqueous solution of 3M KOH. Charge-discharge studies were carried out between 1A/g to 20 A/g current range. The MnO2-GO nanocomposites showed improved electrochemical performances. The capacitance of MnO2 and MnO2-GO electrodes was found to be as 300 F/g, and 350 F/g, respectively at a current of 0.5 A/g.
This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes.
Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation.
Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury.
Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.
Background: Fundoscopy is an important component of the neurological examination, but can be challenging in uncooperative children. This study explores whether playing a video during eye examination, improves the success, duration and ease of pediatric fundoscopy. Methods: We completed a prospective, multi-clinic, block-randomized trial. Patients 1-4 years were recruited in the emergency department, neurology, spinal cord and general pediatric clinic. Patients were randomized (by eye examined) to video/non-video assisted fundoscopy. Successful exams were defined as visualizing the fundus within 60 seconds. Time to visualize optic disc was recorded and difficulty of exam was examined using a 10-point Likert scale. Results: 101 subjects were recruited, with a mean age of 2.8 years. Overall, there was a 20% absolute improvement in the success rate of visualizing the optic disc in the video versus non-video group (p<0.01). Time to visualize optic disc was also improved (Δ5.3s, p<0.01). Improvement in ease of examination with video were noted by caregivers and practitioners (p<0.01). Conclusion: Playing a video improved the ease, duration and most importantly the success of fundoscopy in younger children. This simple, inexpensive adjunct has great potential to improve the ease and efficacy of this aspect of the neurological examination.
We report controlled modifications in the semiconductor-to-metal transition characteristics of VO2 single-crystal thin films induced by swift heavy ion (SHI) irradiation with varying ion fluences. At very high energies of ions (200 MeV Au), the electronic stopping (∼2009 eV/Å) dominates over nuclear stopping (∼16 eV/Å). Under these extreme electronic excitation conditions caused by electronic stopping and the passage of SHIs through the entire thickness of the film, creation of certain unique type of defects and disordered regions occurs. X-ray diffraction, Raman spectroscopy, infrared transmission spectroscopy, x-ray photoelectron spectroscopy (XPS), and electrical measurements were performed to investigate the characteristics and role of these defects on structural, optical, and electrical properties of VO2 thin films. XPS and electrical resistivity measurements suggest that the ion irradiation induces localized defect states that appear to correlate well with the creation of disordered regions in the VO2 thin films. The high-energy heavy-ion irradiation changes the transition characteristics drastically from a first-order to a second-order transition (electronic—Mott type). The low-temperature conductance data for these ion-irradiated films fit well with the quasiamorphous model for resistivity of VO2, where ion irradiation is believed to create mid-bandgap defect states.
Twenty crossbred lactating multiparous cows were used in a 28-day study to compare dry matter intake (DMI), milk yield, milk composition and Bacillus thuringiensis (Bt) protein concentrations in plasma when fed diets containing Bollgard II® cottonseed (BGII) or a control non-genetically modified isogenic cottonseed (CON). Bollgard II cottonseed contains the Cry1Ac and Cry2Ab insecticidal proteins that protect cotton plants from feeding damage caused by certain lepidopteran insects. Cows were assigned randomly to the BGII or CON treatments after a 2-week adjustment period. Cows consumed a concentrate containing 40% crushed cottonseed according to milk yield and green maize forage ad libitum. All cows received the same diet but with different crushed cottonseed sources. Cottonseed was included to provide approximately 2.9 kg per cow daily (dry matter basis). The ingredient composition of the concentrate was 40% crushed cottonseed, 15% groundnut cake, 20% corn, 22% wheat bran, 1% salt and 2% mineral mixture. Milk and blood plasma were analyzed for Cry1Ac and Cry2Ab proteins. DMI, BW, milk yield and milk components did not differ between cows on the BGII and CON treatments. Although milk yield and milk fat percentage were not affected by treatment, 4% fat-corrected milk (FCM) production and FCM/kg DMI for cows on the BGII treatment (14.0 kg/cow per day, 1.12 kg/kg) were significantly improved compared with cows on the CON treatment (12.1 kg/cow per day, 0.97 kg/kg). Gossypol contents in BGII cottonseed and conventional cottonseed were similar. Cry1Ac and Cry2Ab2 proteins in Bollgard II cottonseed were 5.53 and 150.8 μg/g, respectively, and were not detected in the milk or plasma samples. The findings suggested that Bollgard II cottonseed can replace conventional cottonseed in dairy cattle diets with no adverse effects on performance and milk composition.
There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide.
A retrospective study of patients with maxillofacial fractures seen and treated at the Jai Parkash Narayan Apex Trauma Center, AIIMS, New Delhi, India between January 2007 to June 2010. Data extracted from the patients' records include aetiology, age, sex, types and sites of fractures, treatment modality and concomitant injuries.
There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (56.8%) was the most common aetiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 years to 75 years (mean = 34.7) with a peak incidence in the 3rd decade with a male–female sex ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615(77%) and middle third 205(23%). With regards to mandibular fractures, the body (29.6%) was the commonest sites, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%) and Lefort III (3.3%). Majority of the patients were treated by Open reduction and internal fixation (70.6). Concomitant injuries were 10.8% with orthopaedic injuries accounting for the majority (63.9%). Head injury was associated with 16.3 % of cases.
Maxillofacial fractures are on the increase. We advocate the establishment of regionalized trauma centers with basic training available to all surgical residents for initial emergency room management.
We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess.
Case report and review of the world literature.
A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up.
This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.
Our experience with shape memory polymers (SMP) began with a project to develop an embolic coil release actuator in 1996. This was the first known SMP device to enter human trials. Recent progress with the SMP devices include multiple device applications (stroke treatments, stents, other interventional devices), functional animal studies, synthesis and characterization of new SMP materials, in vivo and in vitro biocompatibility studies and device-tissue interactions for the laser, resistive, or magnetic-field activated actuators. We describe several of our applied SMP devices.
In the hilly areas of eastern Gujarat, western Madhya Pradesh and southern Rajasthan, in western India, farmers are very resource-poor and cultivate small and fragmented land holdings. Maize is their main rainy season (kharif) cereal and it is grown as a rainfed crop in low-fertility fields, often on sloping land that is vulnerable to soil erosion. Its productivity is very low, averaging below 1 t ha−1. New farm technologies to increase this productivity have to be low cost to be attractive to farmers who have limited access to purchased inputs and few means to purchase them. From observations of local farming practices, intercropping of maize with legumes was identified as an attractive option because the only additional input needed is seed of the legume crop. Participatory research was conducted on intercropping of maize with improved varieties of horsegram (Macrotyloma uniflorum). Many farmers who tried this intercropping adopted it in subsequent years, while others preferred to grow the new horsegram varieties as a sole crop. Farmers reported that less weeding was required in the intercrop as the horsegram smothered weeds. All farmers used the dry stover from the horsegram as a fodder for their animals. Farmers used the whole seed as dal, which provided additional protein in their diet. Farmers also sold the grain, but it fetched a low price in the poorly developed market for horsegram. Previously intercropping had been tried with local landraces, but the acceptance of intercropping was higher with new varieties such as AK-42 that yielded over 60% more grain. Participatory trials in which only one entry was compared with the local variety did not show a difference between AK-21 and AK-42 as in all cases both were preferred over the local variety. When they were directly compared with each other, farmers' perceptions showed a significant preference for AK-42. Variety IVH-2 was found to be better than AK-42: it matured 15 days earlier, better matching the maturity of the maize, had superior grain quality and yielded about the same. The greater uptake of improved horsegram varieties for sole and intercropping is likely to be limited by the lack of seed supply.
The components of the dielectric tensor for the distribution function given by Leubner and Schupfer have been obtained. The effect of the loss-cone index appearing in the particle distribution function in a hot magnetized plasma has been studied. A case study has been performed to calculate temporal growth rates of Bernstein waves using the distribution function given by Summers and Thorne and Leubner and Schupfer. The effect of the loss-cone index on growth rates is found to be quite different for the two distribution functions.
Magnetic resonance imaging (MRI) of the brain is the most important paraclinical diagnostic test in multiple sclerosis (MS). The appearance of MRI in Asians with MS is not well defined. We retrospectively surveyed the first brain and spinal cord MRI in patients diagnosed to have MS, according to Poser's criteria in seven regions throughout Asia to define the MRI changes among Asians with MS. There were 101 patients with first brain, and 86 with first spinal cord MRI, 66 of whom had both. The brain MRI showed a mean of 17 lesions per patient in T2 weighted images, mostly asymptomatic. Almost all the lesions were in the white matter, particularly in the juxtacortical, deep and periventricular white matter. A third of the lesions were greater than 5 mm, 14% enhanced with gadolinium. There were more supratentorial than infratentorial lesions at a ratio of 7.5: 1. Ninety five percent of the spinal cord lesions were in cervical and thoracic regions, 34% enhanced with gadolinium. The lesions extended over a mean of 3.6 ± 3.3 vertebral bodies in length. Fifty (50%) of the brain and 54 (63%) of the spinal MRI patients had the optic-spinal form of MS. The MRI of the optic-spinal and classical groups of patients were similar in appearance and distribution, except that the optic-spinal MS patients have fewer brain but longer and more severe spinal cord lesions. In conclusion, the brain and spinal cord MRI of Asian patients with MS was similar to that of the West, although, in this study, Asian MS patients had larger spinal cord lesions.
Objective: This retrospective study aims to describe the airway management and benefits of nasotracheal intubation over tracheostomy in 260 patients with oral cancer undergoing surgery. Methods and Results: The medical records of 260 patients undergoing surgery for oral cancer were reviewed for airway management during the perioperative period. Eighteen patients had previous surgery for oral cancer and were scheduled for flap reconstruction, recurrence or other complications. In 28 cases neck movement was restricted and decreased mouth opening was found in 50% of all patients because of a large growth or fixation of tissues of head and neck, oral cavity, pharynx or larynx by tumour, or radiation fibrosis. In 53 patients intubation was undertaken under spontaneous ventilation. In 20 cases the trachea was extubated in the immediate postoperative period. In 220 cases patients were extubated next morning in the intensive care unit. In none of the cases was elective tracheostomy under local anaesthesia performed before surgery for the maintenance of the airway for anaesthesia. Elective tracheostomies were done in 17 cases. Three patients remained intubated for 24–48 h because of a high suspicion of airway obstruction following extubation due to a large pectoralis major flap. These three patients received a tracheostomy because of increased oropharyngeal and laryngeal oedema. In three cases emergency tracheostomies were performed due to upper airway obstruction after extubation and in one case prolonged elective ventilation was required due to severe chest infection. Conclusion: Oral cancer patients have a potentially difficult airway but, if managed properly during perioperative period, morbidity and mortality can be reduced or avoided. Oral cancer patients can be managed safely without the routine use of a tracheostomy. Nasotracheal intubation is a safe alternative to tracheostomy in oral cancer patients except in some selected patients.